Secretory otitis media(SOM) is a common disease in the otology.The main symptoms of adult patients are ear suffocation and tinnitus. The main features are tympanic effusion and conductive sputum.It is often due to eustachian tube dysfunction and middle ear mucosal secretion disorders. Clinically, some of the above symptoms and signs will occur in the early stage of some disease and are easily misdiagnosed as secretory otitis media. Therefore, for adults, unilateral secretory otitis media should be highly alert to nasopharyngeal lesions. This case is an adult patient, secretory otitis media is recurrent, eustachian tube balloon dilatation and myringotomy catheterization were performed before. The postoperative period was good,but the symptoms of secretory otitis media appeared again in the postoperative period. Therefore, during the routine preoperative examination, the patient was found to have bulging at the right pharyngeal recess. the sinus CT and the MRI were scanned and enhanced. The results showed that the patient had a space-occupying lesion in the right axilla. The pterygopalatine is a small but important anatomical gap in which nerve vessels travel. The primary tumor of the pterygopalatine is mainly nasopharyngeal angiofibroma and schwannomas, which are rare. Schwannoma originates from peripheral nerve sheath Schwann cells, grow slowly, having a complete envelope and a clear boundary. It usually grows expansively around the nerve, and the nerve bundle does not enter the inside of the tumor , it can occur in all parts of the body, most of which occur in the head and neck (25% to 45%) , which is rare in the ear, nose and throat (4%). In this case, nasal endoscopy combined with navigation system was used during operation, improving the accuracy and safety of surgery. At the same time, CT and MRI are routine preoperative examinations, which are helpful for diagnosis and differential diagnosis. It can provide an important basis for preoperative diagnosis of pterygopalatine schwannomas .
Treatment of schwannomas: Schwannomas are not sensitive to radiotherapy and chemotherapy. And when the nasal schwannomas are found, such as nasal congestion, eyeball protrusion, facial changes and other corresponding compression or occupying symptoms, the body and psychological damage to the patient, so the treatment of nasal schwannomas is mainly surgery [ 5]. The purpose of the surgery is to completely remove the lesion and relieve the symptoms caused by schwannomas. For the superficial vestibular, nasal and other superficial schwannomas can be directly treated with tumor resection, such schwannomas are easy to find early, the tumor is small, the position is superficial and the operation is simple .
With the development of endoscopic techniques and the improvement of surgical techniques, the use of a planing knife to gradually remove sinus intraspinal schwannomas under nasal endoscopy has become an important method for the treatment of schwannomas. This method can effectively avoid the facial appearance damage caused by conventional open surgery, and at the same time can reduce the economic burden of the patient, and the patient is more acceptable. However, for large schwannomas located in the maxillary sinus, since the endoscopic surgery cannot ensure that the space of the maxillary sinus is clearly seen, the risk of incomplete surgical resection is greatly increased, and the schwannomas located in the maxillary sinus to the axillary fossa are completely removed. The lesion is difficult, so the choice of surgical methods should be combined with imaging examination to determine the location and size of the tumor and choose simple endoscopic surgery or open surgery. In this case, the patient recovered well after surgery and no recurrence.
Through the diagnosis and treatment of patients in this case, the etiology of secretory otitis media is more complicated, especially for adults. Our clinicians need to be cautious and consider the cause in many aspects. In particular, attention should be paid to nasopharyngeal lesions or even pterygopalatine fossa and even inferior orbital fossa lesions. By combining relevant imaging examinations, early diagnosis and early treatment are given to improve the quality of life of patients with missed diagnosis and misdiagnosis.