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Dr. Asnominanda,Sp.THT-
EAR TUMORS
Benign Tumor Cholesteatoma Exostosis Glomus Tumor Acoustic Neuroma Malignant External ear Squamous cell carcinoma Basal cell carcinoma Middle ear Squamous cell carcinoma
CHOLESTEATOMA
Definition
Cholesteatoma can be a birth defect (congenital), but it more commonly occurs as a complication of chronic ear infection.
PATHOGENESIS 1.Invagination theory 2.Immigration theory 3.Metaplasia theory 4.Implantation theory CLASSIFICATION 1.Congenital Cholesteatom (embrionic) 2.Aquisital Cholesteatom (after birth) a. Primary Aquisital Cholesteatom b. Secondary Aquisital Cholesteatom
Symptoms 1.Drainage from the ear 2.Hearing loss in one ear 1.Pain or numbness in the ear or around the ear 1.Dizziness
GLOMUS TUMOR
Glomus Tumors are also known as
temporal bone paragangliomas Vascular tumors of chemoreseptor organ Rather common Benign tumors of the middle ear which arise from glomus bodies Occur within the middle ear or at other sites: the temporal bone and neck, or within the jugular vein It can grow into the mastoid itself or through the wall that divides the middle ear from the mastoid and deeply infiltrate the bone
GLOMUS TYMPANICUM: Picture of a left tympanic membrane with a pulsating red mass occupying the inferior portion of the middle ear space. The rest of the tympanic membrane is normal.
Diagnosis
These tumors are diagnosed by neurophysiological testing, and computed tomography (CT) or magnetic resonance imaging (MRI).
Treatment
Medical therapy For tumors that actively secrete hormones and neurotransmitters, medical therapy can ease the symptom and be useful prior to surgery. Alpha and beta blockers are given before surgery to block possibly lethal blood pressure abnormalities and heart arrhythmias.
Surgery
These tumors are very vascular; therefore, pre-operative blockage of the blood supply to the tumor is often performed. Possible complications of surgery include persistent leakage of cerebrospinal fluid (CSF) from the ear, and also damage to one of the nerves controlling face movement, sensation or hearing
Radiation
Radiation may relieve symptoms and stop growth in spite of persistent tumor mass.
ACOUSTIC NEUROMA
Also known as vestibular
schwannomas, are non-malignant tumors of the 8th cranial nerve Two forms: a sporadic form (95%) and a form associated with an inherited syndrome called neurofibromatosis type II (NF2) Very rare
An acoustic neuroma is a benign tumor that develops on the eighth cranial nerve, which carries sound and balancing information from your inner ear to your brain. The pressure on the nerve may cause hearing loss and dizziness.
Sign and Symptom 1.Hearing Loss - 90% present with a one-sided, slowly progressive hearing impairment - 25% of patients with acoustic neuroma occurs a sudden hearing loss - Estimate the risk of an acoustic neuroma by looking at the pattern of hering loss : 2/3 of patient: A high frequency sensorineural pattern is the most common type
2.Tinnitus
Very common in acoustic neuroma,is usually unilateral and confined to the affected ear
Diagnosis 1. MRI with gadolinium 2. CT Scan 3. Audiometry Management of acoustic neuroma There are three distinct options: 1. medical management 2. surgery to remove the tumor 3. gamma-knife procedure or stereotactic radiotherapy
MRI scan of brain (coronal) showing an acoustic neuroma (the white spot on the left side of the picture).
Exostosis
Surfer's Ear is the common name for
Symptom
1. Decreased hearing or hearing loss, temporary or ongoing 2. Increased prevalence of ear infections, causing ear pain 3. Difficulty evacuating debris or water from the ear causing a plugging
Treatment
Traditionally surfer's ear has been treated by exostectomy
Left Mastoid Osteoma. This patient presented with a slowly growing painless hard mass of the mastoid bone
common malignant pinnal tumor Most prevalent among elderly patients with a history of sun exposure They begin as circular raised areas of skin with central crater-like ulcerations Grow very slowly. Because of this, they are easily cured if treated early. If ignored, however, a basal cell
Treatment
surgical excision or local curretment
cancers. squamous cell cancers are much more aggressive cancers than basal cell cancers spread through the tissues surrounding the site of origin. In addition, squamous cell cancers of the ear can spread to the lymph nodes surrounding the site of origin
Squamous cell cancers of the ear look much like basal cell cancers at an early stage should be considered in elderly patients related to sun exposure and local trauma It appears early as a thickened area of skin or as an ulcer. Sign and Symptom 1.fullness, pruritus, and otorrhea. 2.otalgia, serosanguineous drainage, and cranial neuropathies, including hearing
Diagnosis
Biopsy
Treatment
surgery and radiation therapy Treatment of tumors confined to the pinna consists of wide local excision. The prognosis is good for patients with small tumors of the helix but not for patients with tumors near the opening of the external auditory canal.