Three tumors which often require ear surgery are cancer of the ear canal, glomus tumor of the middle ear and vestibular schwannoma (acoustic tumor) of the balance nerve near the brain.
Ear Canal Cancer
A small cancer limited to the ear canal can be cured through ear surgery by removing the entire canal, ear drum and small portion of the outer ear.
Ear Canal Cancer
Cancer of the ear canal can be cured in 85% of patients if it is diagnosed early and is limited to the canal. The canal, eardrum and hearing bones are removed. Lymph-gland drainage areas in front of the ear and in the neck can be removed at the same time by a head and neck surgeon. Occasionally radiation therapy is added after ear surgery. No attempt is made to restore hearing in the ear so a permanent hearing loss results. The operation is very well tolerated even in elderly patients. More advanced disease has a poor prognosis and requires radiation therapy and more extensive ear surgery.
Compared with a normal eardrum and middle ear, a glomus tympanicum creates a reddish blush behind the eardrum.
Normal Ear Drum
Glomus tumor arises from specialized structures behind the eardrum, and is limited to the ear (glomus tympanicum) or can spread into the neck (glomus jugulare). Although benign and slow growing, glomus tumor can destroy vital functions of the ear, paralyze the face, and even spread to the brain if not treated. Because side effects and complications of surgery for glomus tympanicum are minimal, surgical treatment is usually recommended, either through the canal or behind the ear depending on tumor size. Permanent cure is expected. Surgery also can be performed for glomus jugulare tumor especially in younger patients. Because side effects and complications of glomus jugulare surgery are more significant, gamma knife radiation therapy often is recommended
Vestibular schwannoma (acoustic neuroma) is a benign tumor of the balance nerve within the bony canal between the ear and the brain, and sometimes grows quite large toward the brain. Treatment of very small tumors with good hearing often is “wait and rescan” in six to 12 months. If the tumor grows, treatment is pursued, and consists either of acoustic neuroma surgery for young patients in good health or gamma knife radiation therapy for older patients in poor health. Total removal through acoustic neuroma surgery is achieved in almost all cases, and hearing sometimes can be preserved if the tumor is small. Complications are uncommon. Facial muscle weakness can occur, but often returns to normal. Spinal fluid leak occurs in less than five percent of patients, but may require additional acoustic neuroma surgery. Brain complications are exceedingly rare.
Two magnetic resonance images (MRI) show examples of vestibular schwannomas (acoustic neuromas).