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Case Report
Diagnostic pitfalls in primary Eustachian tube squamous cell carcinoma initially managed as chronic otitis media: A case report
1 Project Assistant Professor, Department of Head and Neck Surgery, Institute of Science Tokyo, Tokyo, Japan
2 Assistant Professor, Department of Head and Neck Surgery, Institute of Science Tokyo, Tokyo, Japan
3 Junior Associate Professor, Department of Otorhinolaryngology, Institute of Science Tokyo, Tokyo, Japan
4 Professor, Department of Otorhinolaryngology, Institute of Science Tokyo, Tokyo, Japan
5 Professor, Department of Head and Neck Surgery, Institute of Science Tokyo, Tokyo, Japan
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Tomoaki Asamori
Department of Head and Neck Surgery, Institute of Science Tokyo, 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8519,
Japan
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Article ID: 100019Z18TA2026
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Asamori T, Okada R, Ito T, Tsutsumi T, Asakage T. Diagnostic pitfalls in primary Eustachian tube squamous cell carcinoma initially managed as chronic otitis media: A case report. J Case Rep Images Otolaryngol 2026;5(1):1–5.ABSTRACT
Introduction: Primary squamous cell carcinoma (SCC) of the Eustachian tube (ET) is an extremely rare and difficult to diagnose because of its deep anatomical location and nonspecific otologic symptoms. In addition, routine temporal bone computed tomography (CT) does not always visualize the entire ET, which can contribute to diagnostic delay.
Case Report: A 53-year-old male presented with a two-year history of unilateral ear fullness and progressive conductive hearing loss without otorrhea, otalgia, or ear bleeding. He was initially treated for otitis media with effusion (OME) with tympanostomy tube placement and subsequently underwent tympanoplasty with canal wall-up mastoidectomy for suspected cholesteatoma at a tertiary care hospital. Histopathological examination of granulation tissue initially revealed inverted papilloma (IP), but pathological review at our hospital led to a diagnosis of SCC. Endoscopic examination revealed a mass at the pharyngeal orifice of the ET, and subsequent imaging studies demonstrated a tumor extending along the course of the ET. Definitive chemoradiotherapy resulted in complete remission, and the patient remains disease-free five years after treatment.
Conclusion: This case illustrates the diagnostic difficulty of ET carcinoma presenting as prolonged unilateral OME. When the clinical course is atypical or prolonged, disease beyond the middle ear should be considered, and assessment of the ET and nasopharynx with appropriate imaging and endoscopic evaluation may help prevent delayed diagnosis.
Keywords: Diagnostic imaging, Eustachian tube carcinoma, Inverted papilloma, Squamous cell carcinoma
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Acknowledgments
During the preparation of this manuscript, the authors used generative AI tools, ChatGPT (version GPT-5.2, OpenAI, CA, USA), for language editing and improving clarity of expression. All content was reviewed and edited by the authors, who take full responsibility for the accuracy and integrity of the final manuscript.
Author ContributionsTomoaki Asamori - Substantial contributions to conception and design, Acquisition of data, Analysis of data, Interpretation of data, Drafting the article, Final approval of the version to be published
Ryuhei Okada - Acquisition of data, Analysis of data, Revising it critically for important intellectual content, Final approval of the version to be published
Taku Ito - Acquisition of data, Analysis of data, Interpretation of data, Revising it critically for important intellectual content, Final approval of the version to be published
Takeshi Tsutsumi - Analysis of data, Interpretation of data, Revising it critically for important intellectual content, Final approval of the version to be published
Takahiro Asakage - Analysis of data, Interpretation of data, Revising it critically for important intellectual content, Final approval of the version to be published
Guarantor of SubmissionThe corresponding author is the guarantor of submission.
Source of SupportNone
Consent StatementWritten informed consent was obtained from the patient for publication of this article.
Data AvailabilityAll relevant data are within the paper and its Supporting Information files.
Conflict of InterestAuthors declare no conflict of interest.
Copyright© 2026 Tomoaki Asamori et al. This article is distributed under the terms of Creative Commons Attribution License which permits unrestricted use, distribution and reproduction in any medium provided the original author(s) and original publisher are properly credited. Please see the copyright policy on the journal website for more information.
