[Skip to Navigation]
Clinical Challenge
May 20, 2021

Hearing Loss, Pulsatile Tinnitus, and Otalgia

Author Affiliations
  • 1Baylor College of Medicine Medical School, Houston, Texas
  • 2Bobby R. Alford Department of Otolaryngology–Head and Neck Surgery, Baylor College of Medicine, Houston, Texas
  • 3M.D. Anderson Cancer Center, Department of Head and Neck Surgery, Houston, Texas
  • 4Department of Neurosurgery, Baylor College of Medicine, Houston, Texas
  • 5Division of Otolaryngology, Department of Surgery Texas Children’s Hospital, Houston
JAMA Otolaryngol Head Neck Surg. 2021;147(7):665-666. doi:10.1001/jamaoto.2021.0853

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).

Add or change institution