Causes and risk factors
The exact cause of cancer of middle ear is unknown, but chronic ear affections can predispose to the cancer of middle ear. Malignant tumors of middle ear can be of 2 types – primary and secondary. Primary commonly includes squamous cell carcinoma, adenocarcinoma, but it may also include malignant melanoma, rhabdomyosarcoma, and myeloma. Secondary tumors include direct extension from nasopharynx, parotid, external auditory canal, and temporomandibular joint. Secondary tumors are rare. Distant metastasis can also cause the disease. Malignant neoplasm of middle ear is common in middle age group.
Clinical presentation
Malignant neoplasm of middle ear may be present as bleeding polyp or granulations in the ear. There is severe pain experienced by the patient. Patient complains of deafness. There is ear discharge which is blood stained [otorrhea]. Enlargement of regional lymph nodes is observed. Patient may get giddiness. Invasion of cancer may affect facial or cranial nerves causing paralysis.
Investigation
Medical history by the patient and clinical examination by the ENT doctor helps in diagnosis. Test for hearing is done. Audiometry is advised. Imaging studies such as MRI of the head, CT scan may be useful. PET scan is advised. Tissue biopsy is obtained which confirms the diagnosis. Routine hemogram is recommended. Microscopic examination of discharge is recommended.
Treatment
Treatment involves radical surgery which consists of subtotal excision of temporal bone [extended radical mastoid operation] followed by irradiation. Supportive treatment in the form of chemotherapy and targeted cell therapy is given.
Other Modes of treatment
The other modes of treatment can also be effective in treating malignant neoplasm of the middle ear. Homoeopathy is a science which deals with individualization and considers a person in a holistic way. This science can be helpful in combating the symptoms. Similarly, the Ayurvedic system of medicine which uses herbal medicines and synthetic derivates is also found to be effective in treating malignant neoplasm of middle ear.
