gms | German Medical Science

We report the case of a 36-year-old woman with a maximum conductive hearing loss and a tinnitus in the right ear under an intact tympanic membrane. Suspecting an otosclerosis we performed a tympanotomy with the objective of delivering a stapedotomy. Intraoperative a bluish structure was observed, which spread from the hypotympanon to the fenestra vestibuli and fenestra ovalis as well as into the adjacent mastoid. The ossicular chain was displaced towards the antrum, the fenestra ovalis was located above the usual. The stapes was fixed in the sense of an otosclerosis. The operation was halted due to an increased risk of bleeding. An imaging diagnostic of the venous alteration was used to differentiate between a high jugular bulb and a vascular tumor in the sense of a glomus tumor. Based on the CT we suspected a glomus jugulare tumor on the right-hand side with a destruction of the bone towards the tympanic cavity. The final clarification was obtained with the help of a MR angiographie (MRA). A glomus tumor could be excluded. We merely observed a markedly elongated vena jugulare in the region of the right-hand skull base, confirming the suspected high jugular bulb.

Three months after the first intervention the targeted stapedotomy was done without complications. Six weeks later we observed a normal tympanic membrane and in the audiometry a nearly complete reversal of the conductive hearing loss.