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- Title
Long-Term Surgical Outcome of Class A and B Tympanomastoid Paragangliomas.
- Authors
Yilala, Melcol Hailu; Fancello, Giuseppe; Fancello, Virginia; Lauda, Lorenzo; Sanna, Mario
- Abstract
Simple Summary: Tympanomastoid paragangliomas are tumors arising from the middle ear an air-filled space located deep to the ear drum. These tumors rarely spread to other parts of our body. Patients who have these tumors usually experience ringing noise that is synchronous with the heartbeat in the affected ear with or without hearing impairment. During clinic visits, the ear examination usually shows a red mass behind the ear drum and decreased hearing levels. The mass is visible during CT and MRI scans. The main goal of treatment is complete surgical removal with preservation of hearing and facial function. The choice of surgical approach, however, depends on the size and extent of the tumor. Smaller tumors can be removed through the external ear canal. Whereas, larger tumors need surgical removal that requires a skin incision behind the ear to go to the external and middle parts of the ear. The objective of this study is to evaluate the usual presenting symptoms, clinical findings, imaging characteristics, the outcome of surgical management, and treatment-related complications including tumor recurrence. The results showed the mean age of presentation to be 54 and females were six times more likely to be affected than males. The most frequent symptoms were tinnitus and hearing loss while on office ear examination all patients had a red mass behind the ear drum. A High-resolution CT scan is the initial preferred modality of investigation that is important to determine the size and extent of the tumor. Depending on the size, 45% of our cases had tumors confined to the middle part of the ear whereas the rest 55% had bigger tumors with growth to the air-filled spaces around the middle ear and erosion of the bone that houses the carotid artery. All smaller tumors were removed through the external canal whereas larger tumors were removed by accessing the middle and external part of the ear from behind the auricle. Results after surgery showed excellent hearing and facial movement function. Complete tumor removal was achieved in 97% of the cases with 3% of recurrence after surgical removal. The most common complication after surgery was a permanent hole in the ear drum. Surgical treatment remains the preferred treatment modality with the benefits of complete disease removal and a lower rate of recurrence and complication. Objective: To analyze the long-term facial function as well as overall postoperative condition in surgically treated tympanomastoid PGL patients. Study Design: Retrospective study. Method: The medical records of patients with surgically managed class A and B tympanomastoid PGLs between 1983 and 2023 were thoroughly evaluated. Result: Our center has treated a total of 213 cases of tympanomastoid PGL surgically. The mean age of patients was 54, and the male-to-female ratio was 1:6. The most common symptoms at presentation were hearing loss (80%), pulsatile tinnitus (77%), and vertigo (15%). According to the modified Fisch classification, 45% of the cases were classified as class A (A1 and A2), while 55% were classified as class B (B1, B2, and B3). All class A and most class B1 and B2 tumors were removed either with transcanal or retroauricular-transcanal approaches. However, more advanced class B3 lesions were removed with subtotal petrosectomy (SP) along with middle ear obliteration. Facial nerve outcome was excellent in all class A and B cases, while chances of postoperative paresis slightly increased with the size and extent of the tumor (p < 0.05). The hearing outcome is excellent for class A1, A2, B1, and B2 tumors, whereas more advanced class B3 cases have a loss of air conduction (AC) and increased bone conduction (BC) threshold (p < 0.05). Complete surgical removal was achieved in 97% of our cases. The most common late complication was permanent TM perforation (7%), and the recurrence rate was 3%. Conclusions: Tympanomastoid PGL represents the most common neoplasm of the middle ear space. The most frequent presenting symptoms include pulsatile tinnitus and hearing loss, whereas the presence of retrotympanic mass was evident in all cases at the time of initial otoscopic evaluation. Proper documentation of facial function and audiometric evaluation are crucial elements of preoperative workup. The most preferred preoperative radiologic examination is high-resolution computer tomography (HRCT), whereas magnetic resonance imaging (MRI) with or without gadolinium enhancement is reserved for cases with a dilemma of carotid artery or jugular bulb involvement. The main goal of tympanomastoid PGL treatment is complete disease removal with preservation of hearing and facial functions. Surgical treatment remains the preferred treatment modality with the benefits of complete disease removal, lower rate of recurrence and complication, and acceptable postoperative hearing level. Here, we present our 40 years of experience, which, to the very best of our knowledge, is the largest series of tympanomastoid PGL in the English literature.
- Subjects
TYMPANIC membrane perforation; EAR tumors; PARAGANGLIOMA; TREATMENT effectiveness; RETROSPECTIVE studies; DESCRIPTIVE statistics; MEDICAL records; ACQUISITION of data; FACIAL nerve; FACIAL paralysis; DISEASE risk factors
- Publication
Cancers, 2024, Vol 16, Issue 8, p1466
- ISSN
2072-6694
- Publication type
Article
- DOI
10.3390/cancers16081466