Facial nerve schwannomas presenting as occluding external auditory canal masses: a therapeutic dilemma.
OBJECTIVE
To present a series of patients with facial nerve schwannomas (FNSs) presenting as occluding external auditory canal (EAC) masses.


METHODS
Retrospective case series.


METHODS
Four patients were identified with mastoid segment FNSs occluding the EAC. Three patients presented with conductive hearing loss (CHL), and the fourth presented with facial paralysis, later developing CHL.


METHODS
One patient underwent conservative debulking, removing the EAC component only. Two patients were managed nonoperatively with periodic cleaning of entrapped keratin. The fourth patient received radiation therapy.


METHODS
Facial nerve function, canal cholesteatoma formation, and hearing.


RESULTS
Among the patients managed with serial cleaning of entrapped keratin, one maintained normal facial function and one worsened to House-Brackmann II/VI. Facial function worsened to House-Brackmann II/VI in the patient who underwent surgical debulking. The fourth patient, who received radiation, developed complete facial paralysis. All patients accumulated keratin medial to the tumor, and all had CHL.


CONCLUSIONS
When evaluating an EAC tumor, it is important to obtain imaging before biopsy because biopsy of a schwannoma can result in paralysis. EAC occlusion by a schwannoma presents a challenging management issue, particularly when cholesteatoma forms between the tumor and the tympanic membrane. The primary goal is maintaining normal facial function as long as possible and avoiding secondary ear canal complications. The presence of canal occlusion limits the choice of stereotactic radiation because this leads to a month-long period of tumor swelling and cutaneous sloughing. Resection and grafting are indicated when substantial facial weakness or twitch develops.
*Department of Otolaryngology - Head and Neck Surgery, Stanford University School of Medicine, Stanford, California; and †Division of Otolaryngology-Head and Neck Surgery, University of Utah, Salt Lake City, Utah, U.S.A.
Jennifer C
JC
Alyono
C Eduardo
CE
Corrales
Richard K
RK
Gurgel
Nikolas
N
Blevins
Robert K
RK
Jackler
D000328:Adult; D000368:Aged; D001706:Biopsy; D002648:Child; D002781:Cholesteatoma / Q000150:complications / Q000473:pathology* / Q000601:surgery; D003390:Cranial Nerve Neoplasms / Q000150:complications / Q000473:pathology* / Q000601:surgery; D004424:Ear Canal / Q000473:pathology* / Q000601:surgery; D005154:Facial Nerve / Q000473:pathology* / Q000601:surgery; D005155:Facial Nerve Diseases / Q000473:pathology* / Q000601:surgery; D005158:Facial Paralysis / Q000209:etiology / Q000473:pathology / Q000601:surgery; D005260:Female; D006314:Hearing Loss, Conductive / Q000209:etiology / Q000473:pathology / Q000601:surgery; D006801:Humans; D008297:Male; D009442:Neurilemmoma / Q000150:complications / Q000473:pathology* / Q000601:surgery; D012189:Retrospective Studies; D016896:Treatment Outcome