TUMORS OF

EXTERNAL AND
MIDDLE EARDr. Rahul Kawatra
Prof. & Head
Dept. of ENT

Dr. Prasoon Varshney

SR ENT
TUMOURS OF PINNA
 Benign Tumours
 Malignant Tumours
BENIGN TUMOURS OF PINNA
 Sebaceous Cyst
 Preauricular Cyst or Sinus
 Dermoid Cyst
 Keloid
 Haemangioma
 Papilloma
 Cutaneous Horn
 Keratoacanthoma
 Neurofibroma
PREAURICULAR SINUS OR
CYST
 Results from faulty union of

– Hillocks of the 1st and 2nd branchial arches during the development of pinna
DERMOID CYST
 Usually presents as a rounded mass over the upper part of mastoid behind the pinna.
KELOID
 Piercing of the ear lobule for ornaments surgical incision
 Genetic susceptibility
 Black races are more often affected
 Pedunculated tumour
HAEMANGIOMAS
 They are congenital tumours often seen in childhood
 Capillary haemangioma.
 Mass of capillary-sized blood vessels
 Present as a "port-wine stain"
 Does not regress spontaneously
HAEMANGIOMAS
 Cavernous haemangioma (strawberry tumour)
 Endothelial-lined spaces filled with blood
 Increases rapidly during the first year
 Regresses thereafter
 May completely disappear by the fifth year.
PAPILLOMA (WART)
 Tufted growth of flat grey plaque
 Rough to feel
 Viral in origin.
 Treatment is surgical excision
 Curettage with cauterization
CUTANEOUS HORN
 Heaping up of keratin
 Presents as horn -shaped tumour
 It is often seen at the rim of helix in elderly
 Treatment is surgical excision
KERATOACANTHOMA
 Benign tumour
 Resembles a malignant one.
 Raised nodule with a central crater
 Initially, it grows rapidly but
 Slowly regresses leaving a scar
 Treatment is excision biopsy
MALIGNANT TUMOURS
 Squamous Cell Carcinoma
 Basal Cell Carcinoma
 Adenocarcinoma
 Malignant Carcinoma
 Melanoma
SQUAMOUS CELL
CARCINOMA
 Painless nodule

 Ulcer with raised everted edges and indurated base.

 Metastases to regional lymph nodes occur very late.

 Common in male +50years

 Prolonged exposure to direct sunlight.

 Fair-complexioned people are more prone.

 Treatment. Small lesions with no nodal metas tases are excised locally with 1 cm of healthy area around
it.
 Larger lesions of the pinna or those coming within 1 cm of external auditory canal and lesions with nodal
metastases,
 May require total amputation of the pinna, often with en bloc removal of parotid gland and cervical
lymph nodes.
TREATMENT-SCC
 Small lesions with no nodal metastases are excised
 Locally with 1 cm of healthy area around it.
 Larger lesions of the pinna or those coming within 1 cm of external auditory canal and lesions
with nodal metastases, may require total amputation of the pinna often
 Bigger tumours removal of parotid gland and cervical lymph nodes.
BASAL CELL CARCINOMA
 Common sites - helix and the tragus
 >50 years
 Nodule with central crust,
 Removal of crest causes bleeding.
 Ulcer has a raised beaded edge
 Extends circumferentially
 May confined to the skin but may penetrate deeper, involving cartilage or bone lymph node
metastases usually do not occur
TREATMENT - BCC
 Radiotherapy
 Superficial lesions, not involving cartilage
 Cosmetic deformity avoided
 Surgical excision
 Lesions involving cartilage
EXTERNAL EAR CANAL
 Benign  Malignant
 Osteoma  Squamous Cell Carcinoma
 Exostosis  Basal Cell Carcinoma
 Ceruminoma  Adenocarcinoma
 Sebaceous adenoma  Malignant Carcinoma
 Papilloma  Melanoma
OSTEOMA
 Arises from cancellous bone
 Single, smooth, bony, hard, pedunculated
 Tumour
 Often arising from the posterior wall of the osseous meatus
 Treatment is surgical removal by
 Fracturing through its pedicle
 Removal with a drill.
EXOSTOSIS
 Smooth, sessile, bony swellings in the deeper part of the
 Meatus
 Multiple and bilateral
 Arise from compact bone
 Exostosis - exposed to entry of cold water
 Divers
 Swimmers
 Males are affected three times more
EXOSTOSIS - TREATMENT
 No treatment
 Small and asymptomatic

 Larger ones
 Impair hearing
 Retention of debris

 Surgical treatment
 High speed drill to restore normal sized meatus
 Use of gouge and hammer should be avoided
SEBACEOUS ADENOMA
 Arises from sebaceous glands
 Smooth, skin covered, swelling in the outer meatus.
 Treatment
 Surgical excision.
CERUMINOMA
 Tumour of modified sweat glands (cerumenous)
 Smooth, firm, skin-covered polypoid swelling
 Usually attached to the posterior or inferiornwall
 Obstructs the meatus leading to retention of wax and debris.
 Malignant : Benign =2: 1

 Treatment.
 Wide surgical excision
 Tendency to recur
 Regular follow up
MALIGNANT TUMOURS - SCC
 Long-standing Ear Discharge
 arise Primarily From the Meatus
 May Be a Secondary Extension From the Middle Ear Carcinoma.
 Presenting Symptoms
 Discharge
 Blood Stained
 Mucopurulent
 Purulent Discharge

 Severe Earache
 Examination
 Ulcerated area In the Meatus
 Bleeding Polypoid Mass
 Granulations
 Facial Nerve Paralysis
 May Spread Into the Middle Ear
 Regional Lymph Nodes (Preauricular, Postauricular, Infra-auricular and Upper Deep
Cervical)
 Treatment – SCC
 En bloc wide surgical excision
 Postoperative radiation.
BASAL CELL AND
ADENOCARCINOMAS
 Rarely arise from the meatus
 Clinical picture is similar - SCC Diagnosis biopsy
Treatment
 Wide surgical excision Postoperative radiation
 CERUMINOMA
 Malignant type is twice as common as benign.

MALIGNANT MELANOMA
 Rare tumour
TUMOURS OF MIDDLE EAR
 Primary Tumours  Secondary tumours

 Benign: Glomus Tumour  From adjacent areas

 Nasopharynx,
 Malignant: Carcinoma, Sarcoma
 External auditory meatus
 Parotid.

 Metastatic from carcinoma of

 Bronchus

 Breast

 Kidney

 Thyroid

 Prostate

 Gastrointesinal tract.
SECONDARY TUMOURS
 From adjacent areas
 Nasopharynx,
 External auditory meatus
 Parotid.

Metastatic
 From carcinoma of bronchus
 Breast,
 Kidney,
 Thyroid,
 Prostate
 Gastrointestinal system.
GLOMUS TUMOUR
 Most common benign neoplasm of middle ear and is so-named because of its origin from the
glomus bodies.
 Resemble carotid body in structure
 Location
 Dome of jugular bulb
 Promontory

 Along the course of tympanic branch of IXth cranial nerve (Jacobson's nerve)
 Paraganglionic cells derived from the neural crest
Aetiology and pathology
 Age 40-50
 Females : Male = 5:1
 Characteristics
 Benign
 Non-encapsulated
 Extremely vascular
 Rate of growth is very slow
 Tumour is locally invasive.
 Microscopically
 Masses or sheets of epithelial cells
 Large nuclei
 Granular cytoplasm.
 Thin-walled blood sinusoids with
 No contractile muscle coat profuse
bleeding
-
TYPES OF GLOMUS TUMOURS
 Glomus jugulare
 Arise from the dome of jugular bulb
 Invade the hypotympanum and jugular foramen, IXth to XIth cranial nerve involvement
 Compress jugular vein invade its lumen .
 Glomus tympanicum
 Arise from the promontory of the middle ear cause aural symptoms
 Aural symptoms facial paralysis.
SPREAD OF GLOMUS
TUMOUR
 Initially Fill the Middle Ear
 Later Perforate Through the Tympanic Membrane - Vascular Polyp.
 May invade
 Labyrinth
 Petrous Pyramid
 Mastoid
 Jugular Foramen
 Base of Skull

 Causing Ixth to Xllth Cranial Nerve Palsies.

 May Spread Through
 Eustachian Tube, It May Present in the Nasopharynx.
 Intracranially to the Posterior and Middle Cranial Fossae.

 Metastatic Spread
 Lungs and Bones is Rare
 Metastatic Lymph Node Enlargement
CLINICAL FEATURES
 19% of Cases,
 Tumour is intra Tympanic
-
 Conductive Deafness
 Pulsatile Tinnitus - stops with Carotid Pressure
 Otoscopy
 Red reflex through intact tympanic membrane "Rising Sun
 Bluish and may be bulging.

 "Pulsation Sign" (Brown's Sign) Ear canal pressure is raised with siegle's speculum,
 Tumour pulsates vigorously and then blanches; reverse happens with release of pressure.

–
 Polyp
 Dizziness or vertigo
 Facial paralysis
 Earache
 Otorrhoea -
 May simulate chronic suppurative otitis media with polyp.
DIAGNOSIS
 CT Scan
 MRI
 Angiography
TREATMENT
 Surgical removal.
 Radiation.
 Embolisation.
 Combination of the above techniques
CARCINOMA OF MIDDLE EAR
AND MASTOID
 Rare condition
 Age group of 40-60
 Slightly more common in females
 Ear discharge
 Radical mastoid cavities
 Primary carcinoma of mastoid air cells
 Radium dial painters.
SPREAD OF TUMOUR
 Destroys  Other structures
 Ossicles  Parotid gland
 Facial canal  Temporomandibular joint
 Internal ear  Infratemporal fossa
 Jugular bulb, carotid canal  Eustachian tube
 Deep bony meatus  Nasopharynx
 Mastoid
 Pctrous apex.
 Dura is usually resistant

 Lymph node enlargement occurs late.

CLINICAL FEATURES
 Like CSOM discharge and deafness

 Females 40- 60 suspicion

 Chronic foul-smelling discharge
 Blood-stained.

 Pain severe and comes at night.

 Facial palsy

 Friable, haemorrhagic granulations or polyp.

 Deafness

 Vertigo
DIAGNOSIS
 Definitive Diagnosis is Made only on Biopsy.
 Extent of Disease
 Cranial Nerve Palsies
 Radiological Examination.

 CT Scan and Angiography are Useful in the Assessment of Disease.

TREATMENT
 Surgery
 Radiotherapy
QUESTIONS
1. Write short note on Preauricular Sinus

2. Write short note on Osteoma.

3. Define exostosis and its management

4. Describe glomus tumour in detail.

5. Write a note on Malignant tumours of external ear.

THANK YOU…