Ear and Temporal Bone Tumors
Cancers of the Ear and Temporal Bone
The temporal bone houses the inner ear, middle ear, ear canal and supports the external ear. It separates the brain from the outside world. Tumors here are very aggressive and have a poor prognosis unless caught early. Most cancers are treated with primary surgery and then radiation therapy with or without chemotherapy after surgery. They are curable potentially if they have not spread outside of the head and neck and thus all patients undergo workup to evaluate them for spread to include CT, MRI and or PET scanning. Issues with the treatment of these tumors include the potential loss of hearing, balance problems, and paralysis of the facial nerve. If the ear must be removed we may perform reconstruction or prosthetic rehabilitation may work very well as well.
Definition of the temporal bone area:
The temporal bone is the area that contains your ear and by extension the side of your head from the eye socket to the back of the head. There are a number of different tumors that affect this area. The temporal bone contains the organ of hearing: the ear canal, the eardrum, the ossicles and the cochlea as well as the organ of balance: the labyrinth. It also transmits very important nerves as they exit from the brain: the facial nerve that provides movement to the face, the vagus nerve that provides movement to the voicebox, swallowing apparatus and sensation from the organs of the chest and abdomen, the glossopharyngeal nerve that provides sensation and movement of the throat and palate and the accessory nerve that provides movement for the shoulder. It also transmits the carotid artery that supplies blood to the brain and the jugular vein that drains the blood from the brain.
The area in front of the temporal bone can be considered part of it and it is called the infratemporal fossa. It contains the upper part of the jaw, the back part of the eye socket and the trigeminal nerve which provides sensation to the face and mouth as well as movement to the muscles of the jaw.
These regions produce on their own a bewildering number of different benign and malignant tumors that require expertise in their cure and the avoidance of problematic outcomes.
Benign tumors related to the ear
Cholesteatoma: is a condition that results from previous ear infections and is essentially a skin cyst. It has a tendency to re – appear after surgery and can cause major complications both inside and outside the head. It is silent and most of the symptoms are hearing loss and drainage from the ear. Proper surgical management results in permanent cure and most often in restoration of hearing. In unusual circumstances where complications are present the surgery requires their management also.
Tumors on the inside of the temporal bone: these are acoustic neuromas and meningiomas. They are benign tumors and they grow silently until they start compressing on the hearing and balance nerves causing problems with hearing and balance. Some don’t need surgery but the ones that are relatively large require complex procedures performed in a team of surgeons to remove them safely without causing problems.
Malignant tumors related to the ear
Skin cancer: though skin cancer around the ear is frequent, it can on occasion involve the deeper structures of the outer ear. This happens through spread into the nerves that traverse the temporal bone (sensory nerves or the facial nerve) or through direct extension into the bone and ear cartilages as well as the jaw joint. Surgery is the only treatment that can effect cure in these type of situations and is carefully planed along with reconstruction.
Parotid cancer: salivary gland cancers are neurotropic. That is they have a propensity to jump into nerves and travel great distances in them. In fact when treatment of these type of cancers fail, it is frequently because these nerves or radiation are out of the field of surgery or radiation. The nerves in the temporal bone that are most likely to be involved with this type of cancer are the facial nerve and branches of the trigeminal nerve. When planning surgery for these types of cancer, these nerves have to be removed when involved by cancer to the point that there is minimal risk that anything will be missed.
Sacromas: these are malignant tumors that originate from the deep structures of the temporal bone and the infratemporal region: muscle, nerve, bone and blood vessels. A subset of these affect children and are called rhabdomyoscaromas, they are treated with combined chemotherapy, radiation and surgery. Sacromas in this area have to be carefully assessed as with all other malignant tumors with extensive radiology studies and biopsies to type them. Their treatment includes surgery that is tailored to the location and size of the tumor.
Rare tumors of the temporal bone and infratemporal fossa: there is a subset of tumors that are exceptionally rare that arise from the temporal bone itself. These frequently produce symptoms of hearing loss and nerve dysfunction and their investigation usually involves extensive radiology studies. A biopsy, when it can be performed safely should be done, but in some instances that is not possible and an approximation of what the tumor may be is done by the CT and MRI scans. Their treatment is invariably by surgery.