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Clinical Problem Solving: Pathology
April 2005

Pathology Quiz Case

Author Affiliations

The Johns Hopkins University School of Medicine, Baltimore, Md

Arch Otolaryngol Head Neck Surg. 2005;131(4):363. doi:10.1001/archotol.131.4.363

A 3-year-old boy presented with an abnormal right eardrum. Physical examination revealed an immobile, bulging, blue tympanic membrane in the patient’s right ear that did not blanche on pneumatic otoscopy. A Weber test demonstrated lateralization to the right ear, with bone conduction greater than air conduction on the affected side. Audiometric testing showed a flat right tympanogram and sound field hearing levels of 30 dB, with 10-dB speech awareness on the left and 15-dB speech awareness on the right. Axial computed tomography of the temporal bones showed soft tissue in the middle ear and epitympanum, without bony dehiscence of the carotid canal, jugular bulb region, or tegmen tympani (Figure 1). An exploratory tympanotomy and a mastoidectomy with facial recess approach were performed, and the mass was removed.