ENCASED IN SCLEROSIS: UNRAVELING A RARE MIDDLE EAR ENIGMA

Abstract

Background: Tympanosclerosis represents a complex physiological response characterized by the accumulation of hyaline material within the middle ear cavity, specifically around the tympanic membrane and the hypertrophic submucosa. This condition arises primarily as a chronic inflammatory sequela of middle ear disease, though it may also manifest following the spontaneous healing of a tympanic membrane perforation. While a substantial majority of these cases remain functionally asymptomatic and do not necessitate clinical intervention, rare and atypical presentations introduce severe structural complications that make therapeutic management highly challenging. Furthermore, a significant clinical controversy persists regarding whether the complete surgical eradication of these sclerotic plaques reliably results in postoperative auditory improvement for patients suffering from chronic otitis media. Aim: This report aims to comprehensively describe the unique clinical presentation, precise diagnostic evaluation, intricate surgical management, and significant intraoperative challenges encountered in a rare case of bilateral tympanosclerosis. Case Presentation: A 22-year-old female patient presented with a three-year history of bilateral otorrhoea and progressive hearing impairment. Extensive preoperative imaging and subsequent surgical exploration of the right ear revealed dense, stony hard tympanosclerotic masses completely obstructing the mastoid antrum and severely restricting the mobility of the ossicular chain. Intervention and Outcome: Through highly precise surgical drilling techniques during a cortical mastoidectomy and epitympanotomy, the ossicular chain was meticulously liberated from the sclerotic encasement. Following a Type I tympanoplasty, the patient demonstrated substantial postoperative hearing improvement. Conclusion: Despite the profound intraoperative challenges posed by stony hard tympanosclerosis causing severe ossicular fixation, meticulous surgical clearance of the disease can successfully restore mechanical mobility and yield highly favorable auditory outcomes.