Cryptic Temporal Bone Fibrous Dysplasia with Predominant Vestibular Symptoms: A Case Report

Background: Temporal bone fibrous dysplasia is relatively uncommon and typically manifests as a monostotic form of the disease. It often presents with noticeable temporal bone deformity, clinically appearing as a hard bony swelling behind or around the ear, external auditory canal stenosis, and conduction deafness. While symptoms such as aural fullness, tinnitus, and hearing loss are commonly reported, specific vestibular symptoms like vertigo and nystagmus are considerably less frequent. Case Presentation: In this report, we describe the diagnostic features, management, and outcome of a 37-year-old Nigerian patient with fibrous dysplasia of the right temporal bone, who presented with recurrent debilitating vertigo, along with tinnitus and aural fullness, but without any obvious temporal bone deformity, which posed an initial diagnostic dilemma. She underwent an exploratory mastoidectomy and received a postoperative stat dose of IV zoledronate, along with oral dexamethasone tapered over 10 days, resulting in significant symptom resolution. Conclusion: This unusual presentation underscores the importance of considering temporal bone dysplasia as a potential differential diagnosis for unilateral tinnitus, regardless of the presence of clear bony deformity.