[Primary carcinoma of the ear canal. Clinical aspects, intratemporal growth behavior and surgical strategy].
OBJECTIVE
The symptoms and microscopic findings in carcinoma of the external auditory meatus are often unspecific and misinterpreted as recurrent otitis externa. A definite diagnosis is therefore often delayed, frequently resulting in advanced tumor stages with unfavorable prognosis at the time of diagnosis.


METHODS
In a retrospective analysis of 11 of our own patients and four cases from the Wittmack collection, the clinical data and course of this disease were examined with particular focus on the intratemporal bone growth pattern and possible surgical strategies.


RESULTS
Histopathologically, all cases consisted of squamous cell carcinoma of variable differentiation, with predomination of higher tumor stages (T2-T4: 93.3%) and little initial lymph node metastases (N+: 14.3%; M+: 0%). Osseous destruction was present (almost obligatory) in 93.3% (determined histopathologically and radiologically with CT). Follow-up (to a maximum of 6 years) after surgical resection and postoperative irradiation shows local recurrence at an average of 10 months in 40% of the cases, with a metastasis rate of 44.4%. Mean overall survival is 29.7 months, and 45.5% of the patients experience an average tumor-free period of 46.4 months. The most important prognostic factor in this context is the initial tumor stage.


CONCLUSIONS
In regard to prognosis of external auditory meatus carcinoma, early diagnosis is of vital importance. Especially older patients (50-80 years) who previously have had no history of ear disease should undergo early computer tomographical examination and biopsy in cases of recurrent external otitis.
Ussmüller
J
J
Universitäts-Klinik und Poliklinik für Hals-Nasen-Ohrenkrankheiten, Kopf- und Hals-Chirurgie, Universitätskrankenhaus Hamburg-Eppendorf. ussmueller@uke.uni-hamburg.de
Hartwein
J
J
Rauchfuss
A
A
Sanchez-Hanke
M
M
D000368:Aged; D000369:Aged, 80 and over; D002294:Carcinoma, Squamous Cell / Q000175:diagnosis* / Q000401:mortality / Q000473:pathology / Q000601:surgery; D018572:Disease-Free Survival; D004424:Ear Canal / Q000473:pathology / Q000601:surgery; D004428:Ear Neoplasms / Q000175:diagnosis* / Q000401:mortality / Q000473:pathology / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008416:Mastoid / Q000473:pathology / Q000601:surgery; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D009364:Neoplasm Recurrence, Local / Q000175:diagnosis / Q000401:mortality / Q000473:pathology / Q000601:surgery; D009367:Neoplasm Staging; D010579:Petrous Bone / Q000473:pathology / Q000601:surgery; D012086:Reoperation; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed