Neoplasms

Neoplasms

Exostosis is an area of hyperostosis rather than a neoplasm that arises from the bone of the ear canal in individuals who swim in cold water (synonym ‘surfer’s ear’) ( Figure 51.14 treatment is required unless the exostosis obstructs the canal. Osteomas are true neoplasms, often singular and more lateral than exostosis. Other benign tumours include papillomas and adenomas. Malignant primary tumours of the external ear are either basal cell or squamous cell carcinomas ( Figure 51.15 Summary box 51.3 - Types of otitis externa /uni25CF /uni25CF /uni25CF ). No /uni25CF /uni25CF ).

Figure 51.14 Exostoses grow from the bony part of the ear canal in response to cold and so are found in swimmers, surfers and divers. Treatment is only required if the exostoses occlude the ear canal. Figure 51.15 Squamous cell carcinomas of the external ear usually originate from the pinna. In this case the tumour is growing from the canal (courtesy of Mr P Beasley). Acute bacterial otitis externa is very common and painful; treat with topical steroid and antibiotic drops Systemic antibiotics should be reserved for cellulitis of the pinna Chronic otitis externa needs the underlying dermatitis to be treated Fungal otitis externa itches and can be diagnosed by the presence of hyphae and spores; treat with meticulous cleaning and stop antibiotics Necrotising otitis externa is a progressive skull base infection that occurs in immunocompromised individuals and can be life-threatening; intensive long-term antibiotic treatment is required

Both may present as ulcerating or crusting lesions that grow slowly and may be ignored by elderly patients. Squamous cell carcinomas metastasise to the parotid and/or neck nodes. The ear canal may be invaded by tumours from the parotid gland and postnasal space carcinomas, which ‘creep’ up the Eusta chian tube. All resectable malignant tumours of the ear are treated primarily with surgery , with or without the addition of radiation therapy .

(b) Figure 51.16 (a) Traumatically perforated tympanic membrane. /uni00A0 (b) The same tympanic membrane 2 days later (courtesy of Dr Christian Deguine). (Reproduced with permission from O’Donoghue GM, Bates GJ, Narula A. Clinical ENT : an illustrated textbook. Oxford: Oxford University Press, 1991.)

Neoplasms

Middle ear tumours are rare, with the most common being a glomus tumour ( Figure 51.25 ). Glomus tumours are para - - gangliomas arising from non-chroma ffi n paraganglionic tissue (the carotid body tumour arising in the neck is an example of this type of tumour). In the temporal bone, two types of glomus tumour are recognised and classification depends on the location: glomus tympanicum (arising in the middle ear) - and glom us jugulare (arising next to the jugular bulb). Symptoms include pulse synchronous tinnitus and conduc - tive and sensorineural hearing loss. Palsies of CNs VII, IX, X, XI and/or XII may occur. The classic sign is a cherry-red mass lying behind the tympanic membrane. The treatment of choice is preoperative embolisation followed by surgical exci - sion. Radiotherapy is also e ff ective. Squamous cell carcinoma may also occur within the mid - dle ear. It usually presents with deep-seated pain and a blood - stained discharge. Facial paralysis often occurs. Squamous carcinomas usually arise in a chronically discharging ear and can arise in a chronically infected mastoid cavity . Radical sur - gical excision with or without radiotherapy provides the only chance of cure. Summary box 51.6 Neoplasms of the middle ear /uni25CF /uni25CF

(b) Figure 51.23 Section of normal stapes (a) and section of stapes affected by otosclerosis (b) . Figure 51.24 The stapedotomy operation showing the piston linking the incus to the vein graft, left ear. (b) Figure 51.25 (a, b) Glomus tumour in the middle ear, left ear (courtesy of Professor Peter Rea, Leicester). Highly vascular glomus tumours are rare and may present with pulsatile tinnitus Squamous cell cancer usually presents with pain and facial paralysis

Neoplasms

Exostosis is an area of hyperostosis rather than a neoplasm that arises from the bone of the ear canal in individuals who swim in cold water (synonym ‘surfer’s ear’) ( Figure 51.14 treatment is required unless the exostosis obstructs the canal. Osteomas are true neoplasms, often singular and more lateral than exostosis. Other benign tumours include papillomas and adenomas. Malignant primary tumours of the external ear are either basal cell or squamous cell carcinomas ( Figure 51.15 Summary box 51.3 - Types of otitis externa /uni25CF /uni25CF /uni25CF ). No /uni25CF /uni25CF ).

Figure 51.14 Exostoses grow from the bony part of the ear canal in response to cold and so are found in swimmers, surfers and divers. Treatment is only required if the exostoses occlude the ear canal. Figure 51.15 Squamous cell carcinomas of the external ear usually originate from the pinna. In this case the tumour is growing from the canal (courtesy of Mr P Beasley). Acute bacterial otitis externa is very common and painful; treat with topical steroid and antibiotic drops Systemic antibiotics should be reserved for cellulitis of the pinna Chronic otitis externa needs the underlying dermatitis to be treated Fungal otitis externa itches and can be diagnosed by the presence of hyphae and spores; treat with meticulous cleaning and stop antibiotics Necrotising otitis externa is a progressive skull base infection that occurs in immunocompromised individuals and can be life-threatening; intensive long-term antibiotic treatment is required

Both may present as ulcerating or crusting lesions that grow slowly and may be ignored by elderly patients. Squamous cell carcinomas metastasise to the parotid and/or neck nodes. The ear canal may be invaded by tumours from the parotid gland and postnasal space carcinomas, which ‘creep’ up the Eusta chian tube. All resectable malignant tumours of the ear are treated primarily with surgery , with or without the addition of radiation therapy .

(b) Figure 51.16 (a) Traumatically perforated tympanic membrane. /uni00A0 (b) The same tympanic membrane 2 days later (courtesy of Dr Christian Deguine). (Reproduced with permission from O’Donoghue GM, Bates GJ, Narula A. Clinical ENT : an illustrated textbook. Oxford: Oxford University Press, 1991.)

Neoplasms

Middle ear tumours are rare, with the most common being a glomus tumour ( Figure 51.25 ). Glomus tumours are para - - gangliomas arising from non-chroma ffi n paraganglionic tissue (the carotid body tumour arising in the neck is an example of this type of tumour). In the temporal bone, two types of glomus tumour are recognised and classification depends on the location: glomus tympanicum (arising in the middle ear) - and glom us jugulare (arising next to the jugular bulb). Symptoms include pulse synchronous tinnitus and conduc - tive and sensorineural hearing loss. Palsies of CNs VII, IX, X, XI and/or XII may occur. The classic sign is a cherry-red mass lying behind the tympanic membrane. The treatment of choice is preoperative embolisation followed by surgical exci - sion. Radiotherapy is also e ff ective. Squamous cell carcinoma may also occur within the mid - dle ear. It usually presents with deep-seated pain and a blood - stained discharge. Facial paralysis often occurs. Squamous carcinomas usually arise in a chronically discharging ear and can arise in a chronically infected mastoid cavity . Radical sur - gical excision with or without radiotherapy provides the only chance of cure. Summary box 51.6 Neoplasms of the middle ear /uni25CF /uni25CF

(b) Figure 51.23 Section of normal stapes (a) and section of stapes affected by otosclerosis (b) . Figure 51.24 The stapedotomy operation showing the piston linking the incus to the vein graft, left ear. (b) Figure 51.25 (a, b) Glomus tumour in the middle ear, left ear (courtesy of Professor Peter Rea, Leicester). Highly vascular glomus tumours are rare and may present with pulsatile tinnitus Squamous cell cancer usually presents with pain and facial paralysis