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Cancer of the ear canal or middle ear and the inner ear

This page tells you about cancer of the ear canal or middle ear. There is a separate page about cancer of the outer ear.

You can find information about

 

The ear

There are 3 parts to the ear

Another important part of the ear is the bone that surrounds and protects the ear.

The middle ear

The middle ear is a small cavity which contains three small bones. These pass on the vibrations from the eardrum to the inner ear.

Middle ear

The inner ear

The inner ear is filled with fluid. It also contains a small spiral tube called the cochlea. The cochlea has lots of tiny hair like nerves on it. It converts the vibrations from the middle ear into nerve impulses which then travel to the brain. The inner ear also has a number of fluid filled cavities which help us to balance.

Inner ear

 

The bone

The bone that surrounds the ear is called the temporal bone. The ear canal, middle ear and inner ear are all within the temporal bone. The temporal bone is part of the skull above the ear.

One part of the temporal bone is called the mastoid bone. It is the lumpy bit you can feel behind your ear. The outside of the mastoid bone is a hard solid bone but inside is bone that is shaped like honeycomb. There is air inside the small cavities. They also contain the inner ear and the nerves that control the movement of the face and tongue.

Temporal bone

 

About cancer of the ear

Cancer of the ear is a rare cancer. Most of these cancers start in the skin of the outer ear. About 5 out of 100 skin cancers develop on the ear. Those that develop inside the ear are very rare. Less than 1 in every million people in the UK will develop cancer in the middle ear each year.

Most cancers of the ear are squamous cell carcinomas. Other types include

  • Basal cell cancer
  • Melanoma
  • Adenoid cystic
  • Adenocarcinoma
 

Causes of ear cancer

The cause of cancers in the middle ear is unknown. People with a history of chronic ear infections have a higher risk of developing cancer in the ear. Chronic means for 10 years or more.

 

Symptoms of cancer of the ear

The symptoms of cancer of the ear depend on where the tumour is within the ear. Some people may also have swollen lymph nodes in their neck.

Middle ear – the most common symptom is a discharge from the ear which may be blood stained. Other symptoms include hearing loss and earache. Occasionally people cannot move their face on the side of the affected ear.

Inner ear – pain including a headache, hearing loss, tinnitus and dizziness.

 

Tests for ear cancer

Your doctor will examine you and you may have blood tests to check your general health.

The only way to confirm a diagnosis of cancer is to take a small amount of tissue from the abnormal area of the ear and examine it under a microscope. Doctors call this a biopsy. Before your doctor takes the biopsy they give you a local anaesthetic to numb the area so you don’t have any pain. Biopsies of the middle ear can be difficult to take and you may need to have a general anaesthetic.

If the biopsy shows a cancer, you may also have an MRI scan or a CT scan to help your doctor decide which treatment you need. There is more information about these scans in the cancer tests section. Occasionally people have scans before a biopsy.

Doctors do not take biopsies of the inner ear. This is because it is very difficult to reach without causing problems to other structures around it. Your doctor will make a diagnosis using MRI scans and CT scans.

 

Stages of cancer of the ear

The staging of a cancer looks at the size of the cancer and whether it has spread. Working out the staging system can be difficult with rare cancers because there are not many people with the cancer. So it is hard to develop the staging system. Doctors use a number of different staging systems for cancer of the ear.

Generally an early stage cancer is small and just within the area it started in. One that is slightly more advanced has grown into the surrounding structures. A secondary or metastatic cancer has spread to another part of the body from where it started. Working out the stage of the cancer helps your doctor to decide about treatment.

For cancers of the ear canal and middle ear doctors can use the TMN staging system. The T part refers to the tumour, the N whether the lymph nodes have any cancer cells in them and M tells us if it has spread to another organ in the body.

The staging for the ear canal and the middle ear is

T1 – the tumour is just in the middle ear and is not causing any numbness of the face and is not in the nearby bone
T2 – the tumour has grown outside the area and is causing numbness or is affecting the bone
T3 – the tumour has grown into the nearby salivary gland (parotid gland) or the base of the skull or the joint of the jaw

 

How your doctor decides on treatment for ear cancer

The main treatments for cancers that start in the ear canal or middle ear are surgery and radiotherapy. Depending on the stage of your cancer you may also have chemotherapy. The treatment you will have depends on

  • Where in the ear the cancer is
  • The type of cancer
  • The size of the tumour
  • Whether it has spread outside the area it started in (the cancer stage)
  • Your general health

People who have cancers that start in the head and neck usually see a team of specialist doctors and other health professionals. They include

  • Head and neck surgeons – including ear, nose and throat surgeons, mouth and facial bone surgeons, and plastic surgeons
  • Specialists in cancer drugs and radiotherapy – oncologists
  • Dentists
  • Specialist nurses, physiotherapists and dieticians
 

Surgery

The type and amount of surgery you need depends on where the cancer is in your ear. And whether it has spread into any of the surrounding tissues, or into nearby structures, such as the bone.

Your surgeon will remove the tumour together with an area of tissue surrounding it that is completely free of cancer cells. This is called a clear margin of tissue. It needs to be at least 5mm all round the cancer. Doing this helps to lower the risk of the cancer coming back.

Surgery may involve having some or all of the following removed

  • The ear canal
  • Part or all of the temporal bone
  • The middle ear
  • The inner ear

The temporal bone is the bone at the side of your skull, by the ear. The operation to remove the temporal bone is called a mastoidectomy or temporal bone resection.

Rarely, your surgeon may need to remove the facial nerve. This runs down the side of the face and through the salivary gland. They may also need to remove the lymph nodes nearby in your neck and the salivary gland on that side of your head.

Obviously how you are after surgery will depend on the operation you had. But for this operation, the wound is usually behind the ear. Immediately after the operation you will have stitches and may have a dressing over your wound. You will also have one or two small tubes near your wound to drain any fluid from the area. This helps to reduce swelling. It usually takes a couple of days for these tubes to stop draining fluid. Then your nurse or doctor will take them out.

You will have a drip for fluids, to stop you getting dehydrated. You will have painkillers to control any pain you have. How long you need to spend in hospital depends on your particular operation. Before your operation, your doctor will tell you what to expect.

Whether you can hear or not after the operation depends on the surgery you have. If you have to have your middle and inner ear removed it is unlikely that you will be able to hear on that side. You may also find that your balance is affected and you feel dizzy. Sometimes it is possible for the surgeon to rebuild (reconstruct) some of the ear so that you can hear.

Many people worry about how their appearance will change. With this operation, appearance won’t change for most people. If you have major surgery it depends on the surgery you have and from person to person. The techniques used to remove the tumour and rebuild the area mean that most people won’t look any different afterwards. Your scar line is likely to be behind your ear or in a natural crease on your face. Talk to your specialist before you have your operation about the surgery you are having and how it will affect your appearance, hearing, and eating. It can help you cope if you know beforehand what to expect.

 

Radiotherapy

Radiotherapy uses high energy waves to treat cancer. You may have radiotherapy as your main treatment. Or you may have it if your surgeon hasn’t been able to remove a clear margin of tissue from around the tumour. Then radiotherapy can lower the risk of the cancer coming back.

You usually have radiotherapy every week for 4 weeks (from Monday to Friday). At your first appointment your radiotherapy doctor (clinical oncologist) plans your treatment. This planning appointment takes a couple of hours but after that each treatment only takes a few minutes. You can find out more about radiotherapy in the about cancer section.

 

Chemotherapy

Chemotherapy uses anti cancer (cytoxic) drugs to destroy cancer cells. Chemotherapy on its own won’t cure cancer of the ear but doctors may use it to relieve symptoms if your cancer comes back or you can’t have other treatments.

To help cure ear cancer, researchers have been looking into giving chemotherapy with radiotherapy before or after surgery. We need more research to find out how well this works and when it is best to have chemotherapy.

The chemotherapy drugs you may have include fluorouracil and cisplatin. The cancer drug section of CancerHelp UK has detailed information about these drugs, including their common side effects.

 

Follow up

You will have regular check ups once your treatment has finished. Your doctor will examine your ear and ask about your general health. This is your chance to ask any questions you have and to tell your doctor if anything is worrying you. How often you have check ups will vary, depending on your situation. They usually start off every 2 or 3 months and become less often as time goes on.

 

Coping with cancer of the ear

Coping with a diagnosis of cancer can be difficult, both practically and emotionally. It can be especially difficult if you have a rare cancer. Being well informed about your cancer and its treatment can make it easier to make decisions and cope with what happens.

It can also help to talk to other people who have the same thing. But it can be hard to find people who have had a rare type of cancer. Check out Cancer Chat – Cancer Research UK’s discussion forum. It is a place for anyone affected by cancer to share experiences, stories and information with other people who know what you are going through.

You may also find it helpful to contact the Rare Cancer Alliance or the Rarer Cancers Foundation who offer support and information to people who have rare cancers.

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Updated: 2 February 2011