“En Plaque Meningioma” masked by Chronic Serous Otitis Media with Effusion

Abstract

Objective To highlight a rare but clinically significant cause of persistent unilateral otitis media with effusion (OME) through a case series of patients ultimately diagnosed with skull base “en plaque” meningioma. Emphasis is placed on the otologic presentation, its diagnostic approach and management.

Methods Single-center, retrospective study of a cohort of patients with persistent unilateral OME ultimately diagnosed as en plaque meningiomas involving the temporal bone. A review of medical records, images, and operative videos was conducted.

Results Five patients (4 females, 1 male; age 45–70) presented with longstanding and refractory hypoacusia, aural fullness tinnitus and othorrea. Delay between symptom onset and referral to our center reached 2 years. CT scans and MRIs showed evidence of sphenotemporal and middle-ear involvement. Prior management included unsuccessful procedures such as VTs, mastoidectomy, and exploratory myringotomy. Four patients underwent biopsy confirming WHO grade I meningioma. Neurosurgical decompression was required in three cases. Adjuvant therapy was employed in selected cases.

Conclusion Persistent unilateral OME that is refractory to treatment should prompt suspicion for underlying skull base lesions, including meningioma en plaque. Awareness of this association helps expedite diagnosis. Otolaryngologists play a pivotal role in early recognition and timely referral can prevent progression. Imaging with CT and MRI aids diagnosis. Individualized approach is required. Surgery may be considered for histologic confirmation and decompression of neural structures with or without postoperative adjuvant therapies. However, total resection is difficult and often achieved at the expense of significant morbidity. Conservative management and surveillance are often the best alternative for asymptomatic lesions.