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A 54-year-old woman with a medical history of hypertension, hyperlipidemia, and migraines presented to a tertiary care otolaryngology clinic reporting 3 months of worsening right ear pain and 1 month of pulsatile tinnitus and hearing loss. She denied a history of fever, otorrhea, prior ear infections, vertigo, or otologic surgery. The patient first saw her primary care physician, who visualized a mass in the right ear canal and attempted needle aspiration, which led to self-resolved bleeding. She was given ciprofloxacin ear drops and trimethoprim/sulfamethoxazole, which did not improve her symptoms. On examination, her right external auditory canal (EAC) was completely obstructed by a fleshy, pulsatile mass with a red hue (Figure 1A). Results of Weber tuning fork examination lateralized to the right ear and a Rinne examination suggested a conductive hearing loss. Formal audiogram results confirmed conductive hearing loss in the right ear and type B tympanometry, which was indicative of poor eardrum mobility. Computed tomography (CT) of the temporal bone without contrast showed a well-circumscribed 9-mm lesion in the EAC with bony erosion along the junction of the anterior wall and floor (Figure 1, B and C). Magnetic resonance imaging results showed a well-circumscribed, contrast-enhancing mass that was confined to the EAC (Figure 1D).
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A. Lobular capillary hemangioma of the EAC
An ear canal cholesteatomas develops spontaneously or after infection, trauma, or surgery. It is not as common as middle ear cholesteatoma and is not a vascular tumor.1 Imaging results would likely reveal bonier canal erosion than seen in this case. Tympanic paraganglioma/glomus tympanicum is a primarily vascular tumor that also presents with conductive hearing loss and bloody otorrhea. However, these tumors arise from the tympanic plexus in the middle ear, not the EAC. High-riding jugular bulbs present with an inferiorly based blue mass behind an intact eardrum. Pulsatile tinnitus and conductive hearing loss are commonly present. The mass may enlarge during a Valsalva maneuver. Imaging results would be diagnostic for this finding.
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CME Disclosure Statement: Unless noted, all individuals in control of content reported no relevant financial relationships. If applicable, all relevant financial relationships have been mitigated.
Corresponding Author: Alex D. Sweeney, MD, Bobby R. Alford Department of Otolaryngology, Baylor College of Medicine, 1977 Butler Blvd, Ste E5.200, Houston, TX 77030 (firstname.lastname@example.org).
Published Online: May 20, 2021. doi:10.1001/jamaoto.2021.0853
Conflict of Interest Disclosures: Dr Sweeney has been a consultant for Advanced Bionics, Cochlear, MED-EL GmbH, and Oticon Medical. No other disclosures were reported.
Additional Contributions: We thank the patient for granting permission to publish this information.
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