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Clinical Challenge
July 2017

Unilateral Hearing Loss and Otorrhea

Author Affiliations
  • 1Department of Otolaryngology–Head and Neck Surgery, Medical University of South Carolina, Charleston
  • 2Department of Otolaryngology–Head and Neck Surgery, University of Cincinnati College of Medicine, Cincinnati, Ohio
  • 3Neurosensory Disorders Center at University of Cincinnati Gardner Neuroscience Institute, Cincinnati, Ohio
JAMA Otolaryngol Head Neck Surg. 2017;143(7):727-728. doi:10.1001/jamaoto.2016.3824

A man in his 70s presented with painless left-sided otorrhea, aural fullness, and hearing loss for nearly 1 year. He had previous complaints of left-sided aural pressure and intermittent clear otorrhea that were unsuccessfully treated at another center with 2 sets of pressure equalization tubes (PETs) and 3 courses of ototopical antibiotics. In the month before presenting to us, the otorrhea had turned bloody. He had not experienced fever, malaise, weight loss, lymphadenopathy, skin lesions, or vertigo. Pertinent medical history included obesity, type 2 diabetes mellitus, allergic rhinitis, and chronic lymphocytic leukemia (CLL). The CLL had been treated successfully with chemotherapy and had been in remission for the past 6 years. The only notable finding from the physical examination was a hypomobile left tympanic membrane with an anterior-inferior PET plugged by granulation tissue. Facial nerve function was normal bilaterally. Audiometry results demonstrated a left moderate sloping to profound mixed hearing loss and speech discrimination score of 68%. A fine-cut, temporal bone computed tomographic (CT) scan was obtained, which demonstrated near-complete opacification of the left mastoid air cells, and middle ear (Figure, A). The patient underwent a left tympanomastoidectomy for continuing otorrhea. Bulky soft tissue was removed from the middle ear and mastoid. Cytopathologic examination revealed numerous, small, basophilic cells (Figure, B). Immunostaining showed that the cells were CD20 positive (Figure, C) and CD3 negative (Figure, D).

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