Otalgia and Facial Nerve Palsy: Common Symptoms Revealing the Uncommon Pathology of Middle Ear Lymphoma

Lymphoma of the middle ear and mastoid is uncommon and is rarely diagnosed early. The clinical presentation occurs due to consequences of extensive progressive disease. It can manifest as benign middle ear pathologies such as otitis media; other presentations include facial nerve palsy, hearing loss, and vestibular dysfunction. We treated a case of a 38-year-old male who presented with extranodal involvement of diffuse large B-cell lymphoma (DLBCL) of the middle ear, mastoid, and temporalis muscle, which mimicked an acute otitis media complicated with facial nerve palsy and hearing loss. He has underlying mediastinal and cervical DLBCL diagnosed 20 months before the current presentation. He underwent cortical mastoidectomy and chemotherapy. Despite treatment, he succumbed to the disease. We discuss the clinical significance of middle ear lymphoma by reviewing similar cases in the literature. To conclude, refractory middle ear disease should alert the surgeon of a more sinister underlying pathology in a patient with malignancy.