Capillary Hemangioma of the Tympanic Membrane

A 45-year-old woman presented with a 2-week history of sudden onset of pulsatile tinnitus involving the left ear. She described it as a constant heartbeat sensation but denied otalgia, dizziness, vertigo, or history of otologic conditions. Her hearing was within normal limits as assessed by an audiologist. An examination of the left ear revealed a vascular lesion covering the area of the pars flaccida with slight extension onto the attic wall (Figure 1). Clinically, the lesion appeared consistent with a vascular lesion such as a hemangioma or atypical glomus tumor. Preoperative computed tomography (CT) scan demonstrated a 6 3 2-mm soft tissue lesion at the tympanic membrane but was otherwise unremarkable. The lesion was resected in the operating room using a postauricular approach. A tympanomeatal flap was created to enter the middle space. Superiorly, the flap was elevated along with the vascular lesion, which appeared confined to within the layers of the tympanic membrane. The tympanomeatal flap was elevated off of the short process of the malleus and down to the level of the umbo, where it was left attached. Belucci scissors were used to excise the lesion from the remaining healthy tympanic membrane. A fascial graft was used for reconstruction in an underlay fashion. Pathology noted protruding lobulated proliferation of capillary-sized vessels, with larger central and more superficial capillaries with branched lumina present, which was consistent with a capillary hemangioma. The patient was last seen at a 3-month postoperative visit where her tympanic membrane had healed well, and she maintained complete resolution of her symptoms.