Middle ear Sarcoidosis – Report of a case

Introduction
In this case study we present a male 36-year-old patient with middle ear sarcoidosis. Symptoms that led to consultation in our outpatient unit included unilateral hearing and middle ear effusion without control under conservative therapy for two years.

Methods
After completing diagnostics with ear microscopy, audiometry, tympanometry, OAE, BERA, Freiburg speech recognition testing, vestibular analysis, and imaging by CT as well as MRI, also a tympanoscopy was performed in order to get a histological diagnosis.

Results
Hearing tests revealed a complete sensorineural hearing loss on the affected left side with an intact contralateral hearing function. In ear microscopy, an intact, hyperconvex and slightly hypervascularized eardrum was detected. Imaging showed a pathological formation within the left middle ear with destruction of the ossicular chain. Total removal of a kind of granulation tissue was microscopically performed, that subsequently resulted in a peripheral facial nerve paralysis, recovering after cortisone therapy. The histological analysis concluded the tissue to be granulation tissue without detecting a specific infectious etiology, matching the histologic presentation of sarcoidosis. A biopsy taken from granulation tissue in the right nasal cavity yielded the same result.

Discussion
This case presents a rare non-cholesteatoma yet highly aggressive destructive inflammatory process in the middle ear. In this patient it reached a stadium in which it progressed to total unilateral sensorineural hearing loss, requiring a cochlear implant in order to restore any hearing on the affected side in the future.

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