Middle ear glandular neoplasms are infrequent causes of a middle ear mass. They can have exocrine and/or neuroendocrine differentiation. It is currently thought that these tumors are indistinguishable each from another. Herein, we present a new case of a middle ear glandular neoplasm. Our objective is to review all cases described in the literature in order to identify the clinical features, the gross pathology, the histopathology, the immunohistochemistry, to discuss the differential diagnosis, the treatment, the rate of recurrence, the follow-up, the incidence of metastasis, the prognosis and to present a new classification of middle ear glandular neoplasm. Case presentation We performed a MEDLINE database search for MEA-related articles published between 1950 and March 2008. The information from the reports was analyzed. Ninety-four patients with a middle ear adenoma are included in this report. We uncovered 75 patients with a carcinoid tumor and 19 patients with a middle ear adenoma diagnosis; the most common presenting symptom was a conductive hearing loss. Middle ear adenomas are lesions that are typically white, gray or reddish brown. They are grossly vascular and well circumscribed, but not encapsulated, and can entrap and destroy the ossicles. Histologically, the cuboidal to low columnar cells are arranged in a solid, trabecular or glandular architecture. The tumor's cells are immunohistochemically positive for a variety of keratin antibodies and most of them are also positive for neuroendocrine markers. Surgical excision is the treatment of choice. Local recurrence following complete excision is quite uncommon and metastases are rare. Our study and the review of the literature showed adenomas and carcinoid tumors of the middle ear to be essentially indistinguishable benign tumors with metastatic potential. Based on the presence or absence of immunohistochemical markers and metastasis, we have classified these lesions into three types. Complete surgical treatment is recommended with an indefinite follow-up for possible recurrence.

Objective: To assess the diagnostic yield of audiograms associated to electronystagmography (ENG) for screening vestibular schwannomas (VSs), to determine what definition of asymmetric sensorineural hearing loss (ASNHL) fits best for the diagnosis of VS, and to determine if cochleovestibular symptoms and atherosclerotic potential risk factors play a role in the VS screening. Study Design: Retrospective chart review in a tertiary care center. Methods: One hundred twenty-two patients were included in the study and divided into 2 groups: 1) patients presenting a VS (n = 74) and 2) patients without VS (n = 48). They had received an audiometry assessment, an ENG, and a posterior fossa magnetic resonance imaging (MRI). In addition, a variety of risk factors and clinical data were collected. Mean hearing threshold by frequency, mean asymmetries by frequency, speech discrimination score (SDS), ENG results, and presence or absence of vertigo are studied. Cochleovestibular symptoms and atherosclerotic potential risk factors were collected. Characteristics were studied with analysis of variance, χ² test, or a paired t test. A receiver operating characteristic curve was obtained. A logistic regression with a step-wise selection based on the likelihood ratio was used to identify the best subgroup of predictors of the VS. Results: The most revealing data were the mean ASNHL at 3,000 Hz (p < 0.001), the interaural SDS asymmetry (p < 0.001), the vestibular deficit (p < 0.049), and the absence of vertigo (p < 0.001). The ASNHL at 3,000 Hz was the most representative value of all the frequencies and for the SDS asymmetry. Interaural difference of 15 dB or more at 3,000 Hz is sufficient to consider hearing loss as asymmetric. When the cutoff for a positive test was placed at 50% probability, the receiver operating characteristic curve shows a sensitivity of 73%. The grade of the tumor was also related with the degree of ASNHL at 3,000 Hz. Caloric test does not predict the localization or the grade of the VS. Tinnitus and atherosclerotic potential risk factors were not considered significantly linked with VS. Conclusion: To reduce the number of negative MRI performed in the investigation of an ASNHL, we propose the "rule 3,000," ASNHL of 15 dB or more at the 3,000-Hz frequency. In this case, an investigation with MRI is crucial. If this ASNHL is less than 15 dB, we recommend a biannual audiometric follow-up.