Promontory osteoma mimicking otosclerosis: case report

Is the promontory a promising site to diagnose otitis media in paleopathology? A search for evidence

OBJECTIVE

The promontory of the middle ear was recently suggested to be an appropriate site for diagnosing otitis media (OM) in archaeological bones by endoscopic inspection. The present study scrutinized the underlying assumption that a bulgy, irregular promontorial surface represents a pathological condition.

MATERIALS

We compared an allegedly healthy individual and an allegedly diseased individual in skeletal remains of two human individuals from the early Medieval period in Germany.

METHODS

The specimens were studied using microscopic analyses of thin ground sections.

RESULTS

The osseous architecture of the three-layered promontorial wall was the same in both specimens. Both the contour of the resorption front of the middle layer and the thickness of the overlying outer periosteal layer showed some variation, resulting in an either smooth or a bulgy promontorial surface, while signs of resorptive or proliferative changes at the periosteal surface were missing in both cases.

CONCLUSIONS

Our results suggest that an irregular promontorial surface represents normal variation in the development of the otic capsule rather than a pathological condition. We therefore conclude that the promontory is not an appropriate site for diagnosing OM in archaeological bone.

SIGNIFICANCE

The study contributes to evidence-based diagnoses in paleo-otological studies. Our assumption is in line with clinical and experimental findings indicating that the otic capsule is protected against bone remodeling.

LIMITATIONS

Only two specimens were studied.

SUGGESTIONS FOR FURTHER RESEARCH

SEM-studies to detect more subtle changes to the promontorial surface.

Middle ear osteoma causing Eustachian tube obstruction: A case report and literature review

Middle ear osteoma is an extremely rare benign tumor of the middle ear. Due to its very slow growth rate and benign nature, osteoma of the middle ear can be found incidentally without causing any symptoms. The most common clinical signs are conductive hearing loss, the sense of fullness in the ear, tinnitus, and otorrhea. Small-sized osteomas can be misdiagnosed as otosclerosis without showing any signs other than conductive hearing loss. When the mass becomes very large, and symptoms caused by the tumor increase, treatment also becomes difficult. In this paper, we report a case of middle ear osteoma causing conductive hearing loss and effusion due to the effect of pressure on the middle ear ossicles and the Eustachian tube. We also present a review of the pertinent literature.