NEUROMA OF THE FACIAL-NERVE MASKED BY CHRONIC OTITIS-MEDIA

The absence of facial twitching, weakness, or palsy makes the diagnosi s of facial neuroma difficult. The authors report a case of a neuroma of the horizontal portion of the facial nerve masked by the presence o f a chronic ear. A woman with a long history of discharge and hypoacou sia in her left ear presented with acute dizziness. Examination reveal ed grade 3 horizontal right nystagmus, left anacousia, and the appeara nce of an epitympanic cholesteatoma. Computed tomography (CT) was perf ormed after the vestibular condition improved. The clinical diagnosis of chronic otitis media with cholesteatoma together with the radiologi c finding of the mastoid and tympanic cavity completely occupied by so ft tissue were enough to send the radiologist astray. The radiologic d iagnosis confirmed that the bony destruction of the vestibule and late ral semicircular canal could be caused by a cholesteatoma. A neuroma o f the horizontal portion of the facial nerve was discovered during sur gery performed for the chronic ear. The postoperative study of the CT scans showed that there was no erosion of the malleus or incus, despit e wide erosion of the vestibule and lateral semicircular canal. This f inding would be enough to suggest the presence of pathology other than cholesteatoma. The patient refused exeresis of the neuroma. The autho rs recognize the difficulty in urging a patient to an operation that s urely will result in worsening of the facial function. Follow-up in th is case has revealed no change in tumor dimension or facial function o ver 3 years.