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Full text of "Diseases Of The Nose Throat And Ear"

CHAPTER 71
MALIGNANT TUMOURS OF THE EAR

EXTERNAL AUDITORY MEATUS

Tumours in this region constitute a relatively small proportion of the total
number of tumours associated with the ear, only some 20 per cent being
found confined to the meatus. Squamous epithelioma begins as a small
ulcer, covered by a horny layer, usually in the cartilaginous part of the
meatus near its junction with the bony portion. The patient complains of
considerable discomfort and irritation; later of severe pain, worse at night;
and of scanty serosanguineous discharge. If a pledget of cotton-wool, soaked
in a solution of sodium bicarbonate, is applied to the lesion the horny
covering is easily removed and the underlying ulcer exposed. Even in the
case of a small growth, operation should involve complete removal of the
cartilaginous and bony meatus and the resulting cavity is lined by a skin
graft. In advanced cases with occlusion of the external meatus by a fungating
growth accompanied by haemorrhage, foetor, excruciating pain, and facial
paralysis operation must of necessity be extremely radical and followed by
an intensive course of radiotherapy. Cancer limited to the external meatus
offers a fairly reasonable prognosis.

MIDDLE EAR

Malignant disease rarely affects the middle ear although both carcinomata
and sarcomata are occasionally met, the former hi the middle-aged and
elderly, while sarcoma is most frequent in children. In either case there is,
as a rule, a history of chronic otorrhoea. Cancer of the middle ear is difficult
to diagnose from epitheliomata beginning in the deeper part of the external
meatus because of the subperiosteal space of the posterior meatal wall
being in anatomical continuity with the submucous space of the tympanum.
Malignant disease is generally associated with severe pain in the ear, copious
and generally very foetid bloodstained discharge, and exuberant granula-
tions which bleed readily and recur rapidly after removal. Facial paralysis
is frequently an early sign, but the cervical lymph glands are only involved
at a late stage. Labyrinthine symptoms such as giddiness and nausea may
be present. Death takes place from general exhaustion or from a chest
complication. Direct extension to the brain is common. Carcinoma is occa-
sionally found to occur in long-standing radical mastoid cavities.

DIAGNOSIS. When malignant disease is suspected, e.g. when the granula-
tions recur rapidly after removal in a patient past middle life, the diagnosis
must be confirmed by biopsy.

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