Fibrous Dysplasia of the Temporal Bone Presenting with Chronic Suppurative Otitis Media

Otorrhea can result from middle ear discharge with tympanic membrane perforation, external ear canal pathology, skull injury and other serious diseases in trauma and immunocompromised patients.1 Thorough investigation is warranted in cases without improvement after treatment. We present a case where fibrous dysplasia was the underlying cause and discuss its treatment. CASE REPORTA 41-year-old farmer man consulted at our ENT Outpatient Clinic with a 1-year history of clear, non-foul-smelling discharge from his left ear, associated with intermittent pounding ear pain. A hard immobile nontender prominence was noted over the patient’s left temporal area. (Figure 1) He was initially treated for chronic suppurative otitis media for 3 months. Severe ear pain was noted, 10/10 on pain scale, squeezing in character, radiating to the left temporal and parietal area associated with progressive hearing loss and ear fullness. Plain CT scans revealed a combined lytic and ground glass expansile lesion involving the left occipital, mastoid, and petrous temporal bone and portion of the parietal bone obliterating the external auditory canal and middle ear. (Figure 2) On physical examination, a hard immobile nontender prominence was noted over the patient’s left temporo-parietal area. No facial asymmetry or numbness was noted. On otoscopy, there was a skin-colored round smooth hard immobile nontender mass in the external auditory canal with non-foul smelling whitish to yellowish purulent discharge. A Weber tuning fork test lateralized to the left and a Rinne test revealed air conduction < bone conduction on the left, and air conduction > bone conduction on the right. The patient was admitted with an impression of chronic suppurative otitis media, left; to consider fibrous dysplasia vs. tuberculosis. Aerobic culture of ear discharge revealed no growth. Canal down mastoidectomy was done. Intraoperative findings revealed granulomatous and cartilaginous lesions on the mastoid and temporal bone. (Figure 3) There were aural polyps and cholesteatoma with the ossicles apparently eroded by the lesion. (Figure 4) Temporal bone fluid was sent for GeneXpert MTB/RIF while the surgical specimen was sent for histopathology. GeneXpert MTB/RIF revealed negative results for tuberculosis. Final histopathology results showed fibrous dysplasia.