Adenomatous tumors of the middle ear and mastoid

Three cases of middle ear and mastoid neoplasms are reported as “adenomatous tumors” since in their search of the literature the authors did not find any previously described lesions with a similar histologic appearance and benign biologic behavior. Microscopically, all three tumors are similarly composed of solid cords and nests of closely-packed small cells having an epithelial appearance. Two distinct cell types are present: cuboidal cells, arranged in a rudimentary gland-like pattern, and angular cells forming irregular nests with no distinct pattern. All three tumors developed in patients in their 20′s, over a period of months with minimal symptoms; yet in all of the lesions the tympanic membrane was intact at the time of initial examination. None of the neoplasms was diagnosed preoperatively, and, once removed, all three tumors were pathologic enigmas and therapeutic problems in view of the initial and subsequent consultant pathologic opinions; nevertheless, total local excision with preservation of the tympanic membrane would appear to be safe treatment in these cases. The term “adenomatous tumor” is applied to these three neoplasms because: 1. a true glandular epithelial origin warranting the term adenoma or adenocarcinoma cannot be proven; and 2. the biologic behavior and prognosis is not necessarily reflected by the histologic appearance. A more specific term reflecting the origin and behavior of these tumors does not appear possible without the study of further cases.     

Adenomatous tumors of the middle ear

Primary adenomatous tumors of the middle ear are preponderantly benign, resectable lesions and arise from the mucosa (adenomas) or salivary tissue (choristomas). Malignant variants are ill defined, are not characterized histologically, and represent less than 10% of the adenomatous tumors. Their presence may be signaled clinically by facial nerve paralysis, invasion of bone, and chronic otorrhea.     

Embryonal rhabdosarcoma of the middle ear and mastoid

Two cases of embryonal rhabdomyosarcoma, arising from the middle ear, are described. It is a rare mesenchymal tumour of childhood, with a very poor prognosis. The literature is briefly reviewed and the difficulties encountered in diagnosis are outlined.     

Glomus jugulare tumors of the middle ear and mastoid: diagnosis and surgical treatment.

At the 1976 Southern Sectional Meeting of American Laryngological, Rhinological and Otological Society, Inc., a color movie presenting two cases on the "diagnosis and treatment of glomus jugulare tumors of the middle ear and mastoid" was shown. The purpose of this paper and film is to describe the author's experience of 16 cases of glomus tumors involving the middle ear and mastoid (seven tympanicum and nine jugulare). A review of the literature and findings pertaining specifically to the two cases shown in the film is presented.     

Aeration of the middle ear and mastoid in tympanoplasty

In order to achieve a good hearing result following tympanoplasty it is necessary to maintain an aerated middle ear space. Poor Eustachian tube function is most commonly blamed in cases of failure to obtain an adequately aerated middle ear following tympanoplasty. Although this may be the true etiology in some cases, middle ear adhesions, loss of support of the posterior canal wall and inadvertent blockage of the Eustachian tube orifice by graft material may be contributing factors. Aeration of the mastoidectomy cavity is also important to prevent collapse of the posterior canal wall, retraction pockets and to insure an adequate air reserve. Surgical techniques for prevention of these complications and a means of bypassing the totally blocked Eustachian tube are discussed.     

Rhabdomyosarcoma of the middle ear and mastoid in children

Three cases of embryonal rhabdomyosarcoma in the middle ear and mastoid in children are presented. Diagnosis was confirmed by histopathology. A multidisciplinary approach employing surgery, chemotherapy and radiation therapy is the method of choice in the management of this rare and highly lethal condition.     

Pseudoepitheliomatous hyperplasia of the external ear,middle ear,and mastoid

A case of pseudoepitheliomatous hyperplasia involving the external, middle ear, and mastoid air cells and labyrinth resulting from long standing irrigations with alcohol is described for the first time.     

Idiopathic brain herniation in the middle ear and mastoid

Idiopathic brain herniation into the middle ear and the mastoid process is a rare clinico-pathological entity, with only 41 cases described in the literature. It should be suspected in presence of spontaneous otoliquorrhea/rhinoliquorrhea, refractory serous otitis media, or meningitis following acute otitis media in an adult. A new case is presented, with a brief review of the pathogenesis, clinico-pathological, and radiological characteristics of these lesions.     

Radiotherapy in the treatment of middle ear and mastoid carcinoma

The treatment of temporal bone carcinoma is a widely discussed topic with marked variation in published results. Most conclude that a combination of radical surgery and radiotherapy is the optimum treatment. The present study reviews the results of radiotherapy used as the main primary treatment for this condition. Five-year survival in 56 patients was 32% for radical and palliative therapy, with an excellent response in ‘early’ cases. It is concluded that improvement in survival could be attained by defining those groups which would benefit from a combination of treatment methods.     

Primary papillary adenocarcinoma confined to the middle ear and mastoid

Primary adenocarcinoma is a rare tumor of the middle ear and temporal bone; its most frequent symptoms are hearing loss, otalgia, and facial paralysis. Otoscopic examination of a 27-year-old man revealed purulent discharge in the ear canal, diffuse edema, and hypertrophy of the right tympanic membrane. He presented with a grade III (House-Brachman) facial paralysis and right conductive hearing loss with a history of aural discharge for 6 months, otalgia, and facial weakness for 2 days. Computed tomography of the temporal bone showed an opacity filling the tympanic cavity, antrum, and aditus. Tympanotomy revealed diffuse edema of the middle ear mucosa, and granulation tissue was encountered during mastoidectomy filling the antrum and periantral cells and eroding the fallopian canal at the level of the oval window. After the histopathological examination revealed papillary adenocarcinoma, a subtotal temporal bone resection, facial nerve segmenter resection, and end-to-end anastomosis of the facial with the hypoglossal nerves were performed. The importance of histopathological examination in all cases of chronic otitis media with granulation tissue is stressed. Received: 9 February 2000 / Accepted: 5 September 2000