TUMOR OF THE EAR

dr. Yuliani M Lubis, SpTHT-KL

 INTRODUCTION

• Carcinoma of the external auditory canal (EAC) is rare.

• The outcome of this disease is related to the stage of the
lesion
• Among EAC carcinomas, squamous cell carcinoma
(SCC) is the most common malignant tumour at
this site.
• Early presentation of symptoms and signs makes early
diagnosis and intervention possible.

The Journal of Laryngology & Otology (2006), 120, 684–686.

 INCIDENCE
• Estimates of incidence are in the range
of 6 cases per million, with a median age of
occurrence at 55 years.
• 60% of malignancies affect the auricle
• 28% in the external auditory canal
• 12% in the midlle ear and mastoid

ORL: Journal for Oto-Rhino-Laryngology and Its Related Specialties Jul/Aug 2001:63;4
 ETIOLOGY

• Chronic ear discharge and infection with aspergillus

and pseudomonas and radiation may be regarded as
risk factors of inducing SCC at this site.
• In the middle ear SCC, two factor associated are:
Chronic Otitis Media and irradiation
• High prevalence of human papillomavirus types 16 and
18 in COM → Patogenesis chronic inflamation related
human malignancies.
The Journal of Laryngology and Otology; Oct 2001; 115, 10; ProQuest Medical Library
 HISTOPATOLOGY
• Most tumours of the auricle are basal cell
carcinoma (BCC) in contrast to squamous cell
carcinoma (SCC) that affect the external
auditory canal and middle ear.
• Other cancers of the temporal bone include
adenocarcinoma, melanoma and sarcoma.
 HISTOPATOLOGY
• Carcinomas of the external auditory canal
include: SCC, basal cell-, adenoid cystic-,
ceruminous-, microcystic, adnexal carcinoma,
and adenocarcinoma.
• Among them the SCC represents the most
common form of EAC
 CLINICAL FINDING
TUMOURS IN EXTERNAL EAR
• Long standing ear discharge
• Blood staining of mucopurulent or purulent
discharge and severe earache.
• Examination : ulcerated area in the meatus or
a bleeding polypoid mass or granulations.
• Facial nerve paralysis
• Regional lymph node may be involved
 CLINICAL FINDING
• TUMOURS IN THE MIDDLE EAR AND
MASTOID
Deafness and tinnitus
Profuse bleeding from the ear
Dizziness or vertigo
Facial paralysis
Cranial nerve palsies : n. IX – XII
• Symptoms of Ca of the Auditory organs:
• Otorrhea
• Otalgia
• Ear bleeding
• Facial nerve paralysis

The Journal of Laryngology and Otology: Oct 2001,115

 TUMOURS EXTENSION

• Lession affecting the EAC rarely metastasize

• Extension anteriorly and inferiorly → fissure
Santorini/foramen of Huschke →
temporomandibular joint.
• Superior extension through he tegmen of the
mastoid or middle ear places disease in direct
proximity to temporal lobe of the brain in the
middle cranial fossa
ORL : Journal for Oto - Rhino - Laryngology and Its Related Specialties; Jul/Aug 2001; 63, 4;
 TUMOURS EXTENSION
• Posterior extension places the facial nerves at risk
as tumor extend s into the mastoid process
• Medial extension of tumor within the middle ear
may cause involvement of the jugular bulb and
carotid artery
• Distant metastasis is usually an extremely rare
event.

ORL :Journal for Oto - Rhino - Laryngology and Its Related Specialties; Jul/Aug 2001; 63, 4;
Squamous cell carcinoma in the midlle ear mastoid
TUMOURS OF EXTERNAL
EAR PINNA
External ear canal
 BENIGN  BENIGN
• Preauricular cyst or sinus • Osteoma
• Sebaceous cyst • Exostosis
• Dermoid cyst • Ceruminoma
• Keloid
• Haemangioma
• Sebaceous adenoma
• Papilloma • Papilloma
• Cutaneous horn
• Keratoachantoma  MALIGNANT
• Neurofibroma • Squamous Cell Carcinoma
• Basal Cell Carcinoma
 MALIGNANT • Adenocarcinoma
• Squamous Cell Carcinoma • Malignant ceruminoma
• Basal Cell Carcinoma
• Melanoma
• Melanoma
 DIAGNOSE

 CT Scan head
 MRI → soft tissue extent of tumour
 Chest CT scan → most sensitive in
identifying and localizing pulmonary metastasis
 Plain chest x-rays are much more easily available
and serves as a useful screening tool.
ORL : Journal for Oto - Rhino - Laryngology and Its Related Specialties; Jul/Aug 2001; 63, 4;
 STAGING

• Carcinomas of the EAC can be staged using the

American Joint Committee on Cancer (AJCC)
general staging system for non melanoma
cancer of the skin, which is a TNM (tumor,
node, metastases) staging system.
 TREATMENT
• Wide surgical excision of EAC, tympanic
membrane,
• Temporal bone resection
• Radical neck dissection
• Radiation
• Chemotherapy
 PROGNOSE
• 5 years survival rates in cases of stage I+II
(tumour confined to auditory canal) were
100%
• Stage II (tumour involving the middle ear or
mastoid) 68,6%
• Stage IV 19,6%
• Atsushi Takano
• The Journal of Laryngology and Otology; Oct 2001; 115, 10;
THANK YOU