Good morning and TGIF! Welcome to today's Euan's ENT blogpost!
Today's topic is about having growths in the middle ear area. Middle ear growths are usually benign, however, they can usually cause damage to the middle ear ossicles and cause hearing loss over time if left untreated.
Let's look together at how to find, test for, and treat growths in the ear, shall we?
Q: What is an ear tumour?
An ear tumour is a mass or lump of abnormal cells that form in the ear. Most ear tumours are benign or not cancerous. But some ear tumours are malignant (cancerous).
Ear tumours can form in any part of the ear, including the inner ear, middle ear and outer ear. They may affect your hearing ability.
Today we will look at tumours that affect the outer and middle ear portions of the ear.
Cholesteatoma
A cholesteatoma is an abnormal, non-cancerous growth that forms behind the eardrum. Cholesteatomas can become large enough to affect hearing and increase your risk of other serious complications. Early treatment can help you get symptom relief and avoid complications.
Diagram showing cholesteatoma in the middle ear
Glomus tumours
A glomus, also called a paraganglioma, is a noncancerous tumour that is locally invasive and arises from the glomus cells of the middle ear. These tumours are highly vascularized and usually occur solitarily. They grow slowly and therefore are often caught before any adverse complications occur
Glomus Tympanicum (middle ear):
Hearing loss
Bleeding from the ear
Pulsating sound or ringing in the ear
Squamous Cell Carcinoma (SCC) Ear
Otoscopic photo of a normal eardrum clear of growth
Otoscopic photo of an eardrum affected by SCC
Squamous cell carcinoma of the temporal bone and external auditory canal is a rare
tumour with a reported incidence of between 1 to 6 cases per million population per year [1].
It accounts for less than 0.2% of all tumours of the head and neck [2] but is the most common neoplasm in the external auditory canal [1]. In general, tobacco and alcohol use are the two most important risk factors associated with squamous cell cancers of the head and neck.
Squamous cell carcinoma of the temporal bone and external auditory canal is often associated with chronic otitis media and exposure to radiation therapy [1]. The diagnosis of squamous cell carcinoma of the temporal bone and external auditory canal is based on histological examination of tissue of the tumour from the ear.
Q: What’s the difference between an ear cyst and an ear tumour?
Both cysts and tumours can cause a bump or lump in the ear.
Cysts are small sacs that often contain fluid. They may also have solid material. Most cysts are not cancerous.
Tumours are solid masses of tissue that may or may not be cancerous.
Q: What are the types of benign (noncancerous) ear tumours?
Non-cancerous ear tumours can block your ear canal, leading to earwax buildup.
Types of benign ear tumours include:
Adenomas are rare noncancerous tumours that develop in the middle ear.
Cholesteatomas are sacs of skin cells that form behind the eardrum in the middle ear. They can lead to hearing loss if not treated.
Glomus tympanicum paraganglioma affects the tympanic nerve. This nerve in the middle ear connects to the eardrum.
Keloids are a type of fibrous scar tissue. They can form after an ear piercing or trauma to the outer ear.
Osteomas and exostoses form on bones in the external ear canal (benign bone tumour).
Sebaceous cysts contain skin cells and oil. They can develop in the ear canal, behind the ear or on the earlobe. They are also called epidermal inclusion cysts.
Q: What are the types of malignant (cancerous) ear tumours?
Cancer can form inside or on the outside of your ear. Ear cancer is rare.
The most common cancer that affects the ear is skin cancer. Skin cancer may first appear on the outer ear or along the ear canal. Skin cancers that affect the ear include:
Basal cell carcinoma.
Melanoma.
Squamous cell carcinoma.
Cancers that directly affect the middle or inner ear are even more uncommon. They include:
Ceruminous adenoma forms in the cells that make earwax. This cancer doesn’t spread, but it can destroy parts of the ear canal.
Rhabdomyosarcoma is a rare childhood cancer that affects muscle tissue. It may develop in the head or neck, including the middle ear.
Q: What are the risk factors for ear tumours?
People of all ages, including children, can get ear tumours. Factors that increase the chances of developing an ear tumour include:
Chronic ear infections.
Ear piercings.
Inherited conditions, such as neurofibromatosis (NFS).
Prior radiation exposure.
Repeated exposure to cold water, such as from scuba diving (surfer’s ear).
Smoking, including exposure to secondhand smoke.
Q: What are the symptoms of an ear tumour?
Symptoms of an ear tumour vary depending on the tumour type and its location. You may be able to feel a bump on the outer part of the ear.
Signs of an ear tumour include:
Ear Blockage
Ear bleeding or discharge.
Headaches.
Non-healing wound or sore.
Skin discolouration, new moles, or changes to a mole.
Swollen lymph nodes.
Tinnitus (ringing in the ear).
Weak facial muscles (facial palsy)
Q: How are ear tumours diagnosed?
Your GP may notice a cyst or tumour during a routine ear exam. He/ she may refer you to an audiologist (hearing specialist) for a hearing test. You will likely also see an ear, nose and throat doctor (an ENT or otolaryngologist) who specialises in ear disorders.
We may then perform a biopsy. This procedure removes the tumour or a sampling of cells from the tumour. A pathologist (a doctor who studies diseases) examines the samples in a lab to make the diagnosis. This usually takes 5 to 7 days.
Because middle and inner ear tumours are difficult to reach and biopsy, your provider may order a CT or MRI scan to learn more about your ear issue. In rare cases, you may need surgery to diagnose an ear tumour.
Q: How are benign ear tumours treated?
Some non-cancerous ear tumours do not need treatment unless the tumour grows to affect hearing or balance. Your specialist may monitor the tumour to keep an eye on its growth and any symptoms by serial scans over time: a so-called "watch and wait" policy
For Cholesteatoma cases, this almost always involves surgery (endoscopic or open) to remove the cholesteatoma sac to prevent its growth and infections, which may lead to severe complications.
To treat keloids, your healthcare provider may inject the tumour with a corticosteroid. Some keloids require surgical removal.
Q: How are malignant ear tumours treated?
For Skin cancer on the outer ear eg BCC, Dermatologists (doctors who specialise in skin diseases) are sometimes called in to treat skin cancer on the outer ear. Treatment for cancerous ear tumours depends on the cancer type and location. Treatment might include:
Mohs surgery to remove the cancerous skin cells.
Radiation therapy, radio-surgery or chemotherapy to destroy cancer cells.
Treatment for ceruminous adenoma tumours involves surgically removing the tumour. Your surgeon might also remove nearby lymph nodes.
Q: What are the complications of ear tumours?
Ear tumours, even ones that are not cancerous, can cause hearing loss especially if they keep enlarging in size.
Middle ear tumours eventually push onto / displace the middle ear ossicles and may cause conductive hearing loss. They may also obstruct the drainage of the middle ear, leading to an Otitis Media with Effusion ( OM e).
Ear tumour treatments, such as surgery or radiotherapy, may also cause side effects such as hearing loss, balance problems, and facial weakness. Your specialist will discuss these risks with you before you embark on treatment.
Q: What’s the prognosis for people with ear tumours?
Most people with ear tumours recover well after treatment. Some do not need treatment at all. Skin cancer can come back (recur) and spread to other parts of your body. You’ll need regular skin exams to look for returning cancer.
Well, I hope this post gives you an insight into the type of tumours that we can find in the middle and outer ears. If you are keen to dig deeper into this topic, here are some useful references you can look up.
Have a good and restful weekend!
Dr Euan
If you would like to consult a specialist about ear drops, or any other ENT-related conditions, please feel free to Contact Us at Euan's ENT Surgery & Clinic to make an appointment.
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