ABSTRACT
Introduction: Hypacusia can be caused by various etiologies; however, hearing loss attributed to gouty tophi remains a rare occurrence. This case report presents, for the first time, a bilateral gouty tophi causing hearing impairment. Case presentation: This report describes a case study involving an 83-year-old Caucasian female patient who presented symptoms of hypacusia, pruritus, and a sensation of pressure in her right ear. A computed tomography scan revealed the presence of non-homogeneous calcified structures in both ears. Following a comprehensive assessment that included pure-tone audiometry and a thorough evaluation of the patient's clinical complaints, a tympanoplasty procedure was initially performed on the right ear. Pathological analysis revealed the presence of gouty tophi. After surgical removal of the tophus, a notable improvement in the patient's hearing threshold was observed. Four months later, a similar surgical intervention was performed on the contralateral ear, achieving a similar positive outcome. The substantial postoperative decrease of bone conduction indicates an inner ear affection by the gout tophi. Conclusion: Gout tophus in both ears is a very rare but possible cause of hypacusia, even in the absence of a pre-existing diagnosis of systemic gout disease. We report a case of gout tophi in both ears as a rare cause of hearing loss.
ABSTRACT
Introduction: Otalgia can have multiple causes. Mostly otalgia is caused by a tubal dysfunction or an acute middle ear infection. This case describes a patient with an inflammation of the Jacobson's nerve causing severe persistent otalgia after an acute otitis media. The patients complaints completely disappeared after neurolysis of the Jacobson's nerve. Case presentation: We describe a case of a 21-year-old female caucasian patient with acute otitis media and persistent intractable otalgia. Infection was first successfully controlled by antibiotics. But the patient reported a persistent otalgia not responding to analgetics. We performed a CT scan, which exhibited a regular aerated middle ear finding, and a diagnostic tympanoscopy to examine the middle ear structures particularly the tympanic Jacobson's nerve as a possible cause for persistent pain. The following neurolysis of Jacobson's nerve under general anaesthesia led to a resolution of otalgia. Conclusion: An inflamed tympanic Jacobson's nerve is a rare observation and a persisting otalgia after an acute otitis media not responding to conservative treatment can be treated by a neurolysis.
