Capillary Hemangioma of the Middle Ear: One Case Report and Review of the Literature

Hemangiomas are rare benign vascular tumors; there are several types including the capillary hemangiomas, we present the case of an exceptional localization of capillary hemangioma in the middle ear. We report the case of a 60-year-old female which consults for episodes of pulsatile tinnitus, otorragies, and hearing loss of the left ear. The clinical examination revealed a reddish polypoid mass in the left external auditory canal, the radiological tests showed a vascular mass in the middle left ear. The tumor was surgically removed, the histological study revealed a capillary hemangioma. The incidence of hemangiomas in the temporal bone, especially in the middle ear, is exceptional. Medical imaging guides to the vascular nature of these tumors that make confusion with other vascular tumors such as tympanic paragangliomas. The management is often surgical and the final diagnosis is histological. 1. Introduction Hemangiomas are rare benign tumors growing in soft tissues and bones, there are several types of hemangiomas including the capillary type, hemangiomas are relatively common in head and neck, but they are exceptionally reported in middle ear [1, 2]. We report the case of a capillary hemangioma of the middle ear, through which we analyze clinical, radiological, and therapeutic aspects of this entity exceptionally encountered by the otologist. 2. Case Report We report a 60-year woman which presents, for six months ago, pulsatile tinnitus, hearing loss, and episodes of otorragies in the left ear. The otoscopic examination of the left ear revealed a reddish polypoid mass, sitting at the bottom of the external auditory canal and covered by a thin and inflammatory tympanic membrane. The examination of the right ear was unremarkable. The tonal audiogram showed a left conductive hearing loss of 30？dB, the audiogram of the right ear was normal. CT of petrous bone showed filling of the tympanic cavity without erosion of its walls and preservation of the ossicles (Figure 1). The MRI showed a nodular lesion, which appeared as an intermediate signal T1 and hypersignal T2 image, this lesion enhanced strongly after injection of gadolinium (Figure 2). Figure 1: CT in axial and coronal, showing filling of the left middle ear without erosion of its bony walls or ossicles lesions. Figure 2: MRI showing a nodular lesion in intermediate signal T1 and Hyper signal T2 with enhancement after gadolinium injection. The diagnosis of tympanic paraganglioma was suspected, in order to achieve a vascular mapping of this formation, an arteriography was performed and confirmed the