A case of an attic lesion presenting with unilateral hearing loss, diagnosed as a meningioma: a case report and review of the literature.

BACKGROUND

Unilateral hearing loss can occur for several reasons. Common causes include sudden sensorineural hearing loss, acoustic neuroma, meningitis, and drug toxicity, among others. One rare tumor that can cause sensorineural hearing loss is meningioma. Extra-cranial (ectopic) meningiomas have been reported in various anatomical locations. Ectopic meningiomas commonly occur near the sensory organs in the head and neck.

CASE PRESENTATION: This report discusses a 48-year-old Iranian woman with unilateral hearing loss, evaluated at our tertiary care center. Diagnostic assessments revealed a unilateral mass in the left attic, confirmed to be a meningioma. Pathological examination showed monomorphic meningothelial cells with round nuclei and eosinophilic cytoplasm. Immunohistochemistry revealed negative results for chromogranin and synaptophysin, patchy positivity for EMA, and diffuse staining for progesterone receptor. Follow-up indicated no recurrence or hearing deterioration, and since the mass was completely excised without brain extension, radiotherapy was considered unnecessary.

CONCLUSIONS

Primary tympanic meningiomas can often be misdiagnosed, particularly when the tympanic membrane is intact. Symptoms such as hearing loss and persistent middle ear effusion may mimic secretory otitis media. Direct examination of the tympanic membrane and prompt imaging, such as computed tomography (CT) scan or magnetic resonance imaging (MRI), are vital for ruling out middle ear lesions and facilitating early intervention. This case report aims to highlight significant causes of unilateral hearing loss that are often overlooked and misclassified as idiopathic sensorineural hearing loss, which otolaryngologists should consider in their evaluations.