9/10/2015

TumorsoftheMiddleEar&MastoidEarSurgeryInformationCenter

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Home>Learn>EarTumors>TumorsoftheMiddleEar&Mastoid

TumorsoftheMiddleEar&Mastoid

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Relatedterms:
Cholesteatomas
GlomusTumors
Cholesterolgranulomas
BasalCellTumors
SquamouscellTumors

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Tumorsoftheearcanbebenignormalignant.Theycanoccurontheexternalear,orintheearcanal,the
middleearorinnerear.Tumorsindifferentareasoftheearbehavedifferently.Thus,itisnecessaryto
describetumorsbasedontheirsiteofoccurrence,aswellastheirbehaviorandtreatment.

ImplantsSoundingBetter
Willcochlearimplantschangedeafculture?

TumorsoftheMiddleEar
PolypsandGranulationTissueoftheMiddleEar:Polypscandevelopinthemiddleear.Assuch,
thesearenotnecessarilybenigntumors.Theylooklikeballsofinflamedtissuewhichformgrapelike
clusterswithintheconfinesofthemiddleearandmastoid.Thesepolypsgenerallyarereddishandbleed
easilyonvacuumingoranymanipulation.Theymaybeindistinguishablefrommoreseriousproblemsof
themiddleearandmastoid.Iftheydonotrespondtomedicaltherapy,polypsshouldbebiopsied.Inmost
casesofadvancedpolypsandinflammationofthemiddleear,surgeryofthemiddleearandmastoidwill
necessary.
Cholesteatoma:Thesearetumorsofthemiddleearwhichareusuallybenignandthemostcommonofall
middleeartumors.Thesearedealtwithfullyinaseparatesection,Cholesteatoma.Cholesteatoma
arisesfromaperforationofthetympanicmembranewithingrowthofskinintothemiddleear.Also,they
appearcongenitallyfromanepidermoidformationwhichisalsodescribedintheRecentResearch
section.Fullinformationonthesetopicscanfoundinthiswebsite.

LessCommonBenignTumorsoftheMiddleEar
FacialNerveNeuroma
Oneofthelesscommonbenigntumorsofthemiddleearisthefacialneuroma,atumorofthefacialnerve.
Asitexpands,itcanputpressureonthefacialnerveandcausefacialparalysis.Thesetumorsare
clinicallyimportant.
Excisionofthefacialnerveneuromamayrequireremovalofasegmentofthefacialnerveaswellasa
regraftingofthefacialnervewithanervetakenfromanothersite.Commondonorsitesincludeanervein
theneckoraportionofthenerveintheleg.
Atsurgery,thetumoriscompletelyremovedandthetwoseparatedsegmentsarereconnectedbyplacing
thenewsegmentofnervegraftbetweentheseends.Regrowthofnormalnerveendingsthroughthenerve
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graftwilltakeatleastsixmonthstobegin,and12to18monthstoseethefullrecuperationofthenerve.In
thissetting,facialexpressionisnevercompletelynormal,butgoodresultscanbeobtained.
CholesterolGranulomas
Cholesterolgranulomasarelesscommonandarenotreallytumors.Rather,theyareamassofgelatinous
materialwhichfillsthemastoidandmiddleearastheresultofhemorrhageofbloodintothemastoidand
middleear.Thematerialwhichformsappearsbluishblackuponexaminationofthetympanicmembrane.
Asthematerialorganizes,itcanformafirmadhesivematerialwithinthemastoidandmiddleearwhichcan
damagethestructureswithinthemiddleear.Surgicalventilationofthemiddleear(insertingatube)is
helpful.Inaggressivecases,actualsurgicalexcisionofallofthecholesterolgranulomaisnecessaryin
ordertoreestablishnormalhearingandadequatedrainageofthediseaseprocess.Inmostcases,alarge
boreventilatingtubeisinsertedintotheeardrumandleftforprolongedperiodsoftimetoprevent
recurrenceofthecholesterolgranuloma.

MalignantTumorsoftheMiddleEarandMastoid(SquamousCell
CancerofMiddleEarandMastoid)
Malignanttumorsinthemiddleearandmastoidareveryuncommon.Oftheseveryuncommontumors,the
squamouscellcancersarethemostprevalent.Thesecancersareusuallyfoundinindividualswhohave
neglectedchronicorlongtermdrainageandinfectioninthemastoidormiddleear.Theexactrelationship
oftheinfectiontotheformationofthesquamouscellcancerisunclear.Presumably,itisrelatedtochronic
inflammation.
Squamouscellcancerofthemiddleearisoftenquiteadvancedbeforeacorrectdiagnosisismade.Pain
isasignificantfeatureofsquamouscellcancerofthemiddleearandmastoid.Intermittenthemorrhage,
bleedinganddrainageforlongperiodsoftimearealsousual.Hearinglossissignificant.Diagnosis
dependsuponabiopsyofthetissue.
Anexaminationbytheearsurgeoninvestigatingaperforatedeardrumwhichshowssuspicioustissuein
themiddleearormastoidthatdoesnothealafterappropriatemedicaltherapywouldindicateaneedfora
biopsy.Suspicionshouldbearousedaboutanyunusualtissuewhichisseenthroughaperforated
eardrumormastoid,particularlythosethatarepainful.Aftertopicalorlocalanesthesiaisplacedintothe
ear,thetissuetobebiopsiedissentoffforanalysisandapathologist(specialistwhostudiesand
diagnosesremovedtissueforbiopsy)willbeabletodeterminewhethercancerispresentinthetissues.
CTscanandMRIarenecessaryinordertohelpdeterminetheextentofsurgerynecessary.Squamous
cellcancerofthemiddleearandmastoidisafataldisease,ifnottreatedproperly.Evenwithearlysurgery
andradiationtherapy,curemaynotbepossibleifthetumorisdeeplyinvasive.Thus,itisimperativethat
diagnosisbemadeasearlyaspossible.Oncediagnosisismade,thepatientmustbepreparedforradical
surgery.

ImagingStudies
CTScan:CTscanningofthemastoidandmiddleeardeterminetheextentofboneinvolvement.As
atumorgrows,itwillinvadeanddestroybones.CancersalsoappearonaCTscan,andan
estimateoftheextentofthediseasecanbeobtained.
MRI:MRIscanningcandemonstratetheinfiltrationofthetumorintosofttissue,specificallytissuein
thefrontoftheearorparotidglandarea.MRIswillalsohelptodetermineifthetumorhasinvaded
thedura,whichisthecapsulesurroundingthebrain.Ifthetumorhasgrownthroughtheplateof
bonethatseparatesthemiddleearandmastoidfromthebrain,thencurebecomesquitedifficult.

PatientAssessment
Followingthephysicalexamination,biopsiesandimagingstudies,thepatientandfamilyshouldmeetwith
theskullbaseteamearsurgeon,headandnecksurgeon,neurosurgeon,andinsomecasesplastic
surgeonandeyesurgeon.Discussionsshouldincludethepossibilityoffacialnerveremovalandgrafting,
ifthetumorhasinvadedthefacialnerve.Inaddition,mostpatientswithextensivetumorswilllosethe
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hearingandbalancefunctionsoftheinnerear.Inordertoisolatethetumorandremoveitcompletely,
portionsoftheearcanal,mastoidandinnerearwillberemovedinanenblocoperation.Thismeansthat
thestructuresoftheearcanal,drum,middleear,andinnerearareremovedinonepiece.Thistechnique
reducesthepossiblespillageoftumortoadjacentsites,butprovidesagreaterchanceofcure.

RadiationTherapy
Radiationtherapyisgenerallyadvisedaftertumorexcision.Intheveryinfirm,radiationtherapymaybe
giveninpreferencetosurgery,butitisusuallynotsuccessfulineradicatingthetumorandprovidinga
cure.Radiationtherapyisperformedaftersurgerytocountertumorspillageintoadjacenttissue.The
additionalradiationtherapy,whichbeginsaboutfourweeksaftertheoperation,isaimedatdestroyingany
cellnestsoranytonguesoftumorthatareinadjacentareas.

StagingoftheTumor
Preoperativestagingofthetumor,usingimagingstudiesaloneisextremelydifficult.Themostaccurate
stagingofthetumorinsquamouscellcanceroftheearisavailableafterthesurgicalprocedureitself.Ifthe
tumorhasinvadedthedura(coveringofthebrain),thencuremaynotbepossible,althoughremovalofthe
tumorandradiationtherapyinsuchcasesisperformedforpalliationtorelievepainandimprovesurvival.

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TomakeanappointmentwithDr.MarkLevenson,pleasecall(518)5872300(officeislocatedinSaratogaSprings,NewYork)

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