TUMORS OF EXTERNAL AND MIDDLE EAR Tumors of

TUMORS OF EXTERNAL AND MIDDLE EAR

Tumors of auricle � Pre auricular sinus or cyst � Due to faulty union of hillocks of 1 st and 2 nd branchial arches � Tract lined by squamous epithelium

Tumors of auricle � Sebaceous cyst – post auricular sulcus � Dermoid cyst – over upper part of mastoid � Keloid follows trauma Surgical excision with injection of triamcinolone

Tumors of auricle � Hemangioma � 1. capillary – port wine stain � 2. cavernous – also called strawberry tumor

Tumors of auricle � PAPILLOMA

Malignant tumors � SQUAMOUS CELL CA � Helix � Painless nodule or ulcer � Males , fifties � Small lesions – excised locally � Large lesions with nodal mets – total amputation of pinna with en bloc removal of parotid and cervical nodes

Malignant tumors � BASAL CELL CA � Men beyond 50 y � Helix and tragus � Nodule with central crust/ ulcer � No lymphatic spread � Superficial lesions – RT � Deep - Surgery

Malignant tumors � MELANOMA � Light complexion � Exposure to sunlight � Superficial <1 cm – wedge resection � Rest – Resection of pinna, parotidectomy and radical neck dissection

Benign Tumors of EAC � OSTEOMA

Benign Tumors of EAC � EXOSTOSES � Multiple, bilateral � Smooth sessile bony swelling in deep meatus � Divers, swimmers � Large – remove with a high speed drill

Benign Tumors of EAC � CERUMINOMA � Smooth skin covered swelling in outer part of meatus � Recurrence � Wide surgical excision

Malignant tumors of EAC � Squamous cell CA � Long standing ear discharge � Blood stained ear discharge , ear ache � Ulcer, polyp / granulation � Facial palsy � Lymphatic spread � Surgery with post op RT

Malignant tumors of EAC � Basal cell CA � Malignant ceruminoma � Malignant melanoma

Tumors of middle ear 1. Primary Benign – glomus tumor Malignant – Carcinoma, sarcoma 2. Secondary From adjacent areas – eg: nasopharynx, external meatus, parotid Metastatic- From CA bronchus, breast, thyroid, prostrate, GIT

Glomus tumor �Most common benign neoplasm of middle ear �Origin – glomus bodies �Paraganglionic cells from neural crest

Aetiology and pathology � Middle age (40 – 50 y) � Females – 5 times more common � Benign non encapsulated extremely vascular � Slow growth

Pathology

Types �Glomus jugulare �Glomus tympanicum

Spread of glomus tumor

Clinical features �Hearing loss �Tinnitus �Profuse bleeding from the ear �Dizziness or vertigo

Clinical features � Rising sun sign � Brown’s sign � Red vascular polyp filling the meatus

�Cranial nerve palsies �Audible bruit �Rule of 10 – 10% familial, 10% multicentric, 10 % functional ie they secrete catecholamines

Investigations

Treatment �Surgical removal �Radiation �Combination of the above

INITIAL CAROTID ARTERIOGRAM

Surgical approaches � Transcanal � Hypotympanic � Extended facial recess � Mastoid neck � Infratemporal fossa ( Fisch) � Transcondylar

�Radiation �Reduces vascularity �Done for inoperable cases, residual and recurrent cases, elderly

Carcinoma of middle ear �Rare � 40 – 60 y �Females

Pathology � Squamous cell CA � Adenocarcinoma

Clinical features � Chronic foul smelling blood stained ear discharge � Pain � Facial palsy � Granulations or polyp � Hearing loss or vertigo

Diagnosis � Biopsy � CT scan

Treatment � Surgery Radical mastoidectomy, subtotal or total petrosectomy � Radiotherapy

Sarcomas �Rare �Children �Arises from pleuripotent stem cells �Ear discharge, facial palsy �Radiotherapy and chemotherapy