Tumours of Ear

It covers tumours of External, Middle and Inner Ear

1. Tumours of Ear BRIG ANWAR UL HAQ 00923018513303

2. Tumours of Ear

3. Parts of Ear External Ear Middle Ear Inner Ear

4. Parts of External Ear Pinna External auditory Canal Cartilagenous Bony

5. Tumours of Pinna Carcinoma 85% Pinna 5% External auditory Canal

6. Tumours of Pinna Benign Tumours Malignant Tumours

7. Benign Tumours of Pinna Benign • Sebaceous Cyst • Preauricular Cyst or Sinus • Dermoid Cyst • Keloid • Haemangioma • Papilloma • Cutaneous Horn • Keratoacanthoma • Neurofibroma

8. Preauricular Sinus or Cyst Results From Faulty Union of Hillocks of the 1 St and 2nd Branchial arches During the Development of Pinna

9. Dermoid Cyst Usually Presents as a Rounded Mass Over the Upper Part of Mastoid Behind the Pinna .

10. Keloid Piercing of the Ear Lobule For ornaments Surgical Incision Genetic Susceptibility Black Races are More often affected Keloid - Pedunculated Tumour

11. Haemangiomas T hey 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

12. 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.

13. Papilloma (Wart) Tufted Growth of Flat Grey Plaque Rough to Feel Viral In origin. Treatment is Surgical Excision Curettage With Cauterization

14. 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

15. 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

16. Malignant Tumours Squamous Cell Carcinoma Basal Cell Carcinoma A denocarcinoma Malignant Cercinoma Melanoma

17. Malignant Tumours Pinna • Squamous Cell Carcinoma • Basal Cell Carcinoma • A denocarcinoma • Malignant Carcinoma • Melanoma

18. 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 Remova l of Parotid Gland and Cervical Lymph Nodes.

19. Treatment-SCC Small Lesions With No Nodal Metastases are Excised Locally with 1 Cm of Healthy Area A round 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.

20. Basal Cell Carcinoma Common Sites - Helix and the Tragus >50 Years Nodule With Central Crust, Removal of Crest its - 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

21. Treatment - BCC Radiotherapy Superficial Lesions, Not Involving Cartilage Cosmetic Deformity avoided Surgical Excision Lesions Involving Cartilage

22. External Ear Canal Benign • Osteoma • Exostosis • Ceruminoma • Sebaceous adenoma • Papilloma Malignant • Squamous Cell Carcinoma • Basal Cell Carcinoma • adenocarcinoma • Malignant Carcinoma • Melanoma

23. Osteoma A rises 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.

24. Exostosis Smooth, Sessile, Bony Swellings In the Deeper Part of the Meatus Multiple and Bilateral A rise From Compact Bone Exostosis - Exposed to Entry of Cold Water Divers Swimmers Males are affected Three Times More

25. Exotosis - 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

26. Sebaceous adenoma A rises From Sebaceous Glands Smooth, Skin Covered, Swelling In the Outer Meatus. Treatment Surgical Excision.

27. 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 Followed Up

28. 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)

29. Treatment - SCC En bloc wide surgical excision Postoperative radiation.

30. Basal cell and adenocarcinomas Rarely arise from the meatus Clinical picture is similar - SCC Diagnosis biopsy Treatment Wide surgical excision Postoperative radiation

31. Ceruminoma Malignant type is twice as common as benign.

32. Malignant melanoma Rare tumour

33. Middle Ear Middle Ear

34. Primary Tumours Benign: Glomus Tumour Malignant: Carcinoma, Sarcoma Secondary Tumours from Adjacent Areas Nasopharynx , External Auditory Meatus Parotid. Metastatic from Carcinoma of Bronchus Breast Kidney Thyroid Prostate Gastrointesinal Tract. Tumours of Middle Ear

35. F rom Adjacent Areas Nasopharynx , External AUDItoRY Meatus Parotid. Metastatic from Carcinoma of Bronchus Breast, Kidney, Thyroid, Prostate Gastrointestinal SYSTEM. Secondary Tumours

36. 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 Glomus Tumour

37. 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 Aetiology and Pathology

38. Glomus Jugulare Arise from the Dome ofjugular Bulb invade the Hypotympanum and Jugular Foramen, Ixth to Xlith Cranial Nerve involvement Compress Jugular Vein invade its Lumen . Glomus Tympanicum Arise from the Promonory of the Middle Ear Cause Aural Symptoms Aural Symptoms Facial Paralysis. Types of Glomus Tumours

39. I nitially 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. My Spread Through Eustachian Tube, It May Present in the Nasopharynx . I ntracranially to the Posterior and Middle Cranial Fossae . Metastatic Spread Lungs and Bones is Rare - 4% Metastatic Lymph Node Enlargement Spread of Glomus Tumour

40. I9% of Cases, - Symptoms Pertain to the Ear. Umour is intra Tympanic - Earliest Symptoms Conductive Deafness Pulsatile Tinnitus - Stops With Carotid Pressure Otoscopy Red Reflex Through intact Tympanic Membrane - "Rising Sun Bluish and May Be Buging . "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 - Profuse Bleeding Dizziness Or Vertigo Facial Paralysis Earache - Less Common Otorrhoea - infection and May Simulate Chronic Suppurative Otitis Media With Polyp. Clinical Features

41. IXth to XIIth Cranial Dysphagia Hoarseness Unilateral Paralysis of Soft Palate Pharynx Vocal Cord Weakness of the Trapezius and Sternomastoid Muscles. Mass Over the Mastoid or in the Nasopharynx . Signs of intracranial involvement Audible Systolic Bruit Secrete Catecholamines and Produce Symptoms Like Headache, Sweating, Palpitation, Hypertension and Anxiety 10% of the Tumours - Familial 10% - Multicentric 10% - Secrete Catecholamines Cranial Nerve Palsies

42. CT Scan MRI Angiography Diagnosis

43. Surgical Removal. Radiation. Embolisation . Combination of the Above Techniques Treatment

44. Rare Condition Age Group of 40-60 Slightly More Common in Females 75% - Ear Discharge Chronic Irritation - Causative Factor Radical Mastoid Cavities Primary Carcinoma of Mastoid Air Cells Radium Dial Painters. Carcinoma of Middle Ear and Mastoid

45. Destroys Ossicles Facial Canal internal Ear Jugular Bulb, Carotid Canal Deep Bony Meatus Mastoid Pctrous Apex. Dura is Usually Resistant Other Structures Parotid Gland Temporomandibular Joint infratemporal Fossa Eustachian Tube Nasopharynx Lymph Node Enlargement Occurs Late. Spread of Tumour

46. 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 Clinical Features

47. 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. Diagnosis

48. Surgery Radiotherapy Treatment

49. Rhabdumyosarcoma Osteosarcoma Lymphoma Fibrosarcoma Chondrosarcoma Distant Metastases Lungs Bone Other Tumours

50. Synonyms Vestibular Schwannoma Neurilemmoma Eighth Nerve Tumour Acoustic Neuroma

51. 8O% - Cerebellopontine Angle Tumours 10% - All the Brain Tumours . incidence

52. Benign Encapsulated Extremely Slow-growing Microscopically Elongated Spindle Cells Rod-shaped Nuclei Cell Lie Rows Or Palisades Bilateral Tumours - With Neurofibromatosis. Pathology

53. Schawan Cells Origin

54. Depending on the Size (A) intracanalicular (Confined to IAC) (B) Small Size (Up to 1.5 Cm) (C) Medium Size (1.5 to 4 Cm) (D) Large Size (Over 4 Cm) Classification

55. 40-60 Years Male:female = 1:1 Clinical Features

56. Earliest Symptoms - Still intracanalicular Pressure on Cochlear Or Vestibular Nerve Progressive Unilateral Sensorineural Hearing Loss, Tinnitus Speech Discrimination Is Poor Out of Proportion to the Pure tone Hearing Loss. May Get Sudden Hearing Loss. Imbalance Or Unsteadiness. True Vertigo is Seldom Seen Cochleovestibular Symptoms

57. Vth Nerve Earliest Nerve - 2.5cm -CP Angle Reduced Corneal Sensitivity Numbness Paraesthesia of Face VIIth Nerve. Sensory Fibers Affected Early - Hypoaesthesia of Posterior Meatal Wall Loss of Taste Reduced Lacrimation on Schirmer's Test. Motor Fibers Are More Resistant and Are Affected Late . IXth and Xth Nerves Dysphagia Hoarseness Other Cranial Nerves. XIth and XIIth , V llrd , IVth and VIth - Very Large. Cranial Nerve involvement

58. Ataxia Weakness Numbness of the Arms Legs Exaggerated Tendon Reflexes Brainstem involvement

59. Pressure Symptoms on Cerebellum Are Seen in Large Tumours . This is Revealed By Finger-nose Test Knee-heel Test Dysdiadochokinesia Ataxic i nability to Walk Along A Straight Line Cerebellar involvement

60. Late Features Headache Nausea Vomiting Diplopia - Vlth Nerve involvement Papilloedema - Blurring of Vision Raised intracranial Tension

61. Pure tone Audiometry Speech Audiometry - Poor Speech Discrimination Reduction of Discrimination Score When Loudness is increased Recruitment Phenomenon is Absent. Short increment Sensitivity index (Sis!) Test Will Score of 0-20% in 70-90% of Cases. Threshold tone Decay - Retrocochlear Lesion Stapedial Reflex Decay Evoked Response Audiometry MRI With Contrast Audiological Tests

62. Meniere's Disease) Tumours of Cerebellopontine Angle Acoustic Meningioma Epidermoid ( Cholesteatoma ) Arachnoid Cyst Schwannoma of Other Cranial Nerves V, VII, IX, X, XI Aneurysm Glomus Tumour Metastatic Tumours Differential Diagnosis

63. Surgery Surgical Removal of the Tumour is the Treatment of Choice. Surgical Approach Will Depend Upon the Size of Tumour . The Various Approaches Are: 1. Mi ddle Cranial Fossa Approach. 2. Translabyrinthine Approach . 3. Suboccipital Approach. 4. Combined Translabrynthine-Suboccipital Approach Treatment

64. Radiotherapy Conventional Radiotherapy By External Beam Has No Role in the Treatment of Acoustic Neuromas due to Low tolerance of the Central Nervous System to Radiation. Treatment

65. Gamma Knife Surgery Stereo-tactic Radiotherapy Radiation Energy is Converged on the Tumour Minimum Effects on the Surrounding Tissue. This Causes Arrest of the Growth of the Tumour Reduction in its Size I ndications Refuse Surgery Contra indications to Surgery Residual Tumour Treatment

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