Ear and Temporal Bone Cancer

The temporal bone is an area of the skull above the ear. Approximately 200 cases of ear and temporal bone cancer are diagnosed each year in the United States.

Symptoms

Tumors often start as scaly areas or white bumps on the outside of the ear. The area might ooze or drain. A tumor also might start inside the ear canal. The patient might notice drainage from the canal or pain inside the ear.

An ear, nose and throat (ENT) specialist must examine any ear infection that does not go away.

Basal skin carcinoma is the most common type of ear and temporal bone cancer. A scaly area of skin on the ear, which does not improve with the application of moisturizer, is usually the first sign. Then, a pearly white bump appears which grows slowly. The lump can be painless or an ulcer might develop in the center of the lump. The ulcer later bleeds and becomes painful. These tumors can spread to the inside of the ear but rarely other parts of the body.

Squamous cell cancer grows deeper into the body and is more likely to spread. If the tumor grows into the temporal bone it can cause hearing loss, dizziness, and facial paralysis.


Causes and Risk Factors for Ear Cancer

The skin on the ear (pinna) is exposed to the sun. After years of exposure, basal cell skin cancer or squamous cell cancer can develop. Temporal bone tumors are usually caused by a tumor that begins on the skin near the ear and later spreads to the bone. Fair skinned people are more susceptible to skin cancer and, therefore, have a greater risk of developing temporal bone cancer.

These tumors can also be caused when cancer spreads from another part of the body to the temporal bone (metastasis).

Chronic skin infections of the ear canal increase the risk.

Diagnosis

A doctor should examine any small lesion (bump or scaly area) on the ear. If the area does not resolve, or it grows larger, a biopsy is needed to determine if the lesion is cancerous.

An ENT specialist must examine any chronic ear infection that an antibiotic does not cure.

Treatments

The lesion needs to be removed if the biopsy indicates cancer. The type of surgery depends on the size of the tumor. The diagnosis should to be made when the cancer is early and treatment should be started immediately to prevent the tumor from spreading.

Ear Canal and Temporal Bone Cancer Treatments

The type of treatment for this tumor depends on the size, the type or stage of cancer, and the exact location of tumor. Surgery is usually performed first, followed by radiation therapy.

Radiation is not usually the primary treatment. Severe complications would occur if the bone of the skull received the large dose of radiation needed to destroy the cancer. If radiation is used after surgery the required dose is much less.

Surgery on the ear canal and temporal bone is divided into three types: sleeve resection, lateral temporal bone resection and radical temporal bone resection.


Pinna (external ear) Cancer Treatment

The type of surgery for cancer of the pinna depends on the size of the tumor. If a lesion on the ear is very small, the doctor might remove it in the office using a local anesthesia. If the tumor is large, a portion of the ear will need to be removed and reconstructed. Reconstruction of the pinna looks fairly natural.


Sleeve Resection Surgery

Sleeve Resection includes removal of the canal, skin, bone, and eardrum. The ear is reconstructed. Hearing is not affected.


Lateral Temporal Bone Resection Surgery

Structures removed include the sleeve area of the outer ear plus the middle ear. Some people can use a hearing aide after surgery, but hearing is never normal again. Most people cannot hear after surgery.


Radical Temporal Bone Resection Surgery

Radical temporal bone resection includes removal of the entire temporal bone (the sleeve, middle ear and inner ear) plus exposure of the brain. Reconstruction of the temporal bone is required. If the tumor has invaded the brain, a head and neck surgical team and a neurosurgical team is needed.


If a diagnosis is made early, the treatment is less extensive. Large tumors require a large incision and the reconstruction is more complex.

Follow-up visits are very important after surgery. The surgeon needs to examine the patient for any side effects after treatments. Some side effects can be avoided if the surgeon closely monitors the patient for symptoms. If a symptom occurs, the effects might be decreased if treated early. The surgeons might also detect if a cancer has recurred and treat it before it has an opportunity to spread.