Consular :

Dr. Asnominanda,Sp.THT-

KL NOOR FITRARIANTI FK USAKTI

EAR TUMORS
Benign Tumor Cholesteatoma Exostosis Glomus Tumor Acoustic Neuroma Malignant External ear Squamous cell carcinoma Basal cell carcinoma Middle ear Squamous cell carcinoma

CHOLESTEATOMA
Definition

Cholesteatoma is a type of cyst located in the middle ear

Causes

Cholesteatoma can be a birth defect (congenital), but it more commonly occurs as a complication of chronic ear infection.

 PATHOGENESIS 1.Invagination theory 2.Immigration theory 3.Metaplasia theory 4.Implantation theory CLASSIFICATION 1.Congenital Cholesteatom (embrionic) 2.Aquisital Cholesteatom (after birth) a. Primary Aquisital Cholesteatom b. Secondary Aquisital Cholesteatom

 Symptoms 1.Drainage from the ear 2.Hearing loss in one ear 1.Pain or numbness in the ear or around the ear 1.Dizziness

 Signs and tests

An ear exam may show a pocket or perforation (opening) in the eardrum, often with drainage. The deposit of old skin cells may be visible with an otoscope, a special instrument to view the ear. Treatment Surgery is needed to remove the cyst

GLOMUS TUMOR
Glomus Tumors are also known as

temporal bone paragangliomas Vascular tumors of chemoreseptor organ Rather common Benign tumors of the middle ear which arise from glomus bodies Occur within the middle ear or at other sites: the temporal bone and neck, or within the jugular vein It can grow into the mastoid itself or through the wall that divides the middle ear from the mastoid and deeply infiltrate the bone

 Sign and symptoms Hearing loss

Pulsing ringing in the ear (pulsatile tinnitus) Dizziness Ear pain Abnormalities of the cranial nerves that control swallowing, gagging, shoulder shrugging and tongue movements They appear as a red ball or mass behind the eardrum

(Glomus Tympanicum tumor (red mass in bottom of middle ear))

GLOMUS TYMPANICUM: Picture of a left tympanic membrane with a pulsating red mass occupying the inferior portion of the middle ear space. The rest of the tympanic membrane is normal.

 Diagnosis
These tumors are diagnosed by neurophysiological testing, and computed tomography (CT) or magnetic resonance imaging (MRI).

Treatment
Medical therapy For tumors that actively secrete hormones and neurotransmitters, medical therapy can ease the symptom and be useful prior to surgery. Alpha and beta blockers are given before surgery to block possibly lethal blood pressure abnormalities and heart arrhythmias.

Surgery
These tumors are very vascular; therefore, pre-operative blockage of the blood supply to the tumor is often performed. Possible complications of surgery include persistent leakage of cerebrospinal fluid (CSF) from the ear, and also damage to one of the nerves controlling face movement, sensation or hearing

Radiation
Radiation may relieve symptoms and stop growth in spite of persistent tumor mass.

ACOUSTIC NEUROMA
Also known as vestibular

schwannomas, are non-malignant tumors of the 8th cranial nerve Two forms: a sporadic form (95%) and a form associated with an inherited syndrome called neurofibromatosis type II (NF2) Very rare

Acoustic Neuroma (swelling of 8th nerve, just under Facial nerve)

An acoustic neuroma is a benign tumor that develops on the eighth cranial nerve, which carries sound and balancing information from your inner ear to your brain. The pressure on the nerve may cause hearing loss and dizziness.

 Sign and Symptom 1.Hearing Loss - 90% present with a one-sided, slowly progressive hearing impairment - 25% of patients with acoustic neuroma occurs a sudden hearing loss - Estimate the risk of an acoustic neuroma by looking at the pattern of hering loss : 2/3 of patient: A high frequency sensorineural pattern is the most common type

A high frequncy sensorineural pattern (Asymmetrical Hearing)

2.Tinnitus
Very common in acoustic neuroma,is usually unilateral and confined to the affected ear

2.Vertigo 2.Numbness in the face

 Diagnosis 1. MRI with gadolinium 2. CT Scan 3. Audiometry Management of acoustic neuroma There are three distinct options: 1. medical management 2. surgery to remove the tumor 3. gamma-knife procedure or stereotactic radiotherapy

MRI scan of brain (coronal) showing an acoustic neuroma (the white spot on the left side of the picture).

Exostosis
Surfer's Ear is the common name for

exostosis, abnormal bone growth, within the ear canal

Symptom
1. Decreased hearing or hearing loss, temporary or ongoing 2. Increased prevalence of ear infections, causing ear pain 3. Difficulty evacuating debris or water from the ear causing a plugging

 Treatment
Traditionally surfer's ear has been treated by exostectomy

Left Mastoid Osteoma. This patient presented with a slowly growing painless hard mass of the mastoid bone

Axial CT scan of the Temporal Bones showing a Left Mastoid Osteoma

Basal cell carcinoma

Basal cell carcinoma, the 2nd most

common malignant pinnal tumor Most prevalent among elderly patients with a history of sun exposure They begin as circular raised areas of skin with central crater-like ulcerations Grow very slowly. Because of this, they are easily cured if treated early. If ignored, however, a basal cell

 These cancers generally do not

metastasize, that is they do not spread to other organs. They spread by increasing in size only

Sign and Symptom

1.sometimes causing an unrelenting discharge 2.hearing loss and facial nerve paralysis may occur

Treatment
surgical excision or local curretment

Squamous cell carcinoma

far less commonly than basal cell

cancers. squamous cell cancers are much more aggressive cancers than basal cell cancers spread through the tissues surrounding the site of origin. In addition, squamous cell cancers of the ear can spread to the lymph nodes surrounding the site of origin

Squamous cell cancers of the ear look much like basal cell cancers at an early stage should be considered in elderly patients related to sun exposure and local trauma It appears early as a thickened area of skin or as an ulcer. Sign and Symptom 1.fullness, pruritus, and otorrhea. 2.otalgia, serosanguineous drainage, and cranial neuropathies, including hearing

Diagnosis
Biopsy

Treatment
surgery and radiation therapy Treatment of tumors confined to the pinna consists of wide local excision. The prognosis is good for patients with small tumors of the helix but not for patients with tumors near the opening of the external auditory canal.