Surgical management of tumors of the middle ear and mastoid

Abstract

The author has presented the two most common tumors of the ear, cancer of the ear and glomus tumors. Most experience has been with extensive carcinomas involving the temporal bone and indeed the author has treated 132 cases with cancer of the ear, of which 105 cases were resectable. The total experience yielded a cure rate of 28 per cent. The best management program should entail an en bloc resection of the temporal bone followed by post-operative radiation therapy. Glomus tumors are generally benign and when confined to the middle ear present no surgical problem. However, when extension occurs into the jugular bulb region and into the jugular vein, the surgery becomes more formidable and the extent of the tumor should be established before surgery. Wide surgical exposure should avoid entering into the tumor prematurely and thereby compromising a total resection. Advanced extension of the tumor intracranially mandates a combined neurosurgical and otolaryngological approach. Radiotherapy, while not destroying the glomus tumor, will shrink down the size of the tumor by causing thrombosis in its blood vessels and subsequent fibrosis of the tumor itself. The management of each tumor should be individualized according to its size, location, and the general status and age of the patient.