Neuroendocrine Adenoma of Middle Ear Causing Acute Onset Facial Palsy- A Rare Case Report

Document Type : Case Report

Authors

1 Department of Otorhinolaryngology-Head and Neck Surgery, Liaquat College of Medicine & Dentistry and Darul Sehat Hospital, Karachi, Pakistan.

2 Department of Otorhinolaryngology-Head and Neck Surgery, Liaquat National Hospital & Medical College, Karachi, Pakistan.

3 Department of Otolaryngology-Head and Neck Surgery, St Mary's Hospital, London, United Kingdom.

Abstract

Introduction:
Acute facial nerve palsy secondary to neuroendocrine adenoma of the middle ear (NAME) is a rare disorder. There is only one case report in the literature describing similar findings.
 
Case Report:
A 50-year-old man initially presented to ENT clinic with a right-sided middle ear mass and normal facial nerve function. Over the next six days, he developed House-Brackmann grade II facial paralysis. He underwent urgent surgical exploration of the tympanic cavity and excision of the middle ear mass via a post-auricular approach. Histopathological and immunohistochemical analysis revealed NAME. Three weeks after the surgery, facial nerve function returned to normal. No recurrence was found at a 3-year follow-up.
 
Conclusion:
Acute onset facial palsy induced by NAME is an extremely rare disorder. For a patient already affected by hearing impairment resulted from middle ear mass, facial weakness can have a significant additional detrimental impact on their wellbeing. The early complete excision of tumor is recommended not only as a curative treatment but also restoration of facial function.

Keywords

Main Subjects

References

1. Hyams VJ, Michaels L. Benign adenomatous neoplasm (adenoma) of the middle ear. Clin Otolaryngol Allied Sci 1976;1(1):17-26.
2. Derlacki EL, Barney PL. Adenomatous tumors of the middle ear and mastoid. Laryngoscope 1976; 86(8):1123-35.
3. Hale RJ, McMahon RF, Whittaker JS. Middle ear adenoma: tumour of mixed mucinous and neuroendocrine differentiation. J Clin Pathol 1991; 44(8):652-4.
4. Ayache S, Braccini F, Fernandes M, Homassin JM. Adenoma of the middle ear: a rare and misleading lesion.Otol Neurotol 2002;23(6):988-91.
5. Paraskevakou H, Lazaris AC, Kandiloros DC, Papadimitriou K, Adamopoulos G, Davaris PS. Middle ear adenomatous tumour with a predominant neuroendocrine component. Pathology 1999; 31(3): 284-7.
6. Tomazic PV, Beham A, Lackner A, Ropposch T, Stockreiter U, Walch C. Neuroendocrine adenoma of the middle ear (NAME) mimicking as chronic otitis media with an episode of facial nerve palsy. B-ENT 2011;7(2):121-5.
7. Hasan Z, McGinness S, Gunaratne DA, Coleman H, Varikatt W, Cruz MD. Neuroendocrine adenoma of the middle ear: a rare histopathological diagnosis. Case Rep Otolaryngol 2016;2016.
8. Wenig BM. Atlas of Head and Neck Pathology. Amsterdam: Elsevier; 2016.
9. Bell D, El-Naggar AK, Gidley PW. Middle ear adenomatous neuroendocrine tumors: a 25-year experience at MD Anderson Cancer Center. Virchows Arch 2017;471(5):667-72.
10. Brambilla E, Lantuejoul S, Sturm N. Divergent differentiation in neuroendocrine lung tumors. Semin Diagn Pathol 2000;17:138-48.
11. Torske KR, Thompson LD. Adenoma versus carcinoid tumor of the middle ear: a study of 48 cases and review of the literature. Mod Pathol 2002;15(5):543-55.
12. Saliba I, Evrard AS. Middle ear glandular neoplasms: adenoma, carcinoma or adenoma with neuroendocrine differentiation: a case series. Cases J 2009; 2:6508
13. Amble FR, Harner SG, Weiland LH, McDonald TJ, Facer GW. Middle ear adenoma and adenocarcinoma. Otolaryngol Head Neck Surg 1993;109(5):871-6.
14. Benecke JJ, Noel FL, Carberry JN, House JW, Patterson M. Adenomatous tumours of the middle ear and mastoid. Am J Otol 1990;11(1):20–6.
15. Manni JJ, Faverly DR, Van Haelst UJ. Primary carcinoid tumors of the middle ear. Report on four cases and a review of the literature. Arch Otolaryngol Head Neck Surg 1992; 118(12):1341–7.
16. Zan E, Limb CJ, Koehler JF, Yousem DM. Middle ear adenoma: a challenging diagnosis. AJNR Am J Neuroradiol 2009;30(8):1602-3.
17. Maintz D, Stupp C, Krueger K, Wustrow J, Lackner K. MRI and CT of adenomatous tumours of the middle ear. Neuroradiology 2001;43(1):
58-61.
18. Mori E, Kojima H, Wada K, Moriyama H. Middle ear adenoma diagnosed by recurrent facial paralysis. Auris Nasus Larynx 2009;36(1):75-8.
19. Duraiyan J, Govindarajan R, Kaliyappan K, Palanisamy M. Applications of immuno-histochemistry. J Pharm Bioallied Sci 2012; 4 (Suppl 2):S307-9.
20. Ferlito A, Devaney K, Rinaldo A. Primary carcinoid tumor of the middle ear: A potentially metastasizing tumor. Acta Otolaryngol 2006; 126(3): 228-31.
21. Jahrsdoerfer RA, Fechner RE, Moon CN, Selman JW, Poxell JB. Adenoma of the middle ear. Laryngoscope 1983;93(8):1041–4.
22. Jones SE, Yung MW, Orell JM, Norris A. Adenoma in the middle ear: a report of two cases. J Laryngol Otol 2001;115(3):216–9.
23. Leong K, Haber MM, Divi V, Sataloff RT. Neuroendocrine adenoma of the middle ear (NAME). Ear Nose Throat J 2009;88(4):874–9.
24. Orendorz-Fraczkowska K, Jaworska M, Gawron W, Badowski R. Middle-ear ceruminous adenoma as a rare cause of hearing loss and vertigo: case reports. Auris Nausus larynx 2005; 32(4):393–7.
25. Yamamoto E, Ohmura M, Isono M, Hirano Y, Mizukami C. Middle-ear paraganglioma masquerading as traumatic facial nerve palsy. ORL J Otorhinolaryngol Relat Spec 1991;53(3):177–9.
26. Piccirillo E, Aqarwal M, Rohit MS, Khrais T, Sanna M. Management of temporal bone hemangiomas. Ann Otol Rhinol Laryngol 2004; 113(6):431–7.
27. Lee SH, Choi H, Chu YC, Kim YH, Kim KS. Huge middle ear adenoma with delayed facial nerve paralysis.Ear Nose Throat J 2012;91(6)E11-4.
28. Kasbekar AV, Donnelly N, Axon P. Facial nerve palsy secondary to middle-ear lipoma. J Laryngol Otol 2008;122(6):e14.
29. Zehlicke T, Punke C, Boltze C, Pau HW. Transient facial palsy in two cases of benign, very rare middle ear tumors (carcinoid tumor and myxoma). Neurologist 2008;14(1):52-5.
Iranian Journal of Otorhinolaryngology
Volume 31, Issue 5 - Serial Number 106
September and October 2019
Pages 305-310

Files

Share

How to cite

Statistics