A 54-YEAR-OLD WOMAN presented with pulsatile tinnitus in her left ear. The pulsatile noise was present only when she lowered her head for a long time. One month earlier, the noise became continuous, and an intermittent hissing component appeared. The noise was disrupting her routine, so she sought medical attention. On otomicroscopy, a reddish lesion was noted over the promontory in the left ear. Because the lesion was very small, some of the examiners were unable to see it clearly. Audiometry demonstrated a 15-dB air-bone gap across the lower frequencies up to 1 kHz in the left ear and a 20-db sensorineural hearing loss at 6 and 8 kHz in both ears. Discrimination scores were normal bilaterally. Figure 1 shows a 1-mm-thick slice of a high-resolution, non–contrast-enhanced computed tomographic (CT) scan of the middle ears and mastoids. Figure 2 shows the slice immediately posterior to the one seen in Figure 1. Figure 3 shows a sequence of 4 0.5-mm-thick slices obtained from the area at the end of the non–ionic contrast medium injection.
Araújo MF, Oliveira CA, Sesana WE. Radiology Quiz Case 1. Arch Otolaryngol Head Neck Surg. 2002;128(4):456. doi:10-1001/pubs.Arch Otolaryngol. Head Neck Surg.-ISSN-0886-4470-128-4-orf10506