Journal of Innovative Clinical Trials and Case Reports

Abstract

A 67-year-old woman presented with more than four months of intermittent left otalgia, headache, pulsatile tinnitus and reduced hearing. Otoscopy revealed a reddish left middle ear mass. Initial computed tomography (CT) demonstrated enhancing soft tissue involving the external auditory canal, middle ear and mastoid air cells, and was interpreted as otomastoiditis. Retrospective review of the CT demonstrated erosion of the caroticojugular spine, corresponding to the Phelp sign. Subsequent magnetic resonance imaging (MRI) revealed a 1.6 × 1.6 × 1.5 cm lobulated lesion centred at the left jugular foramen (pars vascularis), with suspected extension into the middle ear. The findings were consistent with a jugulotympanic paraganglioma. This case highlights the importance of recognising pulsatile tinnitus and a reddish middle-ear mass as potential indicators of a vascular tumor and the value of careful CT and MRI correlation in diagnosis.