Subjective Tinnitus as First Presentation in a Patient with Metastatic Lung Cancer in Temporal Bone - A Case Report

Abstract

Metastasis of lung cancer to the temporal bone is a very rare disease and subjective tinnitus as the presenting symptom in these patients is even rarer. Here we report a case in which a 42-year-old male presented with subjective tinnitus of three months, with no pulmonary disease symptoms. Pure tone audiometry indicated moderate conductive deafness in left ear with an air-bone gap of 21.3 dB. HRCT temporal bone scanning indicated high-density shadows in the left epitympanic cavity, sinus tympani and mastoid cavity. Chronic otitis media with cholesteatoma was suspected and surgical treatment recommended. However, preoperative chest x-ray revealed high-density millet lesions scattered widely in both lungs. HRCT lung scanning confirmed the lungs lesions and indicated lung cancer. In order to determine correlations between the temporal bone and pulmonary lesions, a CT-guided trans-mastoid aspiration biopsy and immunohistochemical study were conducted, which confirmed that the temporal bone lesion was metastatic from the lungs. The patient was given a series of chemotherapy immediately and his tinnitus significantly improved after three months of treatment, with full recovery of his hearing and complete resolution of shadows in the mastoid cavity. Unfortunately, he subsequently developed multiple bone metastases in the 9th month and cerebral metastasis in the 18th month. Multiple organ failure resulted in death in 2.5 years.