Diagnosis and treatment of carcinoma in external auditory canal

Objectives:To evaluate outcomes in treating carcinoma of external auditory canal(EAC) and to analysis factors which effect the prognosis of this disease.Methods:A retrospectively review of 16 patients treated for carcinoma of EAC at our department between April 2000 and April 2014 was conducted.All patients underwent surgical treatment and the diagnosis confirmed by pathological examination.Results:There were adenoid cystic carcinoma(ACC) in 8 patients,squamous cell carcinoma(SCC) in 5 patients,adenocarcinoma(AC) in 2patients,and verrucous carcinoma(VC) in 1 patient.The tumors were classified as Stage I in 4 cases,Stage II in 2 cases,Stage III in 3 cases,and Stage Ⅳ in 7 cases.Five patients underwent extensive tumor resection(ETR),2 patients underwent lateral temporal bone resection(LTBR),5patients underwent modified LTBR,2 patients underwent subtotal temporal bone resection(STBR),and 2 patients underwent only open biopsy.Besides,adjunctive procedures,including neck dissection,parotidectomy and pinna resection were performed when indicated.Ten patients received postoperative radiotherapy.By the end of follow up,two patients had died of their disease,2 lost to follow up,2 survived with the disease,and the rest survived disease-free.The median follow-up period was 24 months.Conclusion: Complete tumor resection appears to be an effective treatment for carcinoma of the EAC. Patients with SCC seem to have worse prognosis than those with ACC. Radiation therapy seems less effective for ihe disease than surgical treatment.

First branchial cleft cyst accompanied by external auditory canal atresia and middle ear malformation:A case report

BACKGROUND We report a rare case of first branchial cleft anomaly(FBCA)accompanied by bony atresia of the external auditory canal,middle ear malformation,and location malformation of the facial nerve according to the intraoperative findings.CASE SUMMARY A 19-year-old male patient presented to our department with a mass behind the right earlobe and recurrent postauricular swelling and pain since childhood,he also had severe hearing loss in the right ear since birth.The patient underwent surgery including mass removal,mastoidectomy,and simultaneous meatoplasty and ossiculoplasty under microscopy.No facial palsy or recurrence was noted during postoperative follow-up.CONCLUSION FBCAs are rare,and to our knowledge,this is the first report of FBCA accompanied by external auditory canal bony atresia,middle ear malformation,and location malformation of the facial nerve.An effective postauricular approach under microscopy facilitated complete lesion removal and simultaneous otologic reconstruction.

Metastatic hepatocellular carcinoma of the external auditory canal

This report describes a rare case of metastatic hepatocellular carcinoma (HCC) presenting a huge mass in the left external auditory canal (EAC). The patient was a 55-year-old man with hepatitis B virus-related HCC. He presented to our department with a three-month history of increasing left otalgia,and hearing loss with recent fresh aural bleeding. Histopathologic examination indicated that the tumor was secondary to HCC. Although external irradiation was not effective,the tumor was treated with surgical debulking and high dose rate 192 Ir remote afterloading system (RALS) for postoperative intracavitary irradiation. A review of the literature revealed only five other cases of HCC metastasis to the temporal bone,all of which mainly metastasized in the internal acoustic meatus. The present case is the first report of HCC metastasis to the EAC.

Capillary Hemangioma of the Middle Ear and External Auditory Canal:a Case Report

We report a case of capillary hemangiomsa that involved the entire middle ear space,external auditory canal(EAC) and tympanic antrum.Symptoms in the case included ear fullness,hearing loss,otalgia and otorrhea.The case was misdiagnosed as recurrent chronic otitis media with granulation preoperatively.A diagnosis of capillary hemangioma was established by postoperative histological examination.The management of capillary hemangioma of the middle ear and external auditory canal is discussed,with a review of the literature.Because of its variable and sometimes misleading clinical presentation,hemangioma can initially be misdiagnosed as other lesions.Therefore,a high index of suspicion is necessary for early and accurate diagnosis.

Middle ear foreign body causing cholesteatoma and external auditory canal granuloma: a case report

Objective Patients with unilateral ear discharge and hearing loss often have external or middle ear diseases. We present a 55-year-old man who suffered from persistent ear discharge and hearing loss in the left ear. Local findings showed that his left ear canal was filled with a large amount of granulation tissue, with purulent, foul-smelling discharge. Computed tomography indicated left middle ear cholesteatoma and mass shadow in the left external auditory canal. Modified radical mastoidectomy was performed. A piece of white plastic stick was found in the middle ear during the operation. Foreign body-induced cholesteatoma and external auditory canal granuloma in adults are very rare. We present this rare case so that these conditions can be better recognized and understood.

Biomedical application of materials for external auditory canal: History,challenges, and clinical prospects

Biomaterials play an integral role in treatment of external auditory canal (EAC) diseases. Regarding the specialanatomic structure and physiological characteristics of EAC, careful selection of applicable biomaterials wasessential step towards effective management of EAC conditions. The bioactive materials can provide reasonablebiocompatibility, reduce risk of host pro-inflammatory response and immune rejection, and promote the healingprocess. In therapeutic procedure, biomaterials were employed for covering or packing the wound, protection ofthe damaged tissue, and maintaining of normal structures and functions of the EAC. Therefore, understandingand application of biomaterials was key to obtaining great rehabilitation in therapy of EAC diseases. In clinicalpractice, biomaterials were recognized as an important part in the treatment of different EAC diseases. Thechoice of biomaterials was distinct according to the requirements of various diseases. As a result, awareness ofproperty regarding different biomaterials was fundamental for appropriate selection of therapeutic substances indifferent EAC diseases. In this review, we firstly introduced the characteristics of EAC structures and physiology,and EAC pathologies were summarized secondarily. From the viewpoint of biomaterials, the different materialsapplied to individual diseases were outlined in categories. Besides, the underlying future of therapeutic EACbiomaterials was discussed.

Neuroendocrine carcinoma in the auditory canal and middle ear

Neuroendocrine carcinoma （NEC） is a malignant tumor characterized by amine precursor uptake andsecretion of amine and polypeptide hormones through decarboxylization, NEC is a rare disease,2 with NECs in the aural region being particularly uncommon. We report here a case of NEC in the auditory canal and middle ear.

EXPERIENCE WITH OVERLAY TYMPANOPLASTY IN 83 CHINESE PATIENTS

Background In many European and American hospitals, represented by the House Ear Clinic (HEC), the overlay tympanoplasty is used with rare exception, with simultaneous canal wall up or down mastoidectomy being taken if needed. In China, underlay tympanoplasty is used across the country, but the overlay tech-nique is used rarely. The aim of the current study was to report the authors’experience with overlay tympa-noplasty in 83 Chinese patients and study its value. Methods Eight-three patients (86 ears) underwent over-lay tympanoplasty in accordance to the standard of the HEC. The patients were followed up and conditions of the external auditory canal, tympanic membrane and hearing were reviewed and analyzed. Results All patients gained stage I incision healing. The size of external auditory canal and tympanic membrane mor-phology were satisfactory. Hearing either remained unchanged or improved. There were no hearing deterio-ration or serious complications. Conclusions Overlay tympanoplasty carries positive value in treating chron-ic otitis media and cholesteatoma with the merits of procedure standardization, adequate operative exposure, thorough disease elimination and extensive adaptation.

Comparison of two surgical approaches for petroclinic lesions

Objective:to compare the methods of petrous apical bone removal and to explore the applicable scope of Kawase approach and retrosigmoid sinus-internal auditory canal approach.Methods:one group of cadaveric head specimens simulated Kawase approach to measure the data of“Kawase triangle”,the other group simulated retrosigmoid sinus-internal auditory canal approach to measure the safety range of the grinding bone window.Then we explored the clinical indications of the two surgical approaches.Result:the grinding depth of Kawase triangle was 11.6±0.14 mm,and the range of clival exposed after grinding Kawase triangle was 22.4±1.22 mm,which could effectively expose the ventrolateral brainstem,the midline of clivus and the area above the facial acoustic nerve.The diameter of the anterior and posterior of the grinding bone window in the retrosigmoid sinus-internal auditory canal approach was 21.95±2.23 mm.In front of the exposure area were the internal carotid artery,the cavernous sinus,and the upper trigeminal nerve;the lower part was the connection between the facial acoustic nerve and the abducent nerve.Conclusion:Kawase approach is suitable for lesions of ventrolateral brainstem,middle superior clivus,with or without invasion of middle cranial fossa;the retrosigmoid sinus-superior internal auditory canal approach is suitable for lesions mainly in cerebellopontine angle area and only slightly invading Meckel’s cavity.

Three cases of uncommon medication-associated osteonecrosis of temporal bone

Introduction:Medication-related osteonecrosis of the temporal bone is rare and has been reported to be associated with the use of anti-resorptive and biologic agents.Here,we present the first case of tyrosine-kinase inhibitor-related external auditory canal(EAC)osteonecrosis as well as two cases related to anti-resorptive therapies.Methods:A retrospective case series.Results:Case one:an 84-year-old female presented with chronic otitis externa and osteonecrosis of EACs bilaterally.She had a history of osteoporosis treated with denosumab and risedronic acid.She successfully underwent left EAC reconstruction using an inferiorly-based pedicle periosteal flap while the right ear canal was managed conservatively.Case two:a 69-year-old male presented with osteonecrosis of the right EAC.He had a history of osteoporosis treated with alendronic acid and zoledronic acid.His osteonecrosis is conservatively managed with local debridement and antibiotic application.Case three:a 60-year-old male presented with osteonecrosis of the right inferior EAC.He had a history of chronic myelogenous leukemia treated with a tyrosine-kinase inhibitor,imatinib.After failing conservative therapy,he underwent right ear canal reconstruction using a periosteal vascular pedicle flap without complication and experienced complete resolution to his symptoms.Conclusion:Anti-resorptive agents and/or tyrosine kinase inhibitors may lead to dysregulation of bone remodeling and result in rare cases of temporal bone osteonecrosis.When a local debridement and antibiotic therapy fail,definitive surgical excision of necrotic bone with subsequent reconstruction of the EAC may offer patients a possible resolution in symptoms.

Microsurgery for vestibular schwannoma:analysis of short-term clinical outcome

Background:Total removal of the vestibular schwannoma when preserving the function of the facial nerve is difficult.The objective of the current study was to investigate the short-term clinical outcome of vestibular schwannoma removal via retro-sigmoid approach.Methods:One-hundred consecutive patients diagnosed with vestibular schwannoma were surgically treated between December 2018 and August 2019 in Xuanwu Hospital,Capital Medical University.The clinical classification,surgical position,gross total removal rate,the anatomical and functional preservation rates of facial nerve,and the postoperative complications were retrospectively analyzed.Results:All 100 patients including 34 males and 66 females were operated on via retro-sigmoid approach.According to Koos vestibular schwannoma grading system,18 cases were grade 2,34 cases were grade 3,and 48 cases were grade 4.According to Hannover vestibular schwannoma grading system,5 cases were T2,6 cases were T3a,8 cases were T3b,30 cases were T4a,and 51 cases were T4b.Seventy-three surgeries were performed under lateral position,and 27 cases were operated under semi-sitting position.The gross total removal rate was 90.0%;the anatomic reservation rate of the facial nerve was 96.0%.According to the House-Brackman system,the facial nerve function was grades 1-2 in 78.0%cases,grade 3 in 7.0%cases,and grades 4-5 in 15%cases.For patients with effective hearing before operation,the hearing reservation rate was 19.0%.Two patients(2.0%)developed intracranial hematoma after operation.Conclusion:Most vestibular schwannoma could be completely removed with good postoperative facial nerve function.If total removal of tumor is difficult,we should give priority to the functional preservation of the nerve function.