For more than 20 years, a woman experienced a range of symptoms in her right ear—including vertigo, tinnitus, hearing loss, and more—but doctors couldn't figure out what was wrong. Then, the woman's dental hygienist made a discovery on a CT scan, Lisa Sanders reports for the New York Times Magazine.
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Decades of neurological symptoms
The patient was in her 40s when her ear-related symptoms began with a bout of vertigo, Sanders writes. At the time, the patient was diagnosed by her ENT with a likely case of Ménière’s disease.
The condition—which doesn't have any formal test or treatment—is caused by increased pressure on the inner ear, and it's typically characterized by intermittent episodes of vertigo alongside tinnitus, a fullness sensation in the ear, and hearing loss, Sanders reports. Some patients find symptom relief with antihistamines and steroids.
The patient's initial vertigo dissipated after a few months, but two years later, she developed problems with her balance, at times finding it difficult to walk in a straight line. These episodes would continue, on and off, for weeks and months at a time, Sanders writes.
During this time, providers using an MRI found a small patch of "something" in the patient's skull near her inner ear on the right side, Sanders writes, but they didn't consider the finding to be significant, as it wasn't located in a place where it would be likely to cause her symptoms. The patient's providers recommended she undergo physical therapy for a condition called benign paroxysmal positional vertigo, but the therapy didn't provide relief.
The woman went on to later develop tinnitus in her right year—a constant buzz for which she couldn't find any treatment. Then, just weeks before the life-changing dental visit, she woke up to realize that she could barely hear out of her right ear; everything sounded muffled.
A visit to the dentist changes everything
A few weeks after her hearing loss began, the patient—who by now was 68 years old—"burst into tears" during a routine dental visit. She confided in her dental hygienist that she thought she must have a brain tumor, even though her doctors disagreed, and felt as if she "'might be dying,'" Sanders writes.
According to Sanders, the dental assistant offered the patient a dental CT scan. The patient accepted—and the resulting images revealed a mass on the left side of her skull in the sinus behind her cheek.
A follow-up CT, ordered by the patient's ENT, confirmed the small mass on the left side, as well as a strawberry-sized mass that had evidently "destroyed" much of the patient's mastoid bone just behind her right ear.
According to Sanders, this second mass was in the same place the smaller mass had been spotted years before—but now it was big enough to compress a vessel that led to the patient's jugular vein.
Worried the mass might be cancerous, the patient sought a second opinion with Mayo Clinic's Peter Weisskopf. He suspected the patient had a cholesteatoma, a benign cell growth that can get trapped in the ear or, in rare cases, the brain, and begin to grow. While these tumors are not cancerous, they must be removed to avoid issues caused by further growth, Sanders writes.
An MRI confirmed Weisskopf's suspicions, and over the course of two surgeries, the mass was removed.
A medical mystery is resolved—or is it?
As Sanders writes, it's still not absolutely clear whether the mass was to blame for the patient's decades-long medical odyssey. The patient believes it was—but Weisskopf remains skeptical that it would have caused the specific symptoms the patient experienced, Sanders writes.
Still, many of the patient's worst symptoms, including fatigue and a sense of "oppression and doom," are completely gone, Sanders writes. While she still experiences tinnitus, balance issues, and certain other symptoms, she "feels back to something like her old self" (Sanders, New York Times Magazine, 4/3).