Malignant tumors of external ear

From the report of J.Leroux-Robert and A.Ennuyer, who analyzed statistical data of many oncological clinics in Europe, it is known that by 1957, the malignant tumors of the external ear were 1.35-2.25% of the number of all malignant tumors and 5-8% from all similar skin tumors. According to the same authors, malignant tumors of the external ear in 93-98% are localized in the region of the auricle and only 3.3-16.6% in the external auditory canal.

In 1957, the IV International Congress was held in Paris under the auspices of the French Society of Otorhinolaryngologists on the problem of "Malignant ear tumors", at which the famous otorhinolaryngologists J.Leroux-Robert and A.Ennuyer made a programmatic presentation. It would seem that malignant ear tumors are a rare disease that does not deserve so much attention of leading specialists, however, it became known from the reports of the mentioned scientists that the problem is not in the frequency of the disease but in its early diagnosis, because, for example, middle ear cancer in the overwhelming majority of cases first take place "under the flag" of chronic, complicated caries, granulations and cholesteatoma, purulent otitis media, and only when the process goes beyond the middle ear to the back or middle h The patient gets a "status" of a hopeless patient, a true diagnosis of this insidious disease is recognized. Most inoperable cases refer specifically to the example above.

Classifications of ear tumors can be based on the same principles as tumors of any other ENT organs: by localization, by prevalence, by morphological structure, by the nature of growth and the degree of malignancy. Each of these principles plays a part in the overall chain of activities of a holistic treatment process, at the center of which is a sick person. This process is subject to a certain algorithm of the sequence of actions, which provides the diagnosis, treatment and prognosis. To implement these principles of classification and their use in practice, there is a set of structurally interrelated methods, which makes up the toolkit of an integral therapeutic-diagnostic process. From the following, all the above provisions will become apparent in the context of a specific clinical material.

According to A.Lewis, out of 150 cases of ear cancer in 60%, there were lesions of the auricle and in 28% of the external auditory canal. Men get cancer of the auricle four times more often than women, while cancer of the external auditory canal occurs equally often in male and female persons. Most often, the disease occurs at the age of 60-70 years.

[1], [2], [3]

What causes malignant tumors of the external ear?

Factors contributing to the development of malignant tumors of the outer ear are long-term insolation, exposure to ionizing radiation, trauma, etc. According to foreign authors (Rozengans), in 77.7% of cases these tumors arise as a result of various diseases of the auricle (chronic eczema, psoriasis, lupus, old scars, benign tumors).

Pathological anatomy of malignant tumors of the external ear

Macroscopically malignant tumors of the auricle can be represented in three forms: solitary vegetative form (20%), ulcer form (20%), ulcerative infiltrative form (60%). Each of these forms, especially ulcerative, can become infected again, complicated by perichondritis of cartilages of the external ear.

In terms of distribution, malignant tumors are subdivided in degrees:

• I degree - a tumor or an ulcer not more than 5 mm, capturing only the skin without germination in the cartilaginous tissue;
• II degree - a tumor that penetrates into the cartilage with the phenomena of its destruction;
• III degree - a tumor that affects the entire outer ear with regional adenopathy;
• IV degree - a tumor that went outside the outer ear and gave metastases to the cervical lymph nodes.

Histologically, the vast majority of malignant tumors of the outer ear are epitheliomas. Sarcomas in their various variants occur rarely and only in the region of the auricle. Melanomas are also rare, and neurinomas, glomus tumors and malignant lymphangiomas are extremely rare in the outer ear area.

Symptoms of malignant tumors of the external ear

Symptoms of malignant tumors of the external ear are largely determined by the histological affiliation of the tumor.

Spinocellular epidermoid epitheliomas, the most frequent, evolve very quickly and are localized more often on the auricle, appearing as a warty type of formation, ingrown into the underlying tissue by all of its bases, often bleeding when rubbed against a pillow during sleep or an inadvertent touch to the auricle. J.Leroux-Robert and A.Ennuyer describe three forms of the epithelioma of the auricle:

1. limited keratinized node, located on the inflamed base and developing for a long time (several years);
2. ulcerative proliferative formation with raised edges, villous bottom covered with crusts;
3. The infiltrative form is a deep ulcer with uneven edges and a bleeding bottom.

Most often (50%) is affected by the curl, then, in decreasing frequency, anticancer, the back surface of the auricle, lobe, goat and protivocaw. Sometimes the epithelium of the auricle extends to the external auditory canal.

The epithelioma of the external auditory canal can take the form of external otitis (furuncle) with an unusually prolonged course without a tendency to cure, or as a single kidney-shaped formation that bleeds when touching or in the form of a long-term non-healing ulcer.

Symptoms of malignant tumors of the outer ear are typical: in addition to the above-described lens pattern, one should pay attention to such complaints of the patient as constant pain in the auricle, more reminiscent of the sensation of burns, the irradiation of pain in the temporal region. At the beginning of the disease, pain occurs periodically, mainly at night, then it becomes constant and increases in intensity, then painful paroxysms arise. When the tumor is localized in the external auditory canal, patients complain of discharge from the ear of a bloody-purulent nature, followed by the pain syndrome described above (unlike the furuncle of the external auditory canal). With total obstruction of the external auditory canal, there is a deafness on the corresponding ear.

In the spinal-cellular epidermoid epithelioma, an erosion of a dark red color, reminiscent of stagnant granulations, either limited in size or extending throughout the external auditory canal, both in breadth and in depth, is revealed in the external auditory canal; when feeling with a buttoned probe of the bottom of the ulcer, either a loosened cartilaginous tissue or a dense bone with a rough surface (a scrape symptom) is felt. After careful and cautious curettage of the curette or a sharp spoonful of all pathological contents, the prevalence of the tumor becomes clear, and whether it comes from the overdrum space, in which the granulation tissue is often malignant in chronic purulent epitimpanitis. Often, in malignant tumors of the external auditory meatus, regional lymph nodes and parotid salivary glands are involved in the process, whether metastatic or inflammatory, which is manifested by swelling and condensation of the corresponding areas.

Basal-cell non-epidermoid epitheliomas of the external auditory meatus occur less frequently than spinal-cell, are characterized by slower development and later metastasis. When the ear is affected, this tumor becomes ulcus rodens or a flat cicatricial tumor in the anterior and posterior surface of the auricle; when the tumor is localized at the base of the auricle, at the site of its attachment to the skull, partial or complete amputation of it may occur.

Sarcoma of the auricle occurs infrequently and is characterized by slow development, tight adhesion to the underlying tissue, late ulceration, and absence of adenopathy. Sarcoma of the external auditory canal differs proliferative growth, early germinates in the middle ear and manifests as functional disorders, often occurs in childhood.

Diagnosis of malignant tumors of the external ear

The diagnosis of "malignant tumors of the external ear" is usually established by the appearance of the tumor, but often for some time this disease passes under the guise of complicated granulations of eczema of the external auditory canal or even chronic purulent otitis media. More accessible to the recognition of a tumor of the auricle. The final diagnosis is established by histological examination. Of great importance is the differential diagnosis of malignant tumors of the external ear, since there are many different diseases of the external ear, which in their appearance are very similar to the initial forms of malignant tumors of the external ear. So, when a tumor occurs in the area of the auricle, differential diagnosis should be performed with the following diseases :

• dyskeratosis of the elderly, manifested by multiple yellowish or brown crusts, localized on different parts of the face and head;
• frostbites, complicated by painful cracks, ulcers, granulations;
• eczema, manifested by wetting or scaling, infiltration of the underlying tissue, but not by the phenomenon of germination into it;
• psoriasis, which manifests itself as a characteristic psoriatic erythroderma throughout the body and mucous membrane;
• various specific granulomas (lupus, syphilis, etc.);
• various benign tumors.

In malignant tumors of the external auditory canal, they should be differentiated:

• from the ear polyp, complicating chronic purulent otitis media of the middle ear;
• from the fistula of Gellee, which occurs in chronic chronic epitimpanitis with caries of the bone and destruction of the upper-posterior bone sections of the external auditory canal;
• from diffuse eczema of the external auditory canal, manifested by itching, periods of remission and exacerbation;
• from the furuncle of the external auditory canal, characterized by sudden onset, acute pain and other typical signs for this disease;
• from purulent mumps, manifested fistula in the external auditory canal and other signs characteristic of this disease;
• from benign tumors of the external auditory canal.

[4], [5], [6], [7], [8], [9]

Treatment of malignant tumors of the external ear

Treatment of malignant tumors of the outer ear depends on the nature of the tumor and its prevalence. In each case, one or another method is selected, depending on the experience, technological means available in the medical institution and on the basis of indications for this or that method. As a means of choice, diathermocoagulation, laser surgery, radiation and corpuscular ionizing therapy (radio and cobalt therapy) are used. Poorly treatable tumors of the external auditory canal, the back surface of the auricle, an ear-mastoid cavity. Usually in advanced cases, death comes from secondary intracranial complications, metastases to the perivascular cervical lymph nodes, followed by their disintegration and arrosive bleeding, cancerous cachexia.

What prognosis are the malignant tumors of the external ear?

Malignant tumors of the external ear, even in the initial stages of this disease, always have a cautious prognosis, serious with common tumors within the tissues of the external auditory canal and pessimistic when the tumor grows into the middle ear, posterior or anterior cranial fossa.