Diseases Of The Nose Throat And Ear

THE EAR

PROGNOSIS. This is bad in the majority of patients, although freedom
from recurrence may occur for long periods following efficient treatment.

TREATMENT. Treatment is by a combination of surgery and radiotherapy.
The surgery consists of a radical mastoid operation with removal of all
malignant tissue, sacrificing the facial nerve and labyrinth if necessary. The
patient's best chance lies in a bold concerted attack by both surgeon and
radiotherapist acting in close accord.

TUMOURS OF THE GLOMUS JUGULARE

The glomus jugulare is one of the components of the chemoreceptor system.
When it becomes involved by tumour it is locally invasive but very rarely
forms metastases. The growth of the tumour is insidious at first and slow.
It invades the middle ear, but backward extension is common with destruc-
tion of the petromastoid bone. It is a disease of the middle-aged and elderly.
Females are more commonly affected than males (6 : 1). The true nature
of these tumours is very apt to be overlooked.

SYMPTOMS. The earliest symptom is pulsating tinnitus. A bloodstained
discharge from the ear occurs when the tumour breaks out through the
drum. It may be accompanied by otalgia varying in intensity but possibly
severe. Complete deafness on the affected side is the rule, while tinnitus and
vertigo may prove very distressing. In the more advanced cases facial para-
lysis is present.

APPEARANCES. Before the growth has eroded the drumhead a cherry-coloured
swelling may be seen through the tympanic membrane. Should this appear-
ance be present a Siegle's speculum is inserted firmly into the external meatus
and when pressure is raised the mass behind the drumhead is seen to pulsate
and as pressure is further increased the pulsation ceases and the mass looks
avascular. On gradual release of the pressure the reverse appearances take
place. More often these tumours present as a fleshy looking polypus growing
from the middle ear and it is only on instrumentation during examination
or on removal that massive bleeding takes place and draws attention to
the true nature of the growth.

DIAGNOSIS. Diagnosis is confirmed by biopsy, where the appearances are
of a duplication of chemoreceptor tissue, complicated by variable combina-
tions of haemorrhage, inflammation, degeneration, fibrosis and epithelial
accompaniments. Involvement of any of the last eight cranial nerves may
be demonstrated.

TREATMENT. In very early cases excision may be possible, but most cases
will be treated by radiotherapy, which reduces the vascularity of the tumour,
delays its spread and occasionally cures the condition.

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