title: Occult infratemporal fossa neurofibroma presenting with persistent unilateral tinnitus and middle ear effusion: More than meets the eye.
abstract: Herein, we present the case of a previously healthy 54year-old female who developed several weeks of unilateral tinnitus and aural fullness. She subsequently underwent unilateral pressure equalization tube placement at an outside institution after exam demonstrated a middle ear effusion, conductive hearing loss and normal nasopharyngoscopy. Ultimately, an MRI revealed an occult mass in the infratemporal fossa (ITF), which was successfully removed via an endoscopic transnasal ITF approach. Following resection of a histopathologically confirmed benign neurofibroma, she reported complete resolution of her symptoms. The antiquated diagnostic algorithm of unilateral effusion suggests that normal nasopharyngscopy successfully "rules out" a causative neoplastic process; however, Eustachian tube occlusion by occult skull base lesions may be missed without further investigation. This case highlights the need for additional radiological investigation of unexplained unilateral persistent middle ear effusion in the setting of normal nasopharyngoscopy.
authors.affiliation: Department of Neurologic Surgery, Mayo Clinic, Rochester, MN, USA. Electronic address: carlstrom.lucas@mayo.edu.
authors.forename: Lucas P
authors.initials: LP
authors.lastname: Carlstrom
authors.affiliation: Department of Otolaryngology, Mayo Clinic, Rochester, MN, USA.
authors.forename: Kathryn M
authors.initials: KM
authors.lastname: Van Abel
authors.affiliation: Department of Otolaryngology, Mayo Clinic, Rochester, MN, USA.
authors.forename: Matthew L
authors.initials: ML
authors.lastname: Carlson
authors.affiliation: Department of Otolaryngology, Mayo Clinic, Rochester, MN, USA.
authors.forename: Eric J
authors.initials: EJ
authors.lastname: Moore
authors.affiliation: Department of Otolaryngology, Mayo Clinic, Rochester, MN, USA. Electronic address: Stokken.Janalee@mayo.edu.
authors.forename: Janalee K
authors.initials: JK
authors.lastname: Stokken
mesh_terms: D003937:Diagnosis, Differential; D005260:Female; D006314:Hearing Loss, Conductive / Q000601:surgery; D006801:Humans; D008279:Magnetic Resonance Imaging; D008339:Mandibular Neoplasms / Q000000981:diagnostic imaging* / Q000601:surgery*; D008875:Middle Aged; D009455:Neurofibroma / Q000000981:diagnostic imaging* / Q000601:surgery*; D010034:Otitis Media with Effusion / Q000601:surgery; D056739:Pterygopalatine Fossa / Q000000981:diagnostic imaging* / Q000601:surgery*; D014012:Tinnitus / Q000601:surgery
keywords: Aural fullness; Endoscopic medial maxillectomy; Infratemporal fossa tumor; Neurofibroma; Tinnitus