[Histopathological studies of intratemporal growth behavior of middle ear carcinoma]

Otological hemorrhage otorrhea, and pain are amongst the first clinical signs of the middle ear carcinoma, which is usually diagnosed in advanced stages. Sudden deafness, facial nerve paralysis, and other symptoms of inner ear damage may be observed in the final stage. However, middle ear carcinoma is diagnosed extremely seldom in its early stages. The clinical management of this pathology is based on the knowledge of the tumor's pathways and its anatomic behavior.

Our study investigated 20 cases of middle ear carcinomas from the Wittmaack temporal bone bank (14 squamous cell carcinomas, 5 adenocarcinomas, and 1 adenoidcystic carcinoma) to analyze the behavior of the tumor growth and its influence on clinical symptoms. The aim was to determine criteria for early clinical diagnosis.

The tumor arises in different regions of the temporal bone, and varying symptoms will subsequently reflect its pathway. When the tumor is confined to the middle ear area, its main location is the hypotympanum from which tumor spreads into the eustachian tube and, via infiltration of the adjacent bone structures (anterior wall of the middle ear), into the tensor tympani muscle and the sympathetic plexus of the internal carotid artery. Destruction of the ossicles was observed in the mid-tympanic cavity, and often only a thin layer of fibrous tissue from the Fallopian canal separated the tumor from the facial nerve (this nerve was rarely affected directly). The medial wall (labyrinthine wall) of the tympanic cavity remained intact in the majority of examined cases. The tympanic sinus, the round window niche, and the oval window niche did not show tumor infiltration. In the epitympanum, the tumor grew and infiltrated the adjacent mastoid. Larger tumors affected the internal auditory canal and infiltrated the acoustic nerve and the labyrinth.

Improving the poor prognosis of middle ear carcinoma requires early diagnosis based on axial computed tomography (CT). Important factors in patient selection include age (50-70 years), sex (mostly women), and especially clinical symptoms (otorrhea, pain, hearing loss).