Tumours of the External, Middle and Inner Ear.pptx

Slide contains outline, benign and malignant tumors affecting the external ear, benign and malignant tumors affecting the middle ear and tumor affecting the vestibulocochlear nerve.
It also contains information on hearing loss, types of hearing loss and causes of hearing loss

1. Tumours of the Ear Dr Ngozi Nzekwue

2. Tumours of the ear are either benign or malignant, of all cases of ear carcinoma 85% occur in the pinna, 10% in the External Auditory Canal and 5 % in the middle ear. Pinna- benign Pre auricular sinus cyst Sebaceous cyst Dermoid cyst Keloids Hemangioma Neurofibroma Papilloma Pinna- Malignant Basal cell carcinoma Squamous cell carcinoma Melanoma

3. EAC- Benign EAC- Malignant Basal cell carcinoma Squamous cell carcinoma Melanoma Malignant Ceruminoma Adenocarcinoma Osteomas Exostoses - Common In Swimmers/Divers Sebaceous adenoma Papilloma Ceruminoma

4. Pre-auricular cyst Incomplete union of hillocks of the 1 st & 2 nd branchial arch Small opening in front crus helix Blockage of the tract results in a cyst Treatment is complete excision Sebaceous Cyst Usually in the post auricular sulcus or below and behind the ear lobe. Treatment is excision D ermoid Cyst Rounded mass in the upper part of the mastoid behind the pinna. Treatment is excision

5. Preauricular sinus

6. Keloid Following ear piercing or surgery Genetic predisposition, Commoner in blacks Treatment is triamcenolone injection+/- excision Hemangioma Congenital tumours seen in childhood -Capillary hemangioma : mass of capillary sized blood vessels-port wine stain -Cavernous hemangioma : aka strawberry tumour

7. Keloids

8. Malignant pinnal tumours Squamous cell Ca Helix is the common site Prolonged exposure to sunlight Commoner in males > 50 years Late metastases Treatment-wide excision, pinnal amputation with removal of surrounding tissues Basal cell Ca Helix and tragus are the common sites Commoner in males > 50 years Presents as an ulcer Lymph node metastases is rare Invades cartilage and bone

9. Benign EAC Tumors Exostoses Common in swimmers and divers + those exposed to cold water Smooth ,sessile, bony swellings in the deeper part of the meatus near the TM Treatment-when small and asymptomatic- nil, when large- excision using drill Others Sebaceous adenoma Papilloma Ceruminoma Osteoma Treatment i s surgical excision where necessary

10. Malignant EAC Tumors Basal cell carcinoma- rare, biopsy to make diagnosis Squamous cell carcinoma- malignant transformation following long standing otorrhea , blood stained discharge, severe otalgia , CN VII palsy- wide excion plus Radiotheraphy Adenocarcinoma Melanoma- Rare Malignant Ceruminoma - twice as common as benign Treatment is excision

11. Middle ear tumours Primary Benign- Glomus tumour : consists of paraganglionic cells derived from the neural crests which originates from glomus bodies found in the jugular bulb or promontry along the course of CN IX Malignant- Carcinoma, Sarcoma- rare Facial nerve palsy occurs early Secondary From adjacent structures through bony erosions/pre-formed pathways eg from nasopharynx , external ear, parotid Metastatic from Ca Bronchus, breast, kidney, thyroid, prostate and GIT

12. Acoustic Neuroma Tumour of the 8 th cranial nerve Also known as vestibular schwannoma Commonest cerebello pontine angle tumour 95% spotradic /unilateral 5 % neurofibromatosis/bilateral Acoustic neuroma represents 8% of all intracranial tumours and 80% of cerebellopontine angle tumours . They arise from Schwann ( neurolemmal ) cells. The commonest nerve of origin is the superior vestibular nerve , followed by the inferior vestibular and then, rarely, the cochlear nerve.

13. Acoustic Neuroma Benign Hearing loss commonest symptom- high frequency unilateral SNHL, Vertigo, Tinnitus Headaches, facial pain, numbness Treatment- observation, surgery, radiotheraphy

14. Acoustic Neuroma Differential diagnosis of a tumour at the cerebellopontine angle 1. Acoustic neuromas (constitute 80% of cerebellopontine angle tumours). 2. Meningioma. 3. Neuroma of the VIIth nerve. 4. Congenital cholesteatoma . 5. Aneurysm of the basilar or vertebral arteries. 6. Cholesterol granuloma of the petrous apex. 7. Cerebellar tumour.

15. Hearing loss Mild hearing loss- 26-40dB Moderate : 41-55dB Moderately severe : 56-70dB Severe : 71-90dB Profound : < 90dB Tuning forks can be used in the clinic to access hearing the best frequency to use is 512Hz

16. Sensorineural , conductive , mixed hearing loss

17. Tuning fork tests

18. Tuning fork tests Webers test The tuning fork is struck and placed on the vertex. The vertex is used as opposed to the forehead If a conductive loss of 10 dB or more exists, the sound should be heard in the affected ear. If a sensorineural hearing loss is present the sound will generally be heard in the normal ear. In the normal subject or some subjects with a long-standing sensorineural hearing loss, the sound will be heard in the midline. Rinnes test The tuning fork is struck and placed 2,5cm or 2 finger breaths in front of the EAM and then placed on the ipsilateral mastoid process The normal response is to hear the sound as louder with air conduction and Rinne positive . A positive response will also occur with a sensorineural hearing loss A negative response ( Rinne negative) will occur in conductive hearing loss

19. Hearing loss Conductive hearing loss Any pathology which prevents sound from reaching the cochlear From the external ear to the stapedovestibular joint Treatment depends on the cause Negative R innes test BC>AC Weber lateralised to the worse ear Low frequencies more affected BC better than AC on audiometry with airbone gap Speech discrimination is good

20. Conductive hearing loss

21. Conductive hearing loss occurs when there’s a problem with the outer or middle ear, hindering sound waves from reaching the inner ear. Usually temporary and treatable. Common causes of conductive hearing loss include: Ear infections Earwax buildup Perforated tympanic membrane Fluid in the middle ear Tumors foreign bodies Symptoms of conductive hearing loss Muffled hearing. Sudden or gradual hearing loss. Pain or discharge from the ear. Difficulty hearing soft sounds Medical treatments:  Antibiotics and other suitable medications can be used to treat ear infections, while earwax removal can help to manually remove earwax blockages. Surgical options:  Tympanoplasty (eardrum repair) or myringotomy (tubes inserted to drain fluid) are some surgical options available for dealing with conductive hearing loss. Hearing aids and assistive devices:  Assistive devices can be beneficial in some cases of conductive hearing loss

22. Mixed Hearing Loss Mixed hearing loss, as its name suggests, is a combination of conductive and sensorineural hearing loss. It requires a comprehensive approach to diagnosis and treatment. Causes of mixed hearing loss vary and include aspects of both conductive and sensorineural hearing loss . For example, a genetic predisposition to sensorineural hearing loss coupled with noise exposure leading to conductive hearing loss. Mixed hearing loss can also be exacerbated by factors such as chronic ear infections, trauma and injury to the ear, or ageing. Symptoms of mixed hearing loss are typically a combination of symptoms from both conductive and sensorineural hearing loss. This can include: Difficulty hearing in all environments, quiet and noisy. Fluctuating hearing levels. Treatment is a combination of medical and audiological interventions, hearing aids Surgery where indiucated

23. Hearing loss Sensorineural hearing loss Lesions of the cochlea, CN VIII Congenital/ acquired positive Rinnes test AC>BC Weber lateralised to the better ear High frequencies more affected No airbone gap Speech discrimination is poor Difficulty hearing in the presence of noise

24. Sensorineural hearing loss is the most common type and involves damage to the inner ear or the auditory nerve. It is usually permanent n some instances, sensorineural hearing loss can affect both ears, which is known as bilateral sensorineural hearing loss. If this bilateral hearing loss worsens over time, it is classified as progressive bilateral hearing loss. Common causes of sensorineural hearing loss include: Age related – presbyacusis Noise exposure:  Genetic factors:  Head trauma or illness:  Symptoms of sensorineural hearing loss Difficulty understanding speech, particularly in noisy environments. Tinnitus (ringing in the ears). Gradual loss of high-frequency sounds. Problems with balance. Management - Hearing aids:  These amplify sounds to make them easier to hear. Cochlear implants:  These surgically implanted devices can be life-changing for people with severe to profound hearing loss. Regular hearing tests:  Going for regular hearing checks is essential for monitoring hearing health and adjusting treatment as needed. Support services:  sign language, lip reading etc

25. Specific causes of Hearing loss Labyrinthitis Viral - measles, mumps, CMV Bacterial – via middle ear or CSF meningitis, complicate CSOM Syphilitic – sudden SNHL, Meniere’s disease Familial SNHL Genetic Progressive cochlear degeneration Bilateral Presbyacusis Age related Occurs early with genetic predisposition, noise exposure or generalised vascular disease

26. Specific causes of Hearing loss Ototoxicity Damage to the inner ear by drugs and chemicals eg Aminoglycosides, diuretics,salicylates,quinine , cytotoxic drugs, marijuana etc Noise Single brief exposure to very loud noise- damage to organ of corti , TM rupture Chronic exposure to loud noise < 85dB recommended 90dbfor 8 hours/5 days should be the maximum exposure to noise

27. Pure tone audiometry

28. Pure tone audiometry Detects the type and degree of hearing loss It is subjective Not done on children

29. Management Based on causative agent Medical Surgery Conservative Hearing aids