coass v-ear tumors
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NOOR FITRARIANTIFK USAKTI
Consular : Dr. Asnominanda,Sp.THT-KL
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EAR TUMORS
Benign Tumor Cholesteatoma Exostosis Glomus Tumor Acoustic NeuromaMalignant External ear Squamous cell carcinoma Basal cell carcinoma Middle ear Squamous cell carcinoma
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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.
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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
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Symptoms
1.Drainage from the ear2.Hearing loss in one ear
1.Pain or numbness in the ear oraround the ear1.Dizziness
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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
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.htm -
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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
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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
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(Glomus Tympanicum tumor (red mass in bottom of middle ear))
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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.
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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.
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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.
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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
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Acoustic Neuroma (swelling of 8th nerve, just underFacial nerve)
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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.
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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
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A high frequncy sensorineural pattern (AsymmetricalHearing)
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2.Tinnitus
Very common in acoustic neuroma,is usuallyunilateral and confined to the affected ear
2.Vertigo
2.Numbness in the face
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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 -
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MRI scan of brain (coronal) showingan acoustic neuroma (the white spoton the left side of the picture).
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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
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TreatmentTraditionally surfer's ear has been treated by
exostectomy
Left Mastoid Osteoma. This patient presentedwith a slowly growing painless hard mass of themastoid bone
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Axial CT scan of the TemporalBones showing a Left MastoidOsteoma
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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
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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
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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
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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
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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.
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