A 32-year-old man presented with an 8-month history of hearing loss and a pulsatile noise that sounded like a heartbeat in his left ear. Medical history In the previous 4-months, he had experienced otalgia in the left ear and headaches. Physical examination The doctor noticed a mass behind the left tympanic membrane, with the pulsation of the membrane. Labs Tuning fork tests identified a conductive hearing loss in the left ear.
Other than headaches, there were no red flag symptoms such as weight loss, fever, or other signs of raised intracranial pressure. ENT exam The patient was referred to an ENT specialist, who noted that the left tympanic membrane was intact and facial nerve function on both sides was normal. There was an obvious pulsating mass behind the left tympanic membrane (image 1). Endoscopic examination The larynx showed normal vocal cord movement, but there was evidence of…
