A number of malignant and benign otic tumors occur, usually manifesting with hearing loss. They may also manifest with dizziness, vertigo, or imbalance. These tumors are rare and can be difficult to diagnose.
(See also Overview of Head and Neck Tumors.)
Malignant otic tumors
Basal cell and squamous cell carcinomas may arise in the ear canal. Persistent inflammation caused by chronic otitis media may predispose to the development of squamous cell carcinoma. Extensive resection is indicated, followed by radiation therapy. En bloc resection of the ear canal with sparing of the facial nerve is done when lesions are limited to the canal and have not invaded the middle ear. Deeper invasion requires a more significant temporal bone resection. These resections are typically done by surgeons specializing in neurotology or skull base surgery.
Rarely, squamous cell carcinoma originates in the middle ear. The persistent otorrhea of chronic otitis media may be a predisposing factor. Resection of the temporal bone and postoperative radiation therapy are necessary.
Nonchromaffin paragangliomas (chemodectomas) arise in the temporal bone from glomus bodies in the jugular bulb (glomus jugulare tumors) or the medial wall of the middle ear (glomus tympanicum tumors). They appear as a pulsatile red mass in the middle ear. The first symptom often is tinnitus that is synchronous with the pulse. Hearing loss develops, followed by vertigo. Cranial nerve palsies of the 9th, 10th, or 11th nerve may accompany glomus jugulare tumors that extend through the jugular foramen. Excision is the treatment of choice, and radiation is used for nonsurgical candidates.
Benign otic tumors
Sebaceous cysts, osteomas, and keloids may arise in and occlude the ear canal, causing retention of cerumen and conductive hearing loss. Excision is the treatment of choice for all benign otic tumors.
Ceruminous adenomas occur in the outer third of the ear canal. These tumors appear benign histologically and do not metastasize regionally or distantly but they are locally invasive and potentially destructive and should be excised widely.
