coass v-ear tumors

8/2/2019 Coass v-Ear Tumors

1/32

NOOR FITRARIANTIFK USAKTI

Consular : Dr. Asnominanda,Sp.THT-KL


2/32

EAR TUMORS

Benign Tumor Cholesteatoma Exostosis Glomus Tumor Acoustic NeuromaMalignant External ear Squamous cell carcinoma Basal cell carcinoma Middle ear Squamous cell carcinoma


3/32

CHOLESTEATOMA

Definition

Cholesteatoma is a type ofcyst located

in the middle ear

Causes

Cholesteatoma can be a birth defect(congenital), but it more commonlyoccurs as a complication ofchronic ear infection.
http://www.umm.edu/ency/article/003240.htmhttp://www.umm.edu/ency/article/000619.htmhttp://www.umm.edu/ency/article/000619.htmhttp://www.umm.edu/ency/article/000619.htmhttp://www.umm.edu/ency/article/003240.htm


4/32

PATHOGENESIS

1.Invagination theory2.Immigration theory3.Metaplasia theory4.Implantation theory

CLASSIFICATION1.Congenital Cholesteatom (embrionic)

2.Aquisital Cholesteatom (after birth)a. Primary Aquisital Cholesteatomb. Secondary Aquisital Cholesteatom
http://www.umm.edu/ency/article/000619.htmhttp://www.umm.edu/ency/article/000619.htmhttp://www.umm.edu/ency/article/000619.htmhttp://www.umm.edu/ency/article/000619.htmhttp://www.umm.edu/ency/article/000619.htmhttp://www.umm.edu/ency/article/000619.htmhttp://www.umm.edu/ency/article/000619.htmhttp://www.umm.edu/ency/article/000619.htmhttp://www.umm.edu/ency/article/000619.htmhttp://www.umm.edu/ency/article/000619.htmhttp://www.umm.edu/ency/article/000619.htmhttp://www.umm.edu/ency/article/000619.htmhttp://www.umm.edu/ency/article/000619.htm


5/32

Symptoms

1.Drainage from the ear2.Hearing loss in one ear

1.Pain or numbness in the ear oraround the ear1.Dizziness
http://www.umm.edu/ency/article/000619.htmhttp://www.umm.edu/ency/article/000619.htmhttp://www.umm.edu/ency/article/000619.htmhttp://www.umm.edu/ency/article/000619.htmhttp://www.umm.edu/ency/article/003042.htmhttp://www.umm.edu/ency/article/003044.htmhttp://www.umm.edu/ency/article/003206.htmhttp://www.umm.edu/ency/article/003093.htmhttp://www.umm.edu/ency/article/003093.htmhttp://www.umm.edu/ency/article/003206.htmhttp://www.umm.edu/ency/article/003044.htmhttp://www.umm.edu/ency/article/003042.htm


6/32

Signs and testsAn ear exam may show a pocket orperforation (opening) in the eardrum,often with drainage. The deposit of old

skin cells may be visible with anotoscope, a special instrument to viewthe ear.

TreatmentSurgery is needed to remove the cyst


7/32


8/32

GLOMUS TUMOR

Glomus Tumors are also known astemporal bone paragangliomas

Vascular tumors of chemoreseptor organ

Rather common Benign tumors of the middle ear which

arise from glomus bodies

Occur within the middle ear or at other

sites: the temporal bone and neck, orwithin the jugular vein

It can grow into the mastoid itself orthrough the wall that divides the middle

ear from the mastoid and deeply infiltratethe bone
http://www.umm.edu/ency/article/003093.htmhttp://www.umm.edu/ency/article/003093.htmhttp://www.umm.edu/ency/article/003093.htmhttp://www.umm.edu/ency/article/003093.htmhttp://www.umm.edu/ency/article/003093.htmhttp://www.umm.edu/ency/article/003093.htmhttp://www.umm.edu/ency/article/003093.htmhttp://www.umm.edu/ency/article/003093.htmhttp://www.umm.edu/ency/article/003093.htmhttp://www.umm.edu/ency/article/003093.htmhttp://www.umm.edu/ency/article/003093.htmhttp://www.umm.edu/ency/article/003093.htmhttp://www.umm.edu/ency/article/003093.htmhttp://www.umm.edu/ency/article/003093.htmhttp://www.umm.edu/ency/article/003093.htmhttp://www.umm.edu/ency/article/003093.htmhttp://www.umm.edu/ency/article/003093.htmhttp://www.umm.edu/ency/article/003093.htmhttp://www.umm.edu/ency/article/003093.htmhttp://www.umm.edu/ency/article/003093.htm


9/32

Sign and symptoms

Hearing loss Pulsing ringing in the ear (pulsatiletinnitus) Dizziness Ear pain Abnormalities of the cranial nerves thatcontrol swallowing, gagging, shouldershrugging and tongue movements They appear as a red ball or mass behindthe eardrum
http://www.umm.edu/ency/article/003093.htmhttp://www.umm.edu/ency/article/003093.htmhttp://www.umm.edu/ency/article/003093.htmhttp://www.umm.edu/ency/article/003093.htmhttp://www.umm.edu/ency/article/003093.htmhttp://www.umm.edu/ency/article/003093.htmhttp://www.umm.edu/ency/article/003093.htmhttp://www.umm.edu/ency/article/003093.htmhttp://www.umm.edu/ency/article/003093.htmhttp://www.umm.edu/ency/article/003093.htmhttp://www.umm.edu/ency/article/003093.htmhttp://www.umm.edu/ency/article/003093.htmhttp://www.umm.edu/ency/article/003093.htmhttp://www.umm.edu/ency/article/003093.htmhttp://www.umm.edu/ency/article/003093.htmhttp://www.umm.edu/ency/article/003093.htmhttp://www.umm.edu/ency/article/003093.htmhttp://www.umm.edu/ency/article/003093.htmhttp://www.umm.edu/ency/article/003093.htmhttp://www.umm.edu/ency/article/003093.htm


10/32

(Glomus Tympanicum tumor (red mass in bottom of middle ear))
http://www.umm.edu/ency/article/003093.htm


11/32

GLOMUS TYMPANICUM: Picture of a left tympanic membranewith a pulsating red mass occupying the inferior portion of the

middle ear space. The rest of the tympanic membrane is normal.
http://www.umm.edu/ency/article/003093.htmhttp://www.umm.edu/ency/article/003093.htmhttp://www.umm.edu/ency/article/003093.htmhttp://www.umm.edu/ency/article/003093.htm


12/32

Diagnosis

These tumors are diagnosed by neurophysiologicaltesting, and computed tomography (CT) ormagnetic resonance imaging (MRI).

Treatment

Medical therapyFor tumors that actively secrete hormones andneurotransmitters, medical therapy can ease thesymptom and be useful prior to surgery.Alpha and beta blockers are given beforesurgery to block possibly lethal blood pressure

abnormalities and heart arrhythmias.
http://www.umm.edu/ency/article/003093.htmhttp://www.umm.edu/ency/article/003093.htmhttp://www.umm.edu/ency/article/003093.htmhttp://www.umm.edu/ency/article/003093.htmhttp://www.umm.edu/ency/article/003093.htmhttp://www.umm.edu/ency/article/003093.htmhttp://www.umm.edu/ency/article/003093.htmhttp://www.umm.edu/ency/article/003093.htmhttp://www.umm.edu/ency/article/003093.htmhttp://www.umm.edu/ency/article/003093.htmhttp://www.umm.edu/ency/article/003093.htmhttp://www.umm.edu/ency/article/003093.htmhttp://www.umm.edu/ency/article/003093.htmhttp://www.umm.edu/ency/article/003093.htmhttp://www.umm.edu/ency/article/003093.htm


13/32

Surgery

These tumors are very vascular; therefore,pre-operative blockage of the blood supplyto the tumor is often performed.Possible complications of surgery includepersistent leakage of cerebrospinal fluid(CSF) from the ear, and also damage to oneof the nerves controlling face movement,sensation or hearing

RadiationRadiation may relieve symptoms and stopgrowth in spite of persistent tumor mass.
http://www.umm.edu/ency/article/003093.htmhttp://www.umm.edu/ency/article/003093.htmhttp://www.umm.edu/ency/article/003093.htmhttp://www.umm.edu/ency/article/003093.htmhttp://www.umm.edu/ency/article/003093.htmhttp://www.umm.edu/ency/article/003093.htmhttp://www.umm.edu/ency/article/003093.htmhttp://www.umm.edu/ency/article/003093.htmhttp://www.umm.edu/ency/article/003093.htmhttp://www.umm.edu/ency/article/003093.htmhttp://www.umm.edu/ency/article/003093.htmhttp://www.umm.edu/ency/article/003093.htmhttp://www.umm.edu/ency/article/003093.htmhttp://www.umm.edu/ency/article/003093.htm


14/32

ACOUSTIC NEUROMA

Also known as vestibularschwannomas, are non-malignanttumors of the 8th cranial nerve

Two forms: a sporadic form (95%)and a form associated with aninherited syndrome called

neurofibromatosis type II (NF2) Very rare


15/32

Acoustic Neuroma (swelling of 8th nerve, just underFacial nerve)
http://www.umm.edu/ency/article/003093.htmhttp://www.umm.edu/ency/article/003093.htm


16/32

An acoustic neuroma is a benign tumor that

develops on the eighth cranial nerve, whichcarries sound and balancing information fromyour inner ear to your brain. The pressure onthe nerve may cause hearing loss anddizziness.
http://www.umm.edu/ency/article/003093.htmhttp://www.umm.edu/ency/article/003093.htmhttp://www.umm.edu/ency/article/003093.htmhttp://www.umm.edu/ency/article/003093.htmhttp://www.umm.edu/ency/article/003093.htmhttp://www.umm.edu/ency/article/003093.htm


17/32

Sign and Symptom

1.Hearing Loss- 90% present with a one-sided,

slowly progressive hearing impairment- 25% of patients with acoustic

neuroma occurs a sudden hearing loss- Estimate the risk of an acoustic

neuroma by looking at the pattern ofhering loss :

2/3 of patient: A high frequencysensorineural pattern is the most

common type1 3: Hearin loss atlow fre uenc
http://www.umm.edu/ency/article/003093.htmhttp://www.umm.edu/ency/article/003093.htmhttp://www.umm.edu/ency/article/003093.htmhttp://www.umm.edu/ency/article/003093.htmhttp://www.umm.edu/ency/article/003093.htmhttp://www.umm.edu/ency/article/003093.htmhttp://www.umm.edu/ency/article/003093.htmhttp://www.umm.edu/ency/article/003093.htmhttp://www.umm.edu/ency/article/003093.htmhttp://www.umm.edu/ency/article/003093.htmhttp://www.umm.edu/ency/article/003093.htmhttp://www.umm.edu/ency/article/003093.htmhttp://www.umm.edu/ency/article/003093.htmhttp://www.umm.edu/ency/article/003093.htmhttp://www.umm.edu/ency/article/003093.htm


18/32

A high frequncy sensorineural pattern (AsymmetricalHearing)
http://www.umm.edu/ency/article/003093.htmhttp://www.umm.edu/ency/article/003093.htmhttp://www.dizziness-and-balance.com/testing/hearing_test.htm


19/32

2.Tinnitus

Very common in acoustic neuroma,is usuallyunilateral and confined to the affected ear

2.Vertigo

2.Numbness in the face
http://www.umm.edu/ency/article/003093.htmhttp://www.umm.edu/ency/article/003093.htmhttp://www.umm.edu/ency/article/003093.htmhttp://www.umm.edu/ency/article/003093.htmhttp://www.umm.edu/ency/article/003093.htm


20/32

Diagnosis

1. MRI with gadolinium2. CT Scan3. Audiometry

Management of acoustic neuroma

There are three distinct options:1. medical management

2. surgery to remove the tumor3. gamma-knife procedure orstereotactic radiotherapy
http://www.umm.edu/ency/article/003093.htmhttp://www.umm.edu/ency/article/003093.htmhttp://www.umm.edu/ency/article/003093.htmhttp://www.umm.edu/ency/article/003093.htmhttp://www.umm.edu/ency/article/003093.htmhttp://www.umm.edu/ency/article/003093.htmhttp://www.umm.edu/ency/article/003093.htmhttp://www.umm.edu/ency/article/003093.htmhttp://www.umm.edu/ency/article/003093.htmhttp://www.umm.edu/ency/article/003093.htmhttp://www.umm.edu/ency/article/003093.htmhttp://www.umm.edu/ency/article/003093.htmhttp://www.umm.edu/ency/article/003093.htmhttp://www.umm.edu/ency/article/003093.htm


21/32

MRI scan of brain (coronal) showingan acoustic neuroma (the white spoton the left side of the picture).
http://www.umm.edu/ency/article/003093.htmhttp://www.umm.edu/ency/article/003093.htmhttp://www.umm.edu/ency/article/003093.htmhttp://www.umm.edu/ency/article/003093.htm


22/32

Exostosis Surfer's Ear is the common name for

exostosis, abnormal bone growth,within the ear canal

Symptom1. Decreased hearing or hearing loss, temporary

or ongoing

2. Increased prevalence of ear infections, causingear pain

3. Difficulty evacuating debris or water from the

ear causing a plugging
http://www.umm.edu/ency/article/003093.htmhttp://www.umm.edu/ency/article/003093.htmhttp://www.umm.edu/ency/article/003093.htmhttp://www.umm.edu/ency/article/003093.htmhttp://wiki/Exostosishttp://wiki/Hearing_impairmenthttp://wiki/Otitis_externahttp://wiki/Otitis_externahttp://wiki/Hearing_impairmenthttp://wiki/Exostosis


23/32

TreatmentTraditionally surfer's ear has been treated by

exostectomy

Left Mastoid Osteoma. This patient presentedwith a slowly growing painless hard mass of themastoid bone


24/32

Axial CT scan of the TemporalBones showing a Left MastoidOsteoma


25/32

Basal cell carcinoma

Basal cell carcinoma, the 2nd mostcommon malignant pinnal tumor

Most prevalent among elderly

patients with a history of sunexposure

They begin as circular raised areas of

skin with central crater-likeulcerations Grow very slowly. Because of this,

they are easily cured if treated early.

If ignored, however, a basal cell


26/32

These cancers generally do not

metastasize, that is they do not spreadto other organs. They spread by increasing in size only

Sign and Symptom1.sometimes causing an unrelenting discharge2.hearing loss and facial nerve paralysis may

occur

Treatmentsurgical excision or local curretment


27/32

Squamous cell carcinoma

far less commonly than basal cellcancers.

squamous cell cancers are muchmore aggressive cancers than basalcell cancers

spread through the tissues

surrounding the site of origin. Inaddition, squamous cell cancers ofthe ear can spread to the lymph

nodes surrounding the site of origin


28/32

Squamous cell cancers of the ear look

much like basal cell cancers at an earlystage should be considered in elderly patients related to sun exposure and local

trauma It appears early as a thickened area ofskin or as an ulcer.

Sign and Symptom1.fullness, pruritus, and otorrhea.2.otalgia, serosanguineous drainage, and

cranial neuropathies, including hearingloss


29/32

DiagnosisBiopsy

Treatment

surgery and radiation therapyTreatment of tumors confined to the

pinna consists of wide local excision. Theprognosis is good for patients with small

tumors of the helix but not for patientswith tumors near the opening of theexternal auditory canal.


30/32


31/32


32/32

coass v-ear tumors

Documents