Skip to main content
AAO-HNSF 2023 Annual Meeting & OTO Experience Main banner
Icon Legend
This session is not in your schedule.
This session is in your schedule. Click again to remove it.
Back
Rate ePoster

Otology/Neurotology

(372) Pediatric Middle Ear Lesion Presenting a Diagnostic Challenge

Monday, October 2, 2023
2:45 PM – 3:45 PM East Coast USA Time
Has Audio

    Presenting Author(s)

  • Dylan Z. Erwin, MD

    Resident Physician
    University of Texas Health at San Antonio
    San Antonio, Texas, United States

    • Senior Author(s)

  • BP

    Brian Perry, MD

    University of Texas Health at San Antonio, USA

    • Co-Author(s)

  • Whitney Bettenhausen, MD

    Assistant Professor
    University of Texas Health at San Antonio
    San Antonio, Texas, United States

Disclosure(s):
Dylan Z. Erwin, MD: No relevant relationships to disclose.


Introduction: A 3-year-old male presented with intractable headache, extremity pain, and emesis. He was transferred from another facility with concern for “cholesteatoma”. After extensive workup, diagnostic mastoidectomy, and further imaging, lesion suspected as middle ear lymphangioma and bilateral transverse sinus stenosis.

Methods: Patient presented as transfer to tertiary center in November 2022 with new-onset and progressive headache, emesis, and upper extremity pain. Per family, he had no significant history. Initial outside computerized tomography (CT) concerning for right ear cholesteatoma. He was taken to the operating room for diagnostic mastoidectomy; eternal auditory canal bony erosion noted with cerebrospinal fluid (CSF) leak immediately after tympanomeatal flap incisions. No mass discovered, though ossicles with lytic changes and dusky mucosa. Biopsies were obtained and CSF leak repaired. His headaches improved, with no leak post-operatively. After discharge, he re-presented two days later with severe headache, but normal exam. Lumbar puncture (LP) was performed with opening pressure of 58 centimeter of water (cm H20). He underwent magnetic resonance venogram showing bilateral transverse sinus stenosis. Initial attempts at medical management with acetazolamide failed, and the patient returned ten days later with headache. He underwent repeat LP with opening pressure of 54 cm H20. Neurosurgery proceeded with bilateral transverse sinus stenting, with post-operative anti-coagulation.

Results: Biopsies and cultures were taken from right middle ear. Final pathology report with reactive inflammation and intraosseous vascular proliferation, favoring lymphangioma.

Conclusions: No prior case report exists in the literature demonstrating a pediatric patient with concurrent lymphangioma and bilateral transverse stenosis. This case demonstrates the necessity of thorough diagnostic workup and avoiding the pitfall of anchoring to an outside diagnosis.