Min-Tsan Shu

Treatments and outcomes of malignant tumors of external auditory canal

PURPOSE Primary cancer of the external auditory canal (EAC) is a rare disease with poor prognosis. Because of the rarity of this entity, there is no large series for staging, treatments, and outcomes. The purpose of this study is to evaluate the treatment modalities and outcomes for malignant tumors of EAC at our institute, comparing with other studies. METHODS We retrospectively reviewed the patients treated for primary cancer of EAC between 1991 and 2002 at our hospital, which is a tertiary referral center. Ten males and 2 females were enrolled in this study. The median follow-up period was 56.5 months. The interventions included sleeve resection, radical mastoidectomy, or lateral temporal bone resection combined with neck dissection or parotidectomy. Adjuvant radiotherapy was performed in case of incomplete resection. All patients were staged according to the Pittsburgh staging system. RESULTS Ten patients had squamous cell carcinoma and 2 had adenoid cystic carcinoma (ACC). Five patients had stage I disease, 2 with stage II, 1 with stage III, and 4 with stage IV. All patients (n = 7) with early stage (I or II) were disease-free, but only 1 of 5 patients with late stage (III or IV) was disease-free. The recurrences occurred in 50% (2/4) of patients with incomplete resection, despite of the adjuvant radiotherapy. Only one patient with complete resection had recurrence and the histologic diagnosis of this particular patient was ACC. CONCLUSIONS Patients with early-stage cancer can benefit from less aggressive surgical interventions without significant morbidity or mortality. No recurrence occurred in patients with complete resection except the one with ACC. The result of our institute was comparable or superior to those of other studies in early-stage disease. However, patients with advanced cancer had high recurrence rate despite of adjuvant radiotherapy, suggesting more aggressive surgical approach for complete resection was necessary.

Radiation-induced squamous cell carcinoma of the external auditory canal.

Radiation treatment of nasopharyngeal carcinoma (NPC) may induce malignancy in the external ear or mastoid (1Y4), occurring with an incidence of approximately 0.15% (1). Modified criteria (1) for the diagnosis of radiation-induced malignancy include a previous history of irradiation, followed by development of a new malignancy in the radiation field diagnosed no less than 2 years after the radiotherapy and which is proven to differ histologically from the original malignancy. En bloc resection including lateral subtotal or total temporal resection is usually recommended for removal of a primary ear malignancy.

Mandibular condyle and tympanic plate fracture causing external auditory canal stenosis.

Severe fractures of the mandibular condyle and tympanic plate resulting from trauma (1,2) can lead to external auditory canal (EAC) stenosis. If this stenosis hinders epithelial migration, complications such as EAC cholesteatoma can occur. As the cholesteatoma develops and grows, it can penetrate the canal bony wall and invade the mastoid. However, with the stenosis of the ear canal, it may be easy to overlook the pathology within the deeper canal as well as tissues surrounding the stenosis on otoscopic examination, leading to misdiagnosis. High-resolution computed tomographic (HRCT) scan can help localize the fracture and any associated complications. Patient 1 was a 35-year-old woman who sustained mandibular trauma 3 months before presentation. The

Brainstem hemorrhage presented as audiovestibular syndromes

Brainstem hemorrhage usually presented with acute multiple neurologic dysfunction, and the prognosis was poor. Rarely, it can manifest with audiovestibular symptoms only. Here, we report a case of brainstem hemorrhage involving the right middle cerebellar peduncle and dorsal lateral pons presented with constant nonpulsatile tinnitus and rotatory vertigo. We believed that rotatory nystagmus should be regarded as a central sign until proven otherwise even if the neurologic signs are subtle.

Carotid Body Paraganglioma Extending to the Middle Ear Cavity

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