Carcinoma of the ear: retrospective analysis of 61 patients

Malignant tumours of the ear canal and middle ear retain a poor prognosis despite the development of increasingly radical procedures. We report the combined experience of 61 patients presenting to our hospital over the past 30 years with this condition. Radiotherapy was the preferred initial treatment in almost all patients. Early surgical treatment by local resection just before or just after radiotherapy and radical mastoidectomy produced disease free survival for two to 20 years in 59 per cent (16 of 27) patients. Long term survival was achieved in 50 per cent of patients with carcinoma of the external auditory meatus and only 24 per cent of those with middle ear carcinoma. Salvage surgery produced a variable degree and duration of palliation but few survivors. Little was gained in the quality of life by petrosectomy.     

Management of stenosis and acquired atresia of the external auditory meatus

The aim of this study was to investigate the aetiology of acquired atresia and stenosis of the external auditory meatus and to present our results for surgical management. Over an 18-year period (from 1986 to 2004), data were collected prospectively from patient cohorts in Dundee and Edinburgh. Stenosis of the auditory meatus was due to chronic otitis externa in 64 per cent of cases, compared with 37 per cent of cases with acquired atresia; the latter had instead a history of chronic suppurative otitis media in 43 per cent. Surgical treatment of canal stenosis with meatoplasty alone achieved a widely patent ear canal in 80 per cent of cases, with 78 per cent of ears remaining free of discharge. Cases of acquired atresia treated with simple surgical excision of the soft tissue plug experienced a 100 per cent failure rate. The additional use of a split skin graft achieved a patent meatus in 70 per cent of cases, with hearing improvement in 79 per cent. However, the ear canal remained unstable and late recurrence was observed.     

Malignancies of the external ear canal and temporal bone: surgical techniques and results

A combined therapy approach to malignancies of the external auditory canal and middle ear has been developed. A technique of external canal resection and gross tumor removal from the middle ear, parotid gland, and superior cervical lymph nodes is followed by postoperative full-therapy irradiation. This combined approach has been used in 30 patients with malignancies involving the external auditory canal and temporal bone. The preoperative evaluation and surgical technique, including the intraoperative decision-making process, is described. Twenty-four patients had squamous cell carcinoma of the external auditory canal, and two patients had basal cell carcinoma. There was one patient each with adenocystic carcinoma, acinic cell carcinoma, high grade mucoepidermoid carcinoma, and a giant cell tumor of bone. This group of patients was broken down into three groups based on the extent of disease as determined at surgery. Overall control of disease, both locally and distant, for the 30 patients was 66%. There were 12 patients with disease limited to the ear canal. These patients had a 91% survival of this disease process. Seven patients were determined to have limited extension beyond the ear canal. These were treated with combined therapy with an overall control of disease of 72%. Eleven patients had extensive disease outside of middle ear into the carotid jugular spine, stylomastoid foramen, and skull base, with a survival rate of 45%. It is concluded that a step-wise removal of all gross tumor, as opposed to an en bloc dissection of the temporal bone and skull base, followed by full-therapy irradiation gives equally as good, or even better, long-term survival for this malignancy of the external auditory canal and middle ear.     

Bacteriological features and chemotherapy of adult acute purulent otitis media

Eighty-eight patients from 16 to 79 years old, with acute purulent otitis media, were bacteriologically examined at the Otorhinolaryngology Department of a primary care hospital in Tokyo from July 1979 to May 1983. Fifty-six patients underwent paracentesis, and 32 patients exhibited otorrhea due to previous spontaneous perforation of the tympanic membrane. Bacteriologic cultures revealed the presence of Streptococcus pneumoniae (62.5 per cent), including S. pneumoniae Type III (28.1 per cent), Haemophilus influenzae (10.5 per cent), Staphylococcus aureus (11.5 per cent), and Streptococcus pyogenes (7.3 per cent). S. pneumoniae Type III had a notably high detection rate in patients from 50 to 79 years old (50-75 per cent). Because Haemophilus influenzae was detected at a relatively high rate in patients of all ages, if can be considered as a major causative pathogen of AOM. In 44 patients, selected mainly from those who underwent paracentesis, a comparative study of bacteria found in middle ear fluid and naso-pharyngeal mucus revealed the same bacteria in 43 out of 44 cases (97.7 per cent), indicating the presence of bacterial infection through the auditory canal. Antibiotics were selected according to an Expected Efficacy Index (EEI), the antibiotic of first choice being Ampicillin or Cefaclor.     

A bacteriological study of the middle ear and upper respiratory tract in children with chronic secretory otitis media

Middle ear effusions and swabs from the external auditory meatus, nasopharynx and anterior nares have been collected from 100 children with chronic secretory otitis media. Isolates of Haemophilus influenzae and Streptococcus pneumoniae were typed and in vitro sensitivities to commonly used antibiotics were determined for these species and Staphylococcus aureus. Positive middle ear cultures were obtained from 21 children (27 effusions). Haemophilus influenzae and S. pneumoniae were the commonest organisms isolated, both from the middle ear and upper respiratory tract. When one or other of these species was isolated from the middle ear, the same organism was generally found in the upper respiratory tract, but not in the ear canal. The serotypes isolated from the different sites were also the same. Type 19 was the commonest Pneumococcal serotype isolated, while type e was the commonest capsulated strain of H. influenzae. Thirty-six per cent of strains of H. influenzae were resistant to penicillin and 25% of those of S. pneumoniae were resistant to trimethaprim. Eighty-one per cent of isolates of S. aureus were penicillin resistant. There was no difference in the incidence of either S. pneumoniae or H. influenzae in the post nasal spaces of children who had had their adenoids removed and those who had not.     

Histopathological study of the temporal bones in patients with primary carcinomas of the ear

The most common symptoms of patients with carcinomas of the middle ear or mastoid are otorrhea, facial paralysis, and hearing loss, including a sensorineural element and vertigo. The latter two symptoms are indicators of inner ear damage. However, few reports have been made concerning the histopathological changes that occur in the inner ear in the presence of a tumor. The present study was performed to determine the pattern of tumor invasion in the inner ear and the histopathological changes that occur in the inner ear in cases of ear carcinomas. Temporal bone sections from five patients (age: #39-73 years; 3 males and 2 females) who died from a primary carcinoma of the ear were studied histologically. The following features were examined: 1) localization of the tumor in the temporal bone, 2) pattern of tumor invasion in the inner ear, 3) pathological changes in the inner ear, including the cochlea, vestibule and semicircular canals. Tumor cells were still present in the temporal bone sections of all the patients except one, even though the patients had received various treatments for the carcinoma, including radiation therapy, surgery and chemotherapy. Marked inflammatory and necrotic changes were observed in cases where the tumor had invaded the external auditory canal, middle ear cleft, internal auditory canal, and in some cases the inner ear. In cases where the tumor invaded the inner ear via the internal auditory canal rather than directly from the middle ear, the otic capsule is thought to have acted as a barrier against tumor invasion. In addition, marked degenerative changes throughout the entire inner ear structures were noted. These changes may have arisen from an attenuated blood supply to the inner ear as a result of pressure from the tumor in the internal auditory canal, tumor infiltration of the labyrinthine artery.     

外耳道及中耳恶性肿瘤的临床分析

目的 探讨外耳道及中耳恶性肿瘤的临床表现、诊断要点及治疗原则和方法,以期提高患者生存率,改善生活质量.方法 回顾性分析2003年6月～2009年6月我院确诊的25例外耳道及中耳恶性肿瘤患者的临床资料.结果 按Still系统临床分期,T1期5例,T2期15例,T3期5例,2年生存率87%,5年生存率67%,单纯手术治疗易...     

Nasopharynx as a microbiologic reservoir in chronic suppurative otitis media: preliminary study

ObjectivesThe present study was designed to identify the correlations of bacterial strains of the middle ear and the nasopharynx in chronic suppurative otitis media (CSOM) patients who were scheduled for operations.MethodsSixty-three patients with CSOM were enrolled in the study. Culture specimens were collected from the middle ear and nasopharynx of patients who were admitted for operation. Samples collections were performed 3 times; from the middle ear and nasophaynx at the admission day, from the middle ear during the operation, and from the external auditory canal post-operatively. Bacteria were identified by gram staining and biochemical tests. The correspondence rate of organisms which simultaneously exist in the middle ear and the nasopharynx was measured.ResultsSixty-eight organisms were isolated from the middle ear and 57 organisms from the nasopharynx among 63 patients. Of 68 bacteria identified in middle ear, 26.52% (18 bacteria) corresponded with those of nasopharynx. MRSA had the high correspondence rate, and of 18 methicillin-resistant Staphylococcus aureus (MRSA) isolated from middle ear, 33.3% (6 bacteria) corresponded with nasophaynx. Meanwhile, 3 organisms of MRSA were detected from the external auditory canal post-operatively, although they were only found in nasopharynx pre-operatively.ConclusionThe current trend of middle ear swab alone for bacterial detection would be insufficient to identify the potent MRSA and impede early antibiotic intervention for the effective middle ear surgery. Therefore, it is necessary to perform nasopharynx cultures together with conventional middle ear culture to control potent risk for infection pre-operatively.     

术前模拟力学研究在拟植入耳赝附体先天性外中耳畸形患者中的应用价值

目的 探讨术前模拟力学研究在拟植入耳赝附体先天性外中耳畸形患者中的应用价值。 方法 选取20例已行外耳道成形术的先天性外中耳畸形患者(研究组),术后复查MSCT,另选取乳突发育良好的20例正常人群作为对照组,行耳颞骨MSCT。利用Mimics10.01软件建立研究对象颞骨CT图像的三维模型,并对其进行网格化处理,通过ANSYS14.5对研究对象耳赝附体植入前的三维定位及颞骨结构进行力学分析,应用球钻750 r/min。 结果 术前薄层颞骨CT图像可实现快速三维化,耳赝附体术前植入位置定位精确。外中耳畸形患者距所开放的骨性外耳道周缘(2.07±0.05)mm距离较为安全,无外中耳畸形患者距骨性外耳道周缘(1.83±0.07)mm较为安全。 结论 对于外中耳畸形已行听力重建拟行耳赝附体植入术患者,术前针对耳赝附体植入钛钉进行模拟力学研究有助于寻找合适的植入点及距外耳道的距离。     

MMP9蛋白与微血管密度在外耳道及中耳鳞状细胞癌中的表达及其临床意义

目的:检测MMP9蛋白与微血管密度(MVD)在外耳道及中耳鳞状细胞癌中的表达,并研究其临床意义.方法:采用免疫组织化学SP法检测26例外耳道及中耳鳞状细胞癌组织中MMP9与CD34标记的MVD.结果:外耳道及中耳鳞状细胞癌组织中MMP9表达阳性率为73.1%(19/26),正常外耳道皮肤中阳性表达率为25.0%(5/20),2组间比较差异有统计学意义(x<'2>=12.615,P<0.05);外耳道及中耳鳞状细胞癌组织中CD34标记的MVD表达为33.58±3.04,正常外耳道皮肤中表达为22.50±5.22,2组比较差异有统计学意义(P<0.01).外耳道及中耳鳞状细胞癌组织中MMP9蛋白的表达和MVD与组织学分级和肿瘤分期密切相关,而在不同年龄和性别的患者中其表达差异无统计学意义.MMP9和CD34蛋白的表达经Pearson相关检验呈正相关关系(r=0.42,P<0.05).结论:MMP9可能参与了外耳道及中耳鳞状细胞癌的发生,在外耳道及中耳鳞状细胞癌的侵袭和转移中发挥着重要作用,联合检测MMP9与MVD可望成为外耳道及中耳鳞状细胞癌早期诊断和预后判断的分子指标之一.     

老年外耳道胆脂瘤(附34例报告)

目的探讨老年外耳道胆脂瘤临床特征。方法回顾性分析34例老年外耳道胆脂瘤临床表现及诊治方法。结果本组外耳道胆脂瘤自发性者27例,外耳道狭窄所致者7例。以慢性耳钝痛及耳漏为主要表现,均有不同程度骨性外耳道侵蚀扩大,其中5例侵犯中耳乳突,面神经垂直段骨管破坏2例。行外耳道胆脂瘤清除术及外耳道成形术、改良乳突根治术治愈,随访1~5年无复发。结论老年外耳道胆脂瘤具有破坏性,多为自发性,须与外耳道恶性肿瘤、坏死性外耳道炎等相鉴别,治疗原则为彻底清除胆脂瘤。     

Anteverted internal auditory canal as an inner ear anomaly in patients with craniofacial microsomia

Craniofacial microsomia involves structure of the first and second branchial arches. A wide range of ear anomalies, affecting external, middle and inner ear, has been described in association with this condition. We report three cases of anteverted internal auditory canal in patients presenting craniofacial microsomia. This unique internal auditory canal orientation was found on high-resolution computed tomography of the temporal bones. This internal auditory canal anomaly is yet unreported in craniofacial anomalies.     

Treatment results in external and middle ear malignant neoplasms of patients treated at the Laryngology Department of Medical University of Silesia between 1991-2001

The authors present 18 patients with malignant neoplasms of the ear and temporal bone who were treated in the Clinic of Laryngology Medical University of Silesia in Katowice in the years 1991-2001. The most frequent was squamous cell carcinoma (11 patients--61%). The neoplasm was located on the auricle in 7 patients (39%), in the external auditory canal in 4 (22%) patients, in the middle ear in 5 patients (28%) and in 2 cases (11%) it was difficult to establish primary site. Ten patients (55.5%) were treated in stage T4. All patients had surgery and in advanced cases the radiotherapy was added. The best outcomes were in auricular neoplasms. The treatment results were much worse in neoplasms of the external auditory canal and the middle ear. Over 3 year follow-up in 10 patients (55%) with ear and temporal bone neoplasms shows no recurrence.     

Patulous internal auditory canal

OBJECTIVE: To investigate a rare anomaly of the internal auditory canal known as a patulous canal and its relationship to hearing impairment. METHODS: High-resolution computed tomographic scans of the temporal bones of patients who presented between August 2001 and August 2002 were reviewed. The patients' medical charts were evaluated for age, sex, and hearing impairment, and the computed tomographic scans were examined for the presence of a patulous canal. RESULTS: The study group included 645 patients who underwent high-resolution computed tomography of the temporal bones for various reasons, including sensorineural hearing loss (50% of patients). A patulous canal without any associated anomaly of the labyrinth was the only finding in 2 patients. Both patients had chronic middle ear disease along with conductive hearing loss. CONCLUSION: Patulous canal is a rare anatomical variant of the internal auditory canal (0.3%), and its association with inflammatory ear disease accompanied by conductive hearing impairment appears to have been incidental in both cases in the present study.     

A middle ear implant with a titanium canal wall prosthesis for a case of an open mastoid cavity

Objective

Open mastoid cavity rehabilitation should focus on both anatomical and functional aspects. We hereby report the technique and results of a combined strategy to reconstruct the external ear canal using a titanium wall implant and the middle ear using a fully implantable active middle ear device.

Methods

A fully implantable active middle ear implant was used to rehabilitate the mixed hearing loss of a 63-year-old woman, and a titanium posterior canal wall prosthesis was used to reconstruct the external ear canal during the same procedure. The middle ear implant was placed directly on the footplate. The auditory results were compared to the preoperative unaided thresholds and to the amplification of a conventional hearing aid.

Results

Following the procedure, there was an anatomically normal external ear canal with a healed tympanic membrane separating the external from the middle ear spaces. The postoperative auditory gains were on average 31.8 dB on pure-tone audiometry, and 20 dB on speech reception threshold. No complications occurred.

Conclusion

The rehabilitation of the external ear canal in an open mastoid cavity allows for clinical follow-up of the patient, and the implantation of an active middle ear implant provides appropriate auditory gains both in pure tones and in speech reception thresholds.     

筋膜外植法鼓室成形术的手术体会

目的 探讨筋膜外植法在鼓室成形术中的应用及价值.方法 回顾分析筋膜外植法鼓室成形术63耳,随访观察患者的外耳道宽敞度、鼓膜形态及听力恢复情况.结果 本组病例包括中耳胆脂瘤25耳,慢性化脓性中耳炎38耳.手术方式分别为筋膜外植法鼓室成形术、筋膜外植法鼓窜成形术+完肇式乳突根治术和筋膜外植法鼓室成形术+开放式乳突根治术三种类型,中耳胆脂瘤和慢性化脓性中耳炎患者实施三种手术的数最分别为4、17、4耳和19、18、1耳.术后切口全部Ⅰ期愈合.随访0.5～3.5年,外耳道宽敞,鼓膜形态良好,听力提高或维持术前水平,未有听力下降者.按时随访者未发现有明显并发症.结论 筋膜外植法鼓室成形术具有操作流程规范、术野暴露充分、病变清除彻底等优点,在慢性中耳炎的外科治疗中具有积极意义.     

先天性小耳畸形全耳廓成形及听力重建术

目的:探讨先天性小耳畸形的临床特点及全耳廓成形及听力重建术的方法和效果。方法:统计、整理2005-01-2010-10期间在我科住院治疗的58例(62耳)小耳畸形患者的资料,本组患者均为先天性耳廓畸形伴外耳道闭锁、听骨链畸形、重度传导性聋。所有患者术前行颞骨CT检查并三维重建,听力学检查。手术分2期进行,一期行耳廓一次成形,外耳道重建,中耳重建手术;二期行耳后植皮,颅耳角再造,对术前、术后的资料进行回顾性分析。结果:耳廓成形加外耳道、中耳重建术后再造耳廓外形良好,耳廓和外耳道口位置接近正常,大部分患者术后听力获得改善。结论:对先天性耳廓畸形并外耳道闭锁的患者,术前应精心设计,根据多层螺旋CT三维重建结果确定听力重建入路及中耳畸形程度,全耳廓成形及听力重建术后可以同时改善耳廓外形和提高听力。     

钛金属管网状支架在外耳道重建术中的应用

目的观察钛金属管网状支架在先天性外耳道闭锁外耳道重建术中的作用,评估钛金属管网状支架预防外耳道重建术后外耳道再度狭窄或闭锁的疗效。方法 16例（16耳）先天性外耳道闭锁患者同期行外耳道和中耳成型术,在成形的外耳道内置钛金属管网状支架支撑;术后14 d取出外耳道内填塞物,保留内置的支撑钛金属管网支架,并于1年后取出。结果术后随访2年,全部病例新成形的外耳道形态良好,局部无感染与肉芽组织增生,无再度狭窄或闭锁。结论外耳道成形术中应用钛金属管网状支架支撑成形的外耳道,对预防术后外耳道再度狭窄或闭锁具有良好效果。     

Bone-conducted vestibular evoked myogenic potentials in patients with congenital atresia of the external auditory canal

OBJECTIVE: The purpose of this study was to determine whether vestibular evoked myogenic potentials from the sternocleidomastoid muscle in response to bone-conducted clicks and short tone-bursts can be used to assess vestibular apparatus function in patients with conductive hearing problems, particularly bilateral external auditory canal atresia. DESIGN: Evoked-potential responses to bone-conducted auditory stimuli were recorded from the sternocleidomastoid muscle of 15 patients (11 male and four female, aged 4--20 years) with congenital bilateral atresia of the external auditory canal, with or without the middle ear anomalies. SETTING: This study was conducted in the outpatient clinic of the Tokyo University Hospital, Department of Otolaryngology, University of Tokyo. INTERVENTION: Diagnostic. OUTCOME MEASURES: Bone-conducted vestibular evoked myogenic potentials in response to clicks and short tone-bursts were recorded with surface electrodes over both sternocleidomastoids in each patient. RESULTS: In all patients, bone-conducted clicks and short tone-bursts evoked larger biphasic responses from the sternocleidomastoid ipsilateral to the stimulated ear. Short tone-bursts evoked vestibular evoked myogenic potentials with higher amplitude and better waveform morphology than clicks at the same subjective intensity. CONCLUSION: Loud auditory stimuli delivered by bone conduction can evoke myogenic potentials from the sternocleidomastoid. This method is a noninvasive, rapid, and convenient test for investigating the vestibular system function in patients with bilateral external auditory canal atresia, with or without the middle ear anomalies.