Fatal Tinnitus; An Unusual Initial Presentation for Non-Small Cell Lung Carcinoma

Metastatic skull base tumors occur in 4% of patients with systemic malignancy1, most commonly prostate (38%), breast cancer (20.5%), lung (6%) and they usually present with cranial neuropathies.2 We discuss a case that presented with otological and jugular fossa syndrome symptoms as the initial presentation for non-small cell lung carcinoma. So far, only one similar case had been reported. 3
A 57-year-old male presented with left reduced hearing, tinnitus and features of jugular fossa syndrome for five months. Examination revealed left IX, X, XI, XII cranial nerve palsy with no abnormality on lung examination and chest X-ray. Computed tomography of brain, skull base and neck showed ill-defined heterogenous enhancing mass occupying the jugular fossa with surrounding erosion suggestive of glomus jugulare. Two weeks later, he showed clinical evidence of primary lung malignancy and bronchial biopsy returned as non-small cell carcinoma of the lung. The jugular fossa tumor was later confirmed by magnetic resonance imaging to be a metastatic skull base tumor.
In conclusion, high index of suspicion must be applied when investigating any jugular foramen tumor as it may be a metastatic lesion from an asymptomatic primary.