Combined management of the external auditory canal carcinoma

Background.

The worldwide annual incidence of temporal bone carcinoma is estimated at 0.8–1.0 cases per million. Squamous cell carcinoma is the most common type, accounting for 28.9 to 54.2% of these tumors. The classic triad of symptoms is hearing loss, otalgia, and otorrhea. The clinical presentation resembles an acute inflammatory process, which makes early diagnosis difficult. Accurate disease staging is of the utmost importance for treatment planning and survival prediction. The Pittsburgh staging system (1990) is commonly used. Surgery is considered the mainstay of treatment. It includes circular resection of the external auditory canal skin within negative margins, sleeve resection to lateral resection (mastoidectomy, removal of the bone part of the external auditory canal with auditory bones, partial lobectomy of the parotid gland), subtotal resection (excision of the labyrinth with the preservation of the top of the pyramid) and total resection of the temporal bone (excision of the entire organ complex of the temporal bone with the removal of the carotid artery).

Clinical case description.

Patient O., 56 years old, complained of serous discharge from the right ear, a feeling of fullness and hearing loss in the right ear. For a year and a half, she had been regularly receiving treatment for acute external otitis without any signs of improvement. The examination revealed a tumor on the anterior wall of the external auditory canal. The tumor had a smooth contour, was pale pink in color, dense, without ulceration and pathological discharge, sized 5 mm x 5 mm. Pathological examination revealed keratoacanthoma (type C) of the right external auditory canal. On follow-up examination 3 months later, an irregular surface tumor was found on the posterior wall of the right external auditory canal, obturating the lumen of the external auditory canal by one-third. According to the temporal bone CT, there were no signs of bone erosion. Within six months, the tumor enlargement with total occlusion of the external auditory canal was observed. The tumor was removed by sleeveresection. The pathological examination diagnosed low grade squamous cell carcinoma of the external auditory canal. The patient underwent a course of 3D-conformal radical radiation therapy. After two years of follow-up, the patient demonstrates no signs of the disease progression or recurrence.

Conclusion.

The presented clinical case indicates the importance of early detection of ear tumors. The complete tumor excision (sleeve resection) is necessary, allowing to perform a pathological assessment. The combination of surgical treatment and 3D conformal radiation therapy showed effectiveness with minimal radiation-associated adverse events.

Key words: external auditory canal, squamous cell carcinoma, radiotherapy, temporal bone resection
Conflict of interest. The authors declare that there is no conflict of interest.
Funding. There was no funding for this study