Patel H, Okuna Y, Ujima W. Atypical jugulotympanic paraganglioma presentation, diagnostic challenges, and role of imaging: A case report. World J Clin Cases 2026; 14(13): 117852 [DOI: 10.12998/wjcc.v14.i13.117852]
Corresponding Author of This Article
Harshil Patel, MD, Department of Medical Physiology, University of Nairobi, Upper Hill, Nairobi 00100, Kenya. harshilpatel@students.uonbi.ac.ke
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Clinical Neurology
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Case Report
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May 6, 2026 (publication date) through Apr 23, 2026
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World Journal of Clinical Cases
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2307-8960
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Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA
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Patel H, Okuna Y, Ujima W. Atypical jugulotympanic paraganglioma presentation, diagnostic challenges, and role of imaging: A case report. World J Clin Cases 2026; 14(13): 117852 [DOI: 10.12998/wjcc.v14.i13.117852]
Atypical jugulotympanic paraganglioma presentation, diagnostic challenges, and role of imaging: A case report
Harshil Patel, Yonnah Okuna, Whinsky Ujima
Harshil Patel, Whinsky Ujima, Department of Medical Physiology, University of Nairobi, Nairobi 00100, Kenya
Yonnah Okuna, Department of Neurosurgery, University of Nairobi, Nairobi 00100, Kenya
Author contributions: Patel H, Okuna Y, and Ujima W contributed to manuscript writing and editing, and data collection; all authors have read and approved the final manuscript.
Informed consent statement: Written informed consent was obtained from the patient for publication of this case report and any accompanying images.
Conflict-of-interest statement: All authors declare that they have no conflict of interest to disclose.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Corresponding author: Harshil Patel, MD, Department of Medical Physiology, University of Nairobi, Upper Hill, Nairobi 00100, Kenya. harshilpatel@students.uonbi.ac.ke
Received: January 4, 2026 Revised: February 14, 2026 Accepted: March 25, 2026 Published online: May 6, 2026 Processing time: 127 Days and 1.7 Hours
Abstract
BACKGROUND
Jugular paragangliomas (JPGLs) are rare, slow-growing neuroendocrine tumors originating from the adventitia of the vessels in the jugular foramen. They typically present with pulsatile tinnitus, conductive hearing loss, and lower cranial nerve palsies. However, atypical presentations can delay diagnosis, especially in resource-limited settings.
CASE SUMMARY
We report the case of a 76-year-old woman with a long-standing history of right-sided hearing loss, intermittent chronic painless ear discharge, and lower motor facial nerve palsy, who presented with acute mastoid pain and otorrhea. Her symptoms were initially attributed to malignant otitis externa, given her diabetic status and history of a canal wall-up mastoidectomy. However, further evaluation with high-resolution computed tomography and contrast-enhanced magnetic resonance imaging (MRI) revealed an expansile lesion involving the middle ear and temporal lobe, consistent with a JPGL. Notably, she lacked pulsatile tinnitus and jugular foramen syndrome, leading to a delay in appropriate imaging and diagnosis.
CONCLUSION
This case underscores the importance of maintaining a broad differential diagnosis in patients with atypical or progressive otologic symptoms, especially when cranial neuropathies are absent. Early use of contrast-enhanced MRI is essential for detecting retrocochlear and vascular tumors in patients with atypical presentations. Clinician awareness and adherence to imaging guidelines can prevent delayed diagnosis and optimize outcomes in patients with paragangliomas.
Core Tip: Jugular paragangliomas are rare skull base tumors that typically present with pulsatile tinnitus and lower cranial nerve palsies. This case highlights an atypical presentation marked by non-pulsatile tinnitus, sensorineural hearing loss, and isolated facial nerve involvement, leading to delayed diagnosis and intracranial extension. The report emphasizes the limitations of symptom-based diagnosis and underscores the critical role of early contrast-enhanced magnetic resonance imaging in patients with unilateral, progressive otologic symptoms to enable timely diagnosis and improved clinical outcomes.
