Abstract：
OBJECTIVE: Tophaceous lesions of the middle ear from calcium pyrophosphate deposition disease (CPPD, or pseudogout) and gout are infrequently reported. Recognizing its characteristic findings will allow clinicians to accurately narrow the differential diagnosis of bony-appearing middle ear lesions and improve management.
METHODS: Two consecutive cases of tophaceous middle ear lesions presenting to a tertiary care center between January 2021 and December 2021. Neither with previous rheumatologic history.
METHODS: Surgical excision of tophaceous middle ear lesions.
METHODS: Improvements in facial weakness and conductive hearing loss.
RESULTS: The first case was a 66-year-old gentleman with progressive conductive loss, ipsilateral progressive facial weakness over years, and an opaque, irregular-appearing tympanic membrane anterior to the malleus found to have CPPD on surgical pathology, with immediate postoperative improvement of facial function. The second was a 75-year-old gentleman with progressive conductive loss and similar appearing tympanic membrane as case 1, previously diagnosed with tympanosclerosis, found to have gout on surgical pathology. In both cases, the CT showed a heterogenous, bony-appearing lesion in the middle ear, and both tophaceous lesions were a of gritty, chalky consistency intraoperatively.
CONCLUSIONS: Tophaceous lesions of the middle ear are rare but have similar findings. Notably, the tympanic membrane can appear opaque and irregular, and the CT demonstrates a radiopaque, heterogeneous appearance. Facial weakness is an unusual finding. Specimens of suspected tophi must be sent to pathology without formalin for accurate diagnosis.
METHODS: Two consecutive cases of tophaceous middle ear lesions presenting to a tertiary care center between January 2021 and December 2021. Neither with previous rheumatologic history.
METHODS: Surgical excision of tophaceous middle ear lesions.
METHODS: Improvements in facial weakness and conductive hearing loss.
RESULTS: The first case was a 66-year-old gentleman with progressive conductive loss, ipsilateral progressive facial weakness over years, and an opaque, irregular-appearing tympanic membrane anterior to the malleus found to have CPPD on surgical pathology, with immediate postoperative improvement of facial function. The second was a 75-year-old gentleman with progressive conductive loss and similar appearing tympanic membrane as case 1, previously diagnosed with tympanosclerosis, found to have gout on surgical pathology. In both cases, the CT showed a heterogenous, bony-appearing lesion in the middle ear, and both tophaceous lesions were a of gritty, chalky consistency intraoperatively.
CONCLUSIONS: Tophaceous lesions of the middle ear are rare but have similar findings. Notably, the tympanic membrane can appear opaque and irregular, and the CT demonstrates a radiopaque, heterogeneous appearance. Facial weakness is an unusual finding. Specimens of suspected tophi must be sent to pathology without formalin for accurate diagnosis.
摘要：
目的：焦磷酸钙沉积病引起的中耳皮损（CPPD，或假性痛风）和痛风很少报告。认识到其特征性发现将使临床医生能够准确地缩小骨性中耳病变的鉴别诊断范围并改善管理。
方法：在2021年1月至2021年12月期间，有两例连续出现在三级护理中心的触毛石中耳病变。均无风湿病史。
方法：手术切除甲状中耳病变。
方法：改善面部无力和传导性听力损失。
结果：第一个病例是一位66岁的先生，他的传导性进行性丧失，多年来同侧进行性面部无力，和一个不透明的，在手术病理上发现有CPPD的锤骨前出现不规则的鼓膜，术后立即改善面部功能。第二个是一位75岁的绅士，进行性传导丧失，鼓膜表现与病例1相似，先前被诊断为鼓室硬化，在手术病理上发现有痛风。在这两种情况下，CT显示不均匀，中耳出现骨性病变，两个痛风石病变都很坚韧，术中白垩稠度。
结论：中耳的耳质病变很少见，但有相似的发现。值得注意的是,鼓膜可以出现不透明和不规则，CT显示不透射线，异质外观。面部无力是一个不寻常的发现。疑似痛风石的标本必须在没有福尔马林的情况下送至病理学以进行准确诊断。
方法：在2021年1月至2021年12月期间，有两例连续出现在三级护理中心的触毛石中耳病变。均无风湿病史。
方法：手术切除甲状中耳病变。
方法：改善面部无力和传导性听力损失。
结果：第一个病例是一位66岁的先生，他的传导性进行性丧失，多年来同侧进行性面部无力，和一个不透明的，在手术病理上发现有CPPD的锤骨前出现不规则的鼓膜，术后立即改善面部功能。第二个是一位75岁的绅士，进行性传导丧失，鼓膜表现与病例1相似，先前被诊断为鼓室硬化，在手术病理上发现有痛风。在这两种情况下，CT显示不均匀，中耳出现骨性病变，两个痛风石病变都很坚韧，术中白垩稠度。
结论：中耳的耳质病变很少见，但有相似的发现。值得注意的是,鼓膜可以出现不透明和不规则，CT显示不透射线，异质外观。面部无力是一个不寻常的发现。疑似痛风石的标本必须在没有福尔马林的情况下送至病理学以进行准确诊断。
