Unilateral Hearing Loss and Otorrhea

Unilateral Hearing Loss and Otorrhea: A man in his 70s had painless left-sided otorrhea, aural fullness, and hearing loss; temporal bone computed tomography demonstrated near-complete opacification of the left mastoid air cells and middle ear. What is your diagnosis?

 

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A man in his 70s presented with painless left-sided otorrhea, aural fullness, and hearing loss for nearly 1 year. He had previous complaints of left-sided aural pressure and intermittent clear otorrhea that were unsuccessfully treated at another center with 2 sets of pressure equalization tubes (PETs) and 3 courses of ototopical antibiotics. In the month before presenting to us, the otorrhea had turned bloody. He had not experienced fever, malaise, weight loss, lymphadenopathy, skin lesions, or vertigo. Pertinent medical history included obesity, type 2 diabetes mellitus, allergic rhinitis, and chronic lymphocytic leukemia (CLL). The CLL had been treated successfully with chemotherapy and had been in remission for the past 6 years. The only notable finding from the physical examination was a hypomobile left tympanic membrane with an anterior-inferior PET plugged by granulation tissue. Facial nerve function was normal bilaterally. Audiometry results demonstrated a left moderate sloping to profound mixed hearing loss and speech discrimination score of 68%. A fine-cut, temporal bone computed tomographic (CT) scan was obtained, which demonstrated near-complete opacification of the left mastoid air cells, and middle ear (Figure, A). The patient underwent a left tympanomastoidectomy for continuing otorrhea. Bulky soft tissue was removed from the middle ear and mastoid. Cytopathologic examination revealed numerous, small, basophilic cells (Figure, B). Immunostaining showed that the cells were CD20 positive (Figure, C) and CD3 negative (Figure, D).

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