middle ear cancer
Introduction
Introduction to middle ear cancer Middle ear cancer (carcinoma of middleear) is a rare malignant cancer that occurs in the middle ear, mostly primary. The cause of middle ear cancer is likely to be a long-term infection of the middle ear. According to statistics, most patients with middle ear cancer have a history of chronic suppurative otitis media. The age of onset is mostly 40 to 60 years old. The pathology of this disease is the most common squamous cell carcinoma, and basal cell carcinoma and adenocarcinoma are rare in the middle ear. During the examination, there are more granulation or polypoid tissue in the external auditory canal or middle ear cavity. It is hard and easy to hemorrhage, and has bloody purulent secretions. Sometimes it is malodorous. After granulation tissue is removed, this situation will reappear quickly and should be alive. Tissue examination, can also take ear secretions for exfoliated cell examination. basic knowledge The proportion of illness: 0.001% - 0.002% Susceptible people: no specific population Mode of infection: non-infectious Complications: deafness
Cause
Middle ear cancer
Virus infection (40%)
The patient had a history of upper respiratory tract infection within one month before the onset of the disease. It was reported that the incidence of sudden onset of upper respiratory tract infection was 8% to 30%. It has been confirmed by serological and viral isolation methods that the virus that causes abrupt mutations includes mumps virus, measles virus, influenza and parainfluenza virus, adenovirus type III, etc., which can cause viral endolymphatic labyrinth, herpes zoster. The virus can cause viral neuronitis and ganglion inflammation. The path of infection of the virus into the inner ear is: 1 through the blood circulation into the inner ear. 2 The subarachnoid space enters the inner ear through the cochlear aqueduct. 3 diffuse into the inner ear through the middle ear mucosa. After infection, the virus proliferates a lot, adheres to red blood cells, makes the blood flow stagnate and is in a hypercoagulable state, and the virus can cause endometrial edema, so it is easy to cause blood vessel embolism, resulting in inner ear blood flow disorder and cell necrosis.
Inner ear vascular disease (30%)
Inner ear vascular disease In patients with diabetes, hypertension, arteriosclerosis and cardiovascular disease, the inner ear vascular matrix is more prone to spasm and thrombosis. This can explain why patients are induced by factors such as fatigue and anxiety. In recent years, some people have observed blood lipids, cholesterol and blood flow maps in patients with sudden onset, and have not found any important factors related to the onset. Wright (1975) reported a case of sudden onset of cardiopulmonary bypass surgery. Zhong Naichuan (1980) reported two cases of erythrocytosis-induced axillary sputum in the northwestern plateau, an example of a sudden convulsion caused by embolization of the inner ear.
Inner ear window film rupture (25%)
Sneezing, nose, vomiting, sexual intercourse and diving can cause sudden increase in venous pressure and cerebrospinal fluid pressure. In addition to rupture of the snail window and vestibular window membrane, it can also cause rupture of the vestibular membrane, lamella and endolymphatic sac. Potential congenital inner ear malformation is more likely to occur, which can cause lymphatic ion disorder and cell poisoning. There is too much lymphatic fluid in Meniere's disease, which can also cause rupture of the volute window and sudden ablation.
Prevention
Middle ear cancer prevention
Chronic suppurative otitis media may be one of the causes of middle ear cancer. Prevention and prevention of otitis media and timely radical cure for chronic suppurative otitis media are effective measures to prevent middle ear cancer.
Complication
Middle ear cancer complications Complications
Conductive deafness, facial paralysis, intracranial and extracranial complications.
Symptom
Middle ear cancer symptoms Common symptoms Bloody ear secretions Hearing loss Ear mites Earaches Bloody secretions Joint stiffness Straight facial nerves
(A) earache: for early symptoms, often pain, severe pain in the late stage, continuous, can be radiated to the ankle, mastoid and occipital.
(2) Hearing loss: early appearance, but the patient often distracts due to ear pain, or the hearing has decreased due to the original otitis media or the contralateral hearing is good.
(C) bloody ear secretions: early common ear bloody secretions, if the cancer in the late stage destroys blood vessels, fatal bleeding can occur.
(D) difficulty in opening the mouth: early can be caused by inflammation, pain and reflex caused by rigidity of the mandibular joint, and late stage is caused by cancer invading the mandibular joint.
(5) Neurological symptoms: cancer invading the facial nerve can cause the same side of the nerve sputum, invading the labyrinth causes labyrinthitis and sensorineural deafness, and the late stage can invade the V, IV, X, XI, XII cranial nerves, causing the corresponding symptoms. And can be transferred to the brain.
Examine
Middle ear cancer examination
It can be seen that there are more granulation or polypoid tissue in the external auditory canal or middle ear cavity. It is hard and easy to hemorrhage, and has bloody purulent secretions. Sometimes it is malodorous. After granulation tissue is removed, this situation will reappear quickly and biopsy should be performed. Ear secretions can also be taken as exfoliated cells for examination.
X-ray examination, bone destruction in the late stage, nasopharyngeal examination should not be negligent, because the middle ear cancer can also originate in the nasopharynx.
Diagnosis
Diagnosis and diagnosis of middle ear cancer
Diagnosis of middle ear cancer, mainly relying on clinical examination, confirmed by biopsy pathological diagnosis. The diagnosis should include the extent of the tumor invasion, the presence or absence of invasion and destruction of the skull base and intracranial structure, and the presence of parotid and facial nerve invasion. If there is cervical lymphadenopathy, needle aspiration cytology should be performed. X-ray or CT scans of the tibia and skull base help determine the extent of the primary site and extent of destruction. Exclude nasopharyngeal carcinoma and look for metastatic lymph nodes in the parotid gland and deep in the neck. Highly suspected to be cancerous in the middle of the following situations:
1. There are granulation or polypoid new organisms in the deep or tympanic cavity of the external auditory canal. After resection, it will recur or explode easily.
2. Chronic suppurative otitis media, pus discharge into pus or bloody secretions.
3. The deep pain in the deep ear is not commensurate with the ear examination of chronic suppurative otitis media.
4. The mastoidectomy has long-term unhealed and refractory granulation.
5. Chronic suppurative middle ear symptoms suddenly aggravated or facial paralysis occurred.
Differential diagnosis
Middle ear cancer should be differentiated from external auditory canal, acoustic neuroma, and lateral skull base tumor.
