Saudi Journal of Otorhinolaryngology Head and Neck Surgery

CLINCAL CASE
Year
: 2013  |  Volume : 15  |  Issue : 1  |  Page : 19--22

Lipoma of the middle ear: An unusal presentation in a 6 year old child


Badi Aldosari1, Richard Nicollas2, Jean-Michel Triglia2,  
1 Department of Pediatric ORL, Hopital de la Timone University aix marseille 2, Marseille, France; Department of ORL & Head and Neck surgery, College of Medicine, King Saud University, Riyadh, Saudi Arabia
2 Department of Pediatric ORL, Hopital de la Timone University aix marseille 2 Marseille, France

Correspondence Address:
Badi Aldosari
Department of Pediatric ORL, Hopital de la Timone University aix marseille 2, Marseille; Department of ORL & Head and Neck surgery, College of Medicine, King Saud University, Riyadh
Saudi Arabia

Abstract

We present a case of lipoma arising in the middle ear of 6 years old girl with down syndrome with severe speech and language difficulties. A CT Scan and MRI of temporal bone revealed abnormal soft tissue mass in the left tympanic cavity and malformation of right inner ear. Left middle ear exploration, revealed an encapsulated lump of fatty tissue filling the anterior middle ear space confirmed by histologic studies as lipoma



How to cite this article:
Aldosari B, Nicollas R, Triglia JM. Lipoma of the middle ear: An unusal presentation in a 6 year old child.Saudi J Otorhinolaryngol Head Neck Surg 2013;15:19-22


How to cite this URL:
Aldosari B, Nicollas R, Triglia JM. Lipoma of the middle ear: An unusal presentation in a 6 year old child. Saudi J Otorhinolaryngol Head Neck Surg [serial online] 2013 [cited 2023 Jan 27 ];15:19-22
Available from: https://www.sjohns.org/text.asp?2013/15/1/19/274644


Full Text



 Introduction



Lipoma is the commonest benign, adipose tissue neoplasm. It is rare before the age of 20 years, but becomes very common thereafter. Embryologically, adipose tissue originate from the maturation of lipoblasts which are mesenchymal in origin and lipomas are encapsulated masses of the mature adipose tissue. Lipoma involving the temporal bone are uncommon and typically occur within the internal auditory canal or cerebellopontine angle. In the pediatric age group, cholesteatomas, congenital and acquired are the most common cause of middle ear mass.

 Case report



A 6 years old girl with down syndrome with severe speech and language difficulties was referred to our team for joint management. She had severe speech and language difficulties. Her hearing was assessed and pure tone audiometry showed moderate conductive hearing loss in the left ear and profound hearing loss in the right ear.

A CT scan and MRI of temporal bone [Figure 1] & [Figure 2] revealed a hypodense mass in the left tympanic cavity and malformation of the right inner ear. {Figure 1}{Figure 2}

Examination revealed a yellowish opaque mass showing through the antero-inferior segment of the tympanic membrane, the right tympanic membrane was normal. Left middle ear exploration was done which revealed an encapsulated lump of fatty tissue filling the anterior middle ear space,the ossicles were intact. The incus and malleus head were removed in order to obtain access to the epitympanum and ossiculoplasty was done by inserting cartilage between malleus and stapes. Histologic studies revealed fiboadipose tissue composed of mature adipocyte, consistent with lipoma [Figure 3].{Figure 3}

The patient’s postoperative course was uneventful and her left audiometry improved from preoperative value of 40 db to a postoperative value of 30 db. Radiological examination was not performed post-operatively.

 Discussion



The differential diagnosis for a middle ear mass includes congenital or acquired cholesteatoma, cholesterol granuloma, inflammatory polyp, facial nerve neuroma, eosinophilic granuloma,adenoma, adenocarcinoma, squamous cell carcinoma, rhabdomyosarcoma, sarcomas, angiosarcomas or middle ear lipoma. This mass was felt to be a lipoma with a high degree of confidence intra-operatively, despite its extreme rarity, based on its characteristic appearance.

Adipose tissue is derived from mesenchyme. The principal tumors of this mesenchymal derivative are lipoma and liposarcoma. Lipomas are extremely common benign tumors which are usually asymptomatic and most commonly occur in the subcutaneous tissue of the neck and trunk. Deep seated lipomas are infrequent and occur in retroperitoneum and mediastinum. Lipomas are composed of mature adipose tissue, and several subtypes occur when other mesenchymal elements are present, such as fibrolipoma, angiolipoma and myeliolipoma. Lipomas have infrequently been described in the middle ear.

Lipomas in the middle ear are rare, and only six cases have been previously reported in the English literature Abdullah et al. [1] describe a case of bilateral lipoma in a 5 year old boy.However, presence of bilateral masses was not confirmed by either imaging or histopathology.The authors report that bilateral small masses in the antero superior quadrent of the middle ear, left smaller mass than right, were visible on otoscopic examination. a subsequent CT scan demonstrated only the right middle ear mass. Ear examination under general anesthesia and biopsy of right mass was performed. The left ear mass could not visualized so biopsy with histological confirmation was only obtained for right ear. The authors report that no further surgery was performed

Selenick et al [2] report the case of a 4 year old girl with unilateral atresia and middle ear effusion. At time of tube placement,a white mass was found in the anterior superior aspect of middle ear when the child underwent tube placement. CT scan revealed middle ear soft tissue mass. Surgical excision of the mass was performed and pathology revealed fibroadipose rissue with mature adipocytes consistent with lipoma.

Edmonds et al [3] report a case of a 7 year old girl with Eustachian dysfunction and secondary otomastoiditis, at time of ventilation tube insertion a mass thought to be cholesteatoma was noted. Middle ear exploration was done and showed a mass in the middle ear confirmed as lipom. Steghuis et al [4] describe a 64 year old female with conductive hearing loss who was found to have lipoma filling the right middle ear, the patient also presented with nasal obstruction secondary to a nasal polyp that was surgically removed and pathology revealed lipoma.

Kasbekar et al [5] describe a 33 year old male who initially presented with right facial nerve weakness. His otologic history was remarkable for having undergone a modified right radical tympanomastoidectomy during childhood to address cholesteatoma. He was initially treated for both bells palsy and acute otitis media with antibiotic, steroids and acyclovir. His facial weakness improved but did not fully resolve. A CT scan of the temporal bone revealed soft tissue density in the anterior epitympanum. Recurrent cholesteatoma was suspected and surgical exploration with excision of the mass was performed. Pathology confirmed a lipoma.

Anatoli caras et al [6] describe 2months old boy with down syndrome and a small atrial septal defect presented with moderate hearing loss and middle ear effusion. At time of myringotomy, they found soft tissue mass which there is histologic evidence of cholesteatoma. A CT scan of temporal bone revealed symmetric bilateral hypo dense masses with anterior epitympanum extending into the anterior superior aspect of the mesotympanum.

At age of 16 months, the mass in the child’s left ear was removed by performing tymanoplasty. The masses from both ears revealed lipoma.

 Conclusion



middle ear lipoma do occur, but are quite rare. Middle ear lipomas should be considered in the differential diagnosis of a middle ear mass.

References

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2Selesnick SH,Edelstein, DR,,Parisier SC. lipoma of the middle ear:an unusual presentation in a 4 year old child,Otolaryngo.Head Neck Surg. 1990;102(1):82-84.
3Edmons JL,Woodroof JM,Ator GA. Middle ear lipoma as a cause of otomastoiditis. J Laryngol Otol. 1997;111:1162-1165.
4Stegehuis HR,Guy AM, Anderson KR. Middle ear lipoma presenting as airway obstruction:case report. J Laryngol Otol. 1985;99(6) :589-591.
5Kasbekr AV, Donnelly N,.Axon P. Facial nerve palsy secondary to middle ear lipoma. J Laryngol Otol. 2008;14
6Anatoli C. et all An unusal pediatric case of bilaterallipoma of the attic and middle ear. Interation J Pediat Otorhinolaryngol. 2010