Presentation and management of uncommon lesions of the middle ear.

Infrequently encountered tumors involving the middle ear cleft can cause symptoms and signs that are identical with those of acute or chronic otitis media. Selection of patients who require a more thorough evaluation is predicated upon a high index of clinical suspicion. Integration of the results of a preoperative neuroradiologic evaluation, including high resolution computerized tomography, magnetic resonance imaging, and either conventional or magnetic resonance angiography, may suggest the histopathologic nature of the lesion and direct appropriate treatment. The authors present their experience with the management of 11 patients who had either malignant or benign middle ear lesions that were initially believed to represent infectious middle ear disease. The perioperative decision making process and patient outcomes are compared to other historical reports.