This case involves a 59-year-old female patient in Oklahoma. The patient presented to an ENT clinic with a three-week history of a clogged ear canal. Additionally, she had right-sided tinnitus that persisted. The patient stated that her ear symptoms began when she developed an upper respiratory infection. Audiometric testing was performed and revealed mild conductive hearing loss involving the right ear. Tympanometry revealed decreased mobility on the right.
A right myringotomy was performed, however, the patient experienced no relief of symptoms. When the decreased hearing persisted following the procedure, the patient underwent a temporal bone CT. The scan revealed extensive soft tissue opacification involving the right mastoid and a small portion of the right middle ear. The physician recommended a tympanoplasty with mastoidectomy to address a cholesteatoma causing a possible obstruction. Intraoperatively, an encapsulated mass was uncovered that enveloped the ossicles and extending into the mastoid antrum.
Initial frozen section of the mass obtained from the tissue located in the antrum suggested benign fibrous tissue inflammation with calcifications. A second frozen section obtained from the mass adjacent to the ossicles raised the question of a nerve sheath tumor. The mass appeared to encompass the facial nerve. Removal of the mass appeared to have disrupted the facial nerve, severing the facial nerve in the tympanic segment. No attempt was made to repair the ossicular chain during the initial surgery as it was determined that the patient would likely require additional surgery to place a cable graft to repair the facial nerve injury.
A nerve graft procedure was performed, but the patient continued to experience facial paralysis. There were concerns that she may have developed visual disturbances. The patient was left with long-term facial paralysis, tears when she drinks water, and has difficulty with swallowing. An expert witness in audiology and otolaryngology was retained for the matter.