Benign Tumors
Benign tumors of the middle ear are relatively rare, primarily including glomus tympanicum tumors and facial nerve tumors. Middle ear polyps and inflammatory granulomas are more common in clinical practice but are not true neoplasms.
Tympanic Paraganglioma
Tympanic paraganglioma is a type of nonchromaffin paraganglioma originating in the inferior tympanic nerve (Jacobson's nerve) and localized in the tympanomastoid area.
Clinical Symptoms and Signs
Symptoms and signs vary depending on the tumor's primary site and extent of progression.
In the early stages, unilateral pulsatile tinnitus that synchronizes with the heartbeat is common, possibly accompanied by a sense of fullness in the ear or hearing loss. Secondary infection may lead to bloody or purulent ear discharge. Facial nerve involvement can result in ipsilateral peripheral facial paralysis.
In the late stages, tumor invasion of the inner ear may cause sensorineural hearing loss and vertigo. Lesions affecting the jugular foramen region may lead to jugular foramen syndrome, marked by difficulty swallowing, choking on liquids, and hoarseness due to involvement of the posterior cranial nerves (IX, X, XI).
In early stages, a dark red mass may be visible in the tympanic cavity through the tympanic membrane. A large tumor may cause bulging or perforation of the tympanic membrane, protruding into the external auditory canal. Tumors protruding into the canal often have a polypoid or granulomatous appearance and bleed readily upon touch.
Diagnosis and Treatment
In addition to clinical presentation and otoscopic examination, enhanced CT or MRI of the temporal bone is required to determine the tumor's location and extent of invasion.
The primary treatment principle is complete surgical excision. Tumors confined to the middle ear can be removed via a tympanum or mastoid approach, while larger tumors involving the jugular foramen and cranial nerves require an infratemporal fossa approach. Radiation therapy can be used for cases where extensive lesions are difficult to excise completely or in patients unfit for surgery due to poor general health.
Other Benign Middle Ear Tumors
Other common benign tumors of the middle ear include facial nerve schwannomas, osteomas, giant cell tumors, and hemangiomas.
Facial Nerve Schwannomas
Details can be found in Facial Nerve Schwannomas.
Osteomas
These are mostly solitary and originate in the mastoid area or tympanomastoid suture. Clinically, they present as localized bony protrusions, which enlarge gradually and can completely obstruct the external auditory canal. Temporal bone CT can confirm the diagnosis and delineate the extent of the lesion. Small, asymptomatic lesions require no intervention, whereas large, symptomatic lesions necessitate surgical removal.
Giant Cell Tumors
Details can be found under Temporal Bone Giant Cell Tumors.
Malignant Tumors
Middle ear carcinoma (cancer of the middle ear) can originate in the middle ear, external auditory canal, or auricle. Tumors from the parotid gland, nasopharynx, and skull base may also invade the middle ear. Patients often have a history of long-term chronic suppurative otitis media, and malignant tumors are more common in middle-aged and elderly individuals. Squamous cell carcinoma is the most prevalent type, followed by adenoid cystic carcinoma, with rare pathological types such as malignant papillomas and sarcomas.
Clinical Presentation
Ear bleeding or bloody discharge is the earliest and most common symptom.
Ear pain presents as deep throbbing, shooting, or stabbing pain that worsens at night and is difficult to alleviate.
Hearing loss is present.
Peripheral facial paralysis occurs when the tumor invades the facial nerve.
Vertigo occurs in the late stages due to labyrinthine involvement.
Symptoms of other cranial nerve involvement, intracranial complications, or distant metastasis are present.
Diagnosis
Middle ear carcinoma should be suspected under the following circumstances, and a biopsy should be conducted promptly to confirm the pathology:
- Chronic otitis media with bloody discharge.
- Sudden worsening of chronic otitis media or the development of facial paralysis.
- Rapidly growing, easily bleeding granulation tissue or polyp-like lesions in the external auditory canal's depths or tympanic cavity.
- Persistent, unrelenting deep ear pain.
Early symptoms of middle ear carcinoma are often nonspecific and may be misdiagnosed as otitis media. Tumors are sometimes identified intraoperatively, with pathology confirming the diagnosis. Late-stage tumors have a poor prognosis, emphasizing the importance of early diagnosis and treatment.
Treatment
Treatment focuses on achieving complete surgical excision as early as possible, with postoperative radiotherapy for further management. Surgical approaches include subtotal or total temporal bone resection, depending on the extent of the lesion. Concurrent parotidectomy (superficial or total) and lymph node dissection may be necessary if the tumor has invaded these regions.
Prognosis
Prognosis depends on the patient's age, tumor size, pathological type, degree of differentiation, and treatment method. Middle ear carcinoma often progresses insidiously, with many patients not receiving early treatment, leading to poor outcomes.