External auditory canal carcinomas: What does optimal management require?

Carcinomas of the external auditory canal (CEAC) are rare with poorly defined treatment guidelines. The aim of this study is to discuss the therapeutic management of patients with CEAC.

It was a retrospective study conducted over an 11-year period (2010-2021), including 8 patients with primary CEAC. Cases were recorded in terms of gender, age, symptoms, physical signs, radiological examinations, surgical methods and follow- up.

Median age was 58 years with a sex ratio of 0.6. Main symptoms were hearing loss (n=6), otorrhea (n=4), otalgia (n=4), and peripheral facial palsy (n=2). According to the Pittsburgh classification, CEACs were classified as T1N0M0 in 3 cases, T4aN0M0 in 4 cases, and T4bN0M0 in one case. Surgery consisted of a local resection of the tumor in four cases. A lateral temporal bone resection with total ipsilateral parotidectomy and functional neck dissection was performed in three cases with, respectively, a resection of the ipsilateral pinna (2 cases) and of the temporomandibular joint (2 cases). Adjuvant radiotherapy was indicated in 4 cases. Exclusive radiation therapy was indicated in one case. Histopathological examination confirmed 5 cases of squamous cell carcinoma, 2 cases of basal cell carcinoma, and one case of adenoid cystic carcinoma. Surgical margins were negative in 5 cases. Follow-up was favorable without recurrence in six cases. In one case, a progressive disease with patient death was observed.

Optimal treatment requires early diagnosis and careful imaging assessment of tumor extension to tailor treatment, which often includes surgery and radiotherapy.