Author(s)
Faris A. Mirza, MD
Samantha L. Newman, BS
Nicholas B. Drury, MD
Diana Bigler, MD
Mohammad Seyyedi, MD
Affiliation(s)
Wellstar MCG Health; Medical College of Georgia;
Abstract:
Educational Objective: At the conclusion of this presentation, the participants should be able to identify the various clinical presentations for chorda tympani schwannomas as well as the general approach to diagnosis and management.
Objectives: Chorda tympani schwannomas (CTS) are rare, benign tumors. Due to their novelty, few cases are reported and no consensus on presentation and management. The aim of this study is to describe an unusual presentation of CTS and its management.
Study Design: Case report and literature review.
Methods: We report a CTS in a 51 year old female referred to us for abnormal findings in the ear exam following an ear infection. The literature review was performed using "chorda tympani schwannoma" in PubMed and Google Scholar. Inclusion criteria was literature containing confirmed cases of CTS.
Results: CTS presents a challenging diagnosis as it mimics other middle ear pathologies. The literature reveals 23 cases of CTS since its discovery in 1969. Hearing loss is the most common symptom, interestingly not observed in our patient. None of the patients in the review reported taste disturbance. There is no predilection for sex, age, or laterality. The diagnostic approach varies, and imaging primarily demonstrates nonspecific findings. Tumors are excised with postauricular transmastoid or transcanal approaches, with or without ossicular chain reconstruction. Intraoperatively, our patient had a round, approximately 4X4 mm pinkish white mass, in the middle ear space, lateral to the incus. It was removed with transcanal approach. She experienced no ossicular chain disruption or tympanic membrane perforation. Direct comparison of these outcomes has not been conducted.
Conclusions: CTS should be considered in the differential diagnosis for middle ear masses, irrespective of hearing loss. Increasing awareness of the anatomical changes seen on imaging in CTS could reduce missed or delayed diagnosis.