Dr. Robert F. Rider: A 25-year-old white woman noted a mass in the right side of her neck that had increased in size for three years. The patient stated that she experienced diminished hearing and later deafness, pain over the right mastoid, serous discharge from the right ear, and, most recently, hoarseness and difficulty in swallowing. Her husband had noted facial asymmetry and also that her right pupil was smaller than the left. She described a feeling of "tiredness" of the entire right side of her face. The feeling had persisted for the past five months.
Physical examination revealed a Horner's syndrome on the right, negative vestibular response, auditory nerve deafness on the right, deviation of the palate and tongue to the right, and paralysis of the right facial nerve. A firm, immobile, nontender 10 × 6-cm mass was palpable from the mastoid process to the right mandibular angle.