Eng Siang Lee1 and Ing Ping Tang1,2*
1ORL HNS Department, Faculty of Medicine and Health Sciences, University Malaysia Sarawak, Sarawak, Malaysia
2Faculty of Medicine & Health Sciences, Kota Samarahan, Sarawak, Malaysia
Received: 03 June, 2017; Accepted: 27 June, 2017; Published: 28 June, 2017
Ing Ping Tang, ORL-HNS Department, Sarawak General Hospital, Jalan Hospital 93586 Kuching, Sarawak, Malaysia, Tel: +60126281537; E-mail:
Lee ES, Tang IP (2017) Middle Ear Carcinoid Tumor: A rare case. Arch Otolaryngol Rhinol 3(3): 061-063. DOI: 10.17352/2455-1759.000048
© 2017 Lee ES, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Carcinoid tumor; Middle ear; Temporal bone; Otalgia; Hearing loss; Facial palsy; Diagnosis
Introduction: Carcinoid tumor of the middle ear (ME) is exceedingly rare and thus its diagnosis is frequently delayed. It is also hard to differentiate between middle ear carcinoid from the middle ear adenoma. Definitive diagnosis is made by identifying neurosecretory tumor cells using immunohistochemistry and electron microscopy.
Case presentation: We report here a case of a carcinoid tumor observed in the middle ear (ME). The patient presented with right otalgia and ear bleed of one month duration.
Outcome: A lateral resection of the right temporal bone was performed. The patient’s initial symptoms immediately improved after surgery, but facial palsy remained in the following months. No recurrence was noted after twelve months of follow-up. The patient is without recurrence of her disease to date.
Discussion: This case suggests the difficulties in distinguishing ME carcinoid tumors from other ME tumors.
Conclusion: This case suggests the difficulties in distinguishing ME carcinoid tumors from other ME tumors. High degree of clinical suspicion is required to consider middle ear adenomas, and carcinoid tumors. Reporting new cases would help to increase the awareness towards the disease.
Carcinoid tumor is a neuroendocrine tumor traditionally from the gastrointestinal tract and lung  and is rarely found in the middle ear (ME). Occasionally, such cases are also reported as primary tumor in the testes . ME carcinoid tumor was first reported in 1980 by Murphy et al . Patients with carcinoid tumor of the ME usually present with nonspecific symptoms including conductive hearing loss, aural fullness, and less commonly tinnitus, otalgia, and headache with acute facial palsy a rare finding. ME exploration is necessary for the common differential diagnoses of a mass in the ME with acute facial palsy, which should include cholesteatoma, glomus tumor, carcinoma, facial nerve neuroma, and other tumors. ME carcinoid tumor is easily confused with ME adenoma by histopathology alone, and the definitive diagnosis is made by immunohistochemistry and ultrastructural examination of biopsy materials, and its treatment of choice is radical resection of the tumor with a wide margin by canal wall-down approach[3,4].
A 30 year old lady presented with right ear bleed and otalgia of one month duration. She also described progressive right tinnitus and hearing loss a year preceding this episode accompanied by facial palsy of 4 months duration. No related history of fever and auricular vesicles was present nor were there symptoms of carcinoid syndrome, such as flushing, wheezing, cramping and diarrhea. A reddish polypoidal mass was observed during otoscopy and right facial palsy was staged as grade V on the House-Brackmann scale. Initial audiogram showed normal hearing in the left ear and a 90-dB hearing loss in the right ear at 500dB, 1000dB, 2000dB and 4000dB. As the patient was at her 37th week of pregnancy at the time of the presentation, imaging was delayed till after delivery. After delivery, the high resolution computed tomography (HRCT) of the temporal bone done showed soft tissue opacification of the external acoustic meatus (EAM), middle ear and mastoid air cells with rarefaction and destruction of the right petrous part of temporal bone apex. However, the patient defaulted her clinic appointment for two years and experienced worsening of symptoms. A repeated HRCT of the temporal bone showed further extension of the temporal bone destruction predominantly involving the petrous part with erosion of the tegmen tympani. A magnetic resonance imaging (MRI) was performed with similar findings of the HRCT whilst showing no dural involvement (Figure 1).
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