Scleroma Affecting the Middle Ear Cavity with Report of Three Cases

Scleroma has especial predilection to the mucous membranes particularly of the nose and larynx. Other sites are rarely affected such as the pharynx, lacrimal sac, sinuses, bone and skin. However, no case of middle ear involvement is mentioned. Among 300 patients examined during the last few years, only three cases showed scleromatous involvement of the middle ear cavity. 1) A patient developed right facial nerve paralysis two days after an operation of tympanoplasty. Exploration showed granulomatous tissue present surrounding the bony facial canal and filling the middle ear, mastoid and attic regions. Biopsy proved to be scleroma. 2) During one tympanoplasty, excessive vascular granulations were observed and biopsy revealed scleroma. 3) A 24-year-old patient had advanced rhinopharyngoscleroma and bilateral chronic suppurative otitis media with granulations. An exploratory operation of the right ear was done and vascular granulations were found infiltrating the middle ear, attic, antrum and mastoid air cells. Biopsy was scleroma. As one of the three cases had rhinopharyngoscleroma, this raises the possibility of direct spread through the submucosa. However the other two cases show no nasal or pharyngeal affections. Scleroma can invade the facial bony canal and cause nerve paralysis as demonstrated in one patient.