XLVII Cancer of the Middle Ear

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Abstract
Thirty-six cases of cancer of the middle ear have been reviewed. Seventy-five of these patients were in Classes II - IV with T 3 and T 4 lesions, indicating that in the majority of instances early diagnosis and treatment are unlikely to be achieved. Sixty-six per cent were squamous cell carcinoma. Sixty-one per cent occurred in males. Four patients were under the age of 4 years, and 2 were in their teens, indicating the applicability of temporal bone resection in this younger age group. Chronic infection, bleeding, pain and facial nerve paralysis were characteristic. Irradiation was used in 22 of the most advanced cases in conjunction with surgery either pre-operatively or postoperatively, with a cure rate of 14% in this critical group. Surgery alone in Class leases was very effective; i. e., there were no failures, 4 patients living free of disease over 5 years and 6 less than 5 years. Temporal bone resection is a formidable operative technique and affords anatomic weak points in the development of an adequate cancer specimen. Irradiation compounds postoperative complications. Local recurrence and spread to the brain were characteristic in the failures. Only 16. 5% of these cancers metastasized to the neck. Hypoglossal nerve crossover ameliorated the facial nerve paralysis in 28 operative cases (87%). The 5-year over-all cure rate was 27%.

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