gms | German Medical Science

We present a case of chronic lymphocytic leukemia (CLL) with manifestation in both mastoid cells.

The CLL is one of the chronic lymphoproliferative disorders (Lymphoid neoplasm). It is characterized by a progressive accumulation of fuctionally incompetent lymphocytes, which are monoclonal in origin.

CLL is an extremely heterogenous disease with certain subsets of patients having survival rates without treatment that are similar to the normal population (2,3)

The patient, a 79-year-old man, presented to his otolaryngologist with hearing loss and ear pain two weeks after an episode of acute sinusitis. After myringotomy the patient had improvement of hearing only a few days. Treated unsuccessfully with several antibiotics the patient was referred to our department.

In his medical history the patient had a CLL (10/2010), stage Binet A. In accordance to indictions für treatment so far a chemotherapy was not recommended.

The tympanic membrane was thickened, reddened and there was fluid in the middle ear cavity on both sides.

The pure tone audiometry showed a combined hearing loss for air conduction treshholds and bone conduction tresholds.

Computertomography scan showed filling of both tympanic and mastoid cavities of soft tissue material and erosions of both mastoid septa.

After mastoidectomy first on the left side 07/2011, then at the right side 09/2011 the patient had no further ear pain, or hearing loss.

The tone auiodmetry showed an improvement of air conduction.

Since no other complication of the CLL occured and stage was still Binet A, the tumor board decided that no further chemotherapy is required.

Conclusions: Lymphomas of the ear are a rarity. In case of therapyresistent otitis, with or without effusion and chronic mastoiditis, a malignant tumor should be excluded by immunohistopathological investigation.