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A case of vesical carcinoma skin metastasis in the external ear is presented. Apart from its uncommonness, cutaneous dissemination of a vesical carcinoma implies a poor prognosis since it is indicative of metastasis spreading to other sites, death occurring in nearly all cases within three months of diagnosis.
This study demonstrated that biologically active points (BAP) of external ear were sensitive to ultrasonic treatment. In order to identify their characteristics, specific conductivity of tissues in the BAP area was measured (in microamperes) by an Elita 4-PEP unit equipped with a silver probe. Conductivity was measured in five points. Such points as i-feng, er-meng, nei-er were shown to influence the cochleovestibular system and exhibit conductivity of approximately 150 microA. The risk of point hyperactivity increased drastically by the 4th and 13th exposure in response to unilateral endaural pharmacophysical treatment with 0.4 W/cm2 ultrasound. The use of ultrasound of lower intensity (0.05-0.2 W/cm2) helped to avoid this complication. These observations suggest that phonopuncture can constitute a component of endaural pharmacophysical treatment of internal ear.
Management problems in patients with recurrent squamous cell carcinoma (SCC) of the external ear (pinna) have prompted a review of the management and treatment outcomes of patients who present with localized disease. Forty patients were seen over a 15-year period (1972 to 1991). Thirty-six were men, and 4 were women, with an age range from 43 to 93 years (average age: 71 years). Presenting TNM status was stage 0 in 2 patients, stage I in 15 patients, stage II in 13 patients, stage III in 2 patients, stage IV in 4 patients, and unknown stage in 4 patients. Thirty-six patients had clinically negative nodes at presentation (N0), and 4 had palpable nodes (N+). The primary treatment was local excision in 13 patients, Mohs' micrographic surgery in 16 patients, local excision plus external beam radiotherapy in 4 patients, and radical resection (parotidectomy/neck dissection/mastoidectomy) with or without radiotherapy in 5 patients. Two patients with stage IV disease died after diagnosis and prior to treatment, and two other patients with stage IV disease received palliative chemotherapy. Twenty patients developed recurrence from 2 months to 8 years. It included nine local recurrences, eight regional recurrences (parotid/neck/mastoid), and three distant metastases (lung or brain). After treatment of the recurrences in 20 patients, 8 are alive 15 months to 16 years later, 2 patients died of other diseases, and 10 patients died of SCC. The recurrences were managed by reoperation, radiotherapy, or chemotherapy. From the results of this study, we conclude that localized carcinoma of the external ear has a high propensity for local and regional failure and merits more aggressive treatment of the primary lesion and elective treatment of the regional lymph nodes and parotid gland in high-risk patients.
An investigation was done on the suitability of four porous synthetic materials--Dacron, porous polyethylene, Proplast II and Teflon--for use as a framework in external ear reconstruction. For this purpose, folded implants up to 1,8 mm thick were implanted under the abdominal skin of rats to create a standing skin fold. The fibrin glue proved useful. After 10 months the most convincing of the synthetic materials was porous polyethylene, which offered advantages over the other materials in handling, and retained a lasting form. This synthetic was also used in clinical reconstruction of the external ear.
We report on a patient who developed far-ranging metastases of adenocarcinoma of the colon that followed a gradual cephalad progression, including the right external ear canal, and led to hearing loss. The patient was a 63-year-old white male with stage III adenocarcinoma of the colon. After 2 years with metastases elsewhere, he developed hearing loss on the right side. Physical examination of the head and neck showed a mass in the external ear canal, and biopsy confirmed adenocarcinoma. After removal, the patient's hearing improved. This case is interesting not only because of the unusual metastasis to the external ear canal, but also because of the patient's previous history of metastasis over the course of more than 2 years. The significance of such wide-ranging metastases is that metastasis of adenocarcinoma to the ear did not signal imminent death, and relief of the hearing loss it caused was possible.
The purpose of this paper is to study the incidence of external ear pathology in our ENT Service in the period between November 1987 and November 1988. During this period 238 cases of this pathology were diagnosed.
Our methods of the reconstruction of the microtia are mentioned. In microtia of both auricles we first try to reconstruct the structures of middle ear and the external channel. If possible we use a "transposition-rotation flap" and rib cartilage for support. The advantages of pedicled flaps in auricle surgery are described.
Otoscopic examination and cytology of the equine ear would be beneficial in diseases such as head trauma, headshaking, otitis externa secondary to otitis media, vestibular disease, aural neoplasia and aural pruritus secondary to parasites. In practice, otic examinations of horses are rarely done due to the perceived difficulty in visualizing the equine external ear canal and tympanic membrane, as well as the need for chemical restraint. In this study, the proximal external ear canal was examined in live horses using a handheld otoscope and in cadaver heads using video otoscopy. Visualization of the proximal ear canal of the sedated horse could be done with a handheld otoscope, but more sedation or general anaesthesia and a video otoscope would be required to adequately visualize the tympanic membrane in the live horse. The proximal ear canals of 18 horses were examined cytologically and cultured aerobically. In three horses, both ears were sampled. No cells or organisms were seen on cytological examination of 11/21 ears. Nine of the 21 ears were sterile when cultured. Ten of the 21 ears had mixed growth with low numbers of organisms (Corynebacterium sp. being most common). Two of the 21 ears had heavy growth of a single organism (Corynebacterium sp. and Staphylococcus intermedius, respectively). Equine cadaver heads were examined in cross-section by computed tomography (CT) imaging and histopathology in order to further understand the anatomy of the equine external ear canal. Equine practitioners should be aware that otic examination is possible and may provide important diagnostic information.
BACKGROUND: The cytologic diagnosis of ear canal tumors is difficult or impossible by swab alone because cell exfoliation may be poor and neoplastic cells may be masked by associated inflammation. Fine-needle biopsy (FNB) can be used to obtain a higher yield of cells for diagnosis. OBJECTIVE: The purpose of this study was to assess the efficacy and diagnostic value of FNB and cytologic examination in providing an accurate diagnosis of masses growing in the external ear canal of cats. METHODS: Cytologic specimens from masses in the external ear canal, taken under inhaled, general anesthesia, were classified into 4 groups: 1) ceruminous gland hyperplasia or adenoma, 2) ceruminous gland adenocarcinoma, 3) inflammatory polyps, and 4) other neoplastic and non-neoplastic masses. Cytopathologic diagnoses were compared with the final histopathologic diagnoses, and indices of diagnostic test accuracy (sensitivity, specificity, likelihood ratios, diagnostic-odds ratios) were calculated. RESULTS: Twenty-seven masses (from 25 cats, including 2 cats affected bilaterally) were included in the study. The results showed good correspondence between cytologic and histologic diagnoses with an overall agreement index (kappa) of .74, a diagnostic odds ratio of 22, and 100% (27/27) agreement in the diagnosis of inflammatory polyps versus neoplasia (both benign and malignant). CONCLUSIONS: FNB cytopathology of external ear masses in the cat was sufficiently accurate for distinguishing inflammatory polyps from neoplasia. For differentiation of benign proliferation and malignant neoplasia, however, histopathologic confirmation is recommended.
Selected ultrastructural features of chondrocytes and the extracellular matrix in the developing elastic cartilage of the external ear were studied in rat fetuses and young animals. The cytoplasmic lipid droplets were first observed in the 19-day fetus. They increase in number and size during the first post-natal week. The elastogenesis proceeds in the sequence: oxytalan fibers (17-day fetus), elaunin fibers (1-day rat), elastic fibers (5-day rat). Intermediary stages between the randomly oriented individual microfibrils and bundles of microfibrils (oxytalan fibers) were also observed.
The medical records of 486 patients with pathologically proved squamous carcinoma of the skin of the external ear were analyzed. It is a disease of elderly white men, and the helix is the most common site of origin. Well-differentiated squamous carcinoma is the most frequent histologic variant. Ninety-five percent of our patients were treated surgically with above-clavical control in 87 percent and 28 percent survival. The low survival rate was related to the old age of the patients who frequently died of intercurrent disease and second cancers. A 12 percent incidence of nodal metastases is comparable with the incidence reported in other series. Aggressive surgical ablation and the selected use of adjunctive postoperative irradiation appear justified in those patients with locally invasive tumors, multiple nodal metastases, and extracapsular invasion.
A number of cases with carcinoma of the auricular concha, carcinoma, cilindroma and sarcoma of the external acoustic meatus are analyzed after a thorough literature survey. The opinion is set forth that insatisfactory results in the treatment of malignant tumours of the external ear should be attributed to the delay of undertaking effective therapeutical measures. Operative menagement with subsequent radiation therapy is recommended in X-ray sensitive neoplasms.
1. This study demonstrates the influence of experience on the establishment and maintenance of the auditory map of space in the optic tectum of the barn owl. Auditory experience was altered either by preventing the structures of the external ears (the facial ruff and preaural flaps) from appearing in baby barn owls (baby ruff-cut owls) or by removing these structures in adults (adult ruff-cut owls). These structures shape the binaural cues used for localizing sounds in both the horizontal and vertical dimensions. 2. The acoustic effects of removing the external ear structures were measured using probe tube microphones placed in the ear canals. In both baby and adult ruff-cut owls, the spatial pattern of binaural localization cues was dramatically different from normal: interaural level difference (ILD) changed with azimuth instead of with elevation, the rate of change of ILD across space was decreased relative to normal, and the rate of change of interaural time difference (ITD) across frontal space was increased relative to normal. 3. The neurophysiological representations of ITD and ILD in the optic tectum were measured before and > or = 3 mo after ruff removal in adults and beginning at 4.5 months of age in baby ruff-cut owls. Multiunit tuning to ITD and to ILD was measured using dichotic stimulation in ketamine-anesthetized owls. The tectal maps of ITD and ILD were reconstructed using visual receptive field location as a marker for recording site location in the optic tectum. 4. Adjustment of the tectal map of ITD to the altered spatial pattern of acoustic ITD was essentially complete in adults as well as in baby ruff-cut owls. This adjustment changed the magnification of ITD across the tectum, with resultant changes in ITD tuning at individual tectal sites of up to approximately 25 microseconds (approximately 5% of the physiological range) relative to normal values. 5. Adaptation of the tectal ILD map to the ruff-cut spatial pattern of acoustic ILD was substantial but clearly incomplete in both adult and baby ruff-cut owls. Although changes of up to approximately 15 dB (approximately 47% of the physiological range) relative to normal tuning were observed at certain tectal sites, the topography of the ILD map was always intermediate between normal and that predicted by the ruff-cut spatial pattern of acoustic ILD.(ABSTRACT TRUNCATED AT 400 WORDS)
Primary care physicians are influential in diagnosing and initiating treatment of most pathologic conditions in patients with a history of hearing loss, chronic ear infection, diabetes, immunosuppression, or otologic symptoms with excessive exposure to sunlight. Lesions of the external ear and the external auditory canal (external acoustic meatus) are significant and common. Patients with such a history should have a thorough basic examination, which can be done with simple tools. Symptoms of hearing loss, otalgia, otorrhea, tinnitus, aural fullness, vertigo, and facial weakness may warrant referral of the patient to an otolaryngologist. The crux of preventing worsening otologic sequelae is early detection and treatment.
The medical records of 102 patients with a diagnosis of melanoma of the external ear seen at The M.D. Anderson Hospital over approximately a 30 year period were reviewed. Survival was correlated with the sex, the clinical appearance of the lesion, the anatomic site of origin, the microscopic thickness and level of invasion, the absence or presence of clinical and pathologic nodal metastasis, the type of neck dissection and the type of definitive surgical treatment to the ear. The thickness and nodal metastasis adversely affected prognosis. Proper surgical treatment usually involves less than total amputation of the ear. A randomized prospective study should answer the question of whether elective neck dissection of the periauricular, parotid and upper posterior cervical and jugulodigastric nodes is justified. The use of chemoimmunotherapy offers a negligible therapeutic benefits for disseminated disease but may be of prophylactic value in a planned, adjunctive protocol for poor risk patients.
We studied the lipophilic microbiota of the external ear canals of 332 animals (264 dogs and 68 cats), with and without otitis externa, over an 11-year period from 1988 to 1999. Malassezia pachydermatis was isolated from 62.2% and 50% of dogs with and without otitis externa, respectively, and from 41.2% and 17.6% of cats with and without otitis externa, respectively. In the group of animals studied for lipid-dependent species, these yeasts were isolated from 4.5% of dogs with otitis externa and from 23.1% and 8.9% of cats with and without otitis externa, respectively. M. sympodialis and M. furfur were isolated from cats and M. furfur and M. obtusa from dogs. Our findings show that lipid-dependent Malassezia species may contribute to the etiology of otitis externa in dogs and cats.
A rare case of angiolymphoid hyperplasia with eosinophilia, or Kimura's disease, of the external ear, occurring in a 21-year-old woman, is reported. The lesion has recurred twice after surgical excision and corticosteroid therapy was then elected. The clinical and histological features of this disease are described.
Benign osteonecrosis (BON) of the external ear canal (EEC), also termed as focal or circumscribed necrotizing lesion, is an infrequent phenomenon with distinctive features and of an obscure origin. Five patients with BON of the EEC presented with aggressiveness and extension of varying degree including involvement of the middle ear. It seems that the disease might have a self limited course (two patients) though, at times, extensive measures including hyperbarric oxygen therapy (one patient) should be applied.