AUCTORES
Globalize your Research
Case Report | DOI: https://doi.org/10.31579/2692-9562/050
Associate Professor, Department of ENT, Subbaiah Institute of Medical Sciences, NH-13, Purle, Holebenavalli Post, Shimoga-577222, Karnataka, India.
*Corresponding Author: Sphoorthi Basavannaiah, Associate Professor, Department of ENT, Subbaiah Institute of Medical Sciences, NH-13, Purle, Holebenavalli Post, Shimoga-577222, Karnataka, India.
Citation: Sphoorthi Basavannaiah (2022) Sinister growth behind the ear: how can a person be sloppy and shoddy???Journal of Clinical Otorhinolaryngology 4(2); DOI: 10.31579/2692-9562/050
Copyright: © 2022 Sphoorthi Basavannaiah. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Received: 15 April 2022 | Accepted: 30 April 2022 | Published: 07 May 2022
Keywords: temporal bone; malignancy; mastoid region; external auditory canal; petrous apex
Malignancy of ear & temporal bone are uncommon and unusual, but if occurs belongs to destructive variety. It can have both local as well as distant spread from external ear canal to inner ear passages. The spread can involve parotid gland to petrous apex. After a prompt radiological investigation, treatment is scheduled as per staging of the disease process. Early detection with treatment will have good prognosis while delayed recognition will have poor prognosis.
Malignancy of ear & temporal bone are rare, aggressive types of tumours. The incidence has been reported to be 1 in 6 cases per million population years, which is < 0>
Here, is this adult male aged about 54 years who was encountered in the health camp. He comes with foul smelling discharge from the growth behind the left ear since > 2 months. As per history, the growth was initially size of a pea behind the ear nearly 2 years back which has gradually progressed to have attained the present size. Patient has completely neglected about the growth since the time it has appeared and with no self - hygiene. There is association of pain with this growth occasionally (as per the history from the patient) for which the patient takes analgesics (oral or intramuscular) as and when it pleases him. There was history of otalgia, hearing loss from the left ear. He also gives previous history of recurrent otitis externa taking symptomatic treatment for the same then and there. Patient also gives history of trismus. Patient who is farmer by occupation is a chronic alcoholic, smoker and tobacco/supari /ghutka chewer. There is no h/o any systemic illness.
Patient is normal built and nourished and oriented to time, place and person. His vitals and systemic examination findings are within normal limits. On local ear examination: ulcero-proliferative growth as shown in Figure 1 roughly 4X1 cm seen occupying the left post-auricular region extending vertically from upper edge of pinna upto lower end of lobule of the left ear and horizontally involving the mastoid and temporal bone partly of the left ear. This hard growth has ulcerative margins with areas of necrosis with foul smelling discharge from it. The growth has irregular margins & surface and fixed to the underlying skin. The growth is tender on palpation, sensitive to touch with bleeding from the growth with superficial skin peeling present. The surrounding area of the growth is normal in contour and surface with no induration and with no affect to hair line. Permeatal finding of left ear showed canal erosion and postero-superior retraction of the drum. Biopsy was done under local anaesthesia and later HRCT temporal bone +/- MRI was planned. But the patient did not follow up. The clinical staging in this case was T3. Biopsy report was suggestive of 2 varied diagnosis- Squamous cell carcinoma (as expected most likely) and Haemangioendothelioma (which was just out of the box anticipation).
Tumors of temporal bone include skin cancer of pinna extending to temporal bone, primary tumors of external auditory canal, middle ear, mastoid or petrous apex and metastatic lesions in temporal bone. Primary malignant tumors of temporal bone have an incidence of 0.8-1/10 lakh individuals/year and 60-80% of them are squamous cell carcinoma. Metastatic lesions in temporal bone are rare and originate from breast, lung or kidney tumours [1,3]. Although they can occur at any age, temporal bone tumors are more common in 6th- 7th decade of life and in males. A multifactorial etiology has been suggested for these tumors in whom the risk factors include chronic otitis media, past radiotherapy in the neighbouring regions and exposure to UV radiation (actinic tumours with invasion of EAC) for tumors originating in skin of pinna and EAC, especially in fair-skinned individuals. There can be development of temporal bone carcinoma in patients who have undergone radiotherapy for carcinoma elsewhere in head and neck (i.e nasopharyngeal carcinoma as per Lim et al study). But chronic otitis media has been associated with presence of temporal bone carcinoma with no scientific evidence in etiology till date. Agents such as chlorinated disinfectants or human papillomavirus in cases of carcinomas associated with inverted papillomas have been mentioned as possible carcinogens[2].
Temporal bone tumours manifest with nonspecific symptoms such as otorrhoea, otalgia and/or hearing loss that are often attributed to inflammatory ear diseases. Thus, the ones which have superficial location, diagnosis is often delayed. Tumors of pinna and EAC are known to be more aggressive and have a higher risk of recurrence and lymph node metastasis possibly due to presence of fusion of multiple embryonic planes in this region, which may facilitate tumour dissemination. In addition to clinical examination and histo-pathological analysis, diagnostic imaging assessment of head and neck are essential for accurate tumor diagnosis and staging [4,6]. CT with contrast allows assessing bone erosion and presence of regional adenopathy, whereas MRI with contrast allows a better assessment of its extension to parotid gland, temporomandibular joint, petrous apex and intracranial invasion. In locally advanced tumors, PET allows exclusion of distant metastasis. Currently, there is no universally accepted system for staging of temporal bone carcinoma. The most commonly used is modified Pittsburgh by Moody et al. in 2000 as described below which is based on physical examination, pre-operative CT and presence of facial paralysis [5].
Modified Pittsburgh staging system for temporal bone carcinomas: T1: Tumor limited to EAC without bone erosion, or soft tissue involvement, T2: Tumor with bone erosion limited to EAC (without involving entire thickness) or limited involvement <0>0.5 cm of soft tissues involvement of temporomandibular joint, styloid apophysis or evidence of peripheral facial paralysis [1,6].
Treatment of temporal bone tumours is a challenge for otorhinolaryngologists due to presence of significant neurovascular structures in this region. This usually includes extended tumor surgical resection, which according to its length can be a wide local excision, lateral temporal bone resection, subtotal temporal bone resection or total temporal bone resection. This surgical approach may be combined with cervical dissection with superficial or total parotidectomy and/or supplementary radiotherapy and/or chemotherapy, according to disease extent, presence of lymph node metastases, histological subtype, available resources, and surgeon’s inclination [2,3,4,5].
Temporal bone malignancies are rare often presenting in the setting of long standing chronic otitis media and often at an advanced stage. The tissue diagnosis is relatively forthright but can be tricky sometimes. However, staging the disease is a intricate task that is best approached with consideration of triad features that is clinical, radiological and pathological findings. The evidence based management of these uncommon tumors is not well established and as such standardisation of surgical and adjuvant treatment, as well as pathological reporting will contribute to more clear management pathways in the future.
Clearly Auctoresonline and particularly Psychology and Mental Health Care Journal is dedicated to improving health care services for individuals and populations. The editorial boards' ability to efficiently recognize and share the global importance of health literacy with a variety of stakeholders. Auctoresonline publishing platform can be used to facilitate of optimal client-based services and should be added to health care professionals' repertoire of evidence-based health care resources.
Journal of Clinical Cardiology and Cardiovascular Intervention The submission and review process was adequate. However I think that the publication total value should have been enlightened in early fases. Thank you for all.
Journal of Women Health Care and Issues By the present mail, I want to say thank to you and tour colleagues for facilitating my published article. Specially thank you for the peer review process, support from the editorial office. I appreciate positively the quality of your journal.
Journal of Clinical Research and Reports I would be very delighted to submit my testimonial regarding the reviewer board and the editorial office. The reviewer board were accurate and helpful regarding any modifications for my manuscript. And the editorial office were very helpful and supportive in contacting and monitoring with any update and offering help. It was my pleasure to contribute with your promising Journal and I am looking forward for more collaboration.
We would like to thank the Journal of Thoracic Disease and Cardiothoracic Surgery because of the services they provided us for our articles. The peer-review process was done in a very excellent time manner, and the opinions of the reviewers helped us to improve our manuscript further. The editorial office had an outstanding correspondence with us and guided us in many ways. During a hard time of the pandemic that is affecting every one of us tremendously, the editorial office helped us make everything easier for publishing scientific work. Hope for a more scientific relationship with your Journal.
The peer-review process which consisted high quality queries on the paper. I did answer six reviewers’ questions and comments before the paper was accepted. The support from the editorial office is excellent.
Journal of Neuroscience and Neurological Surgery. I had the experience of publishing a research article recently. The whole process was simple from submission to publication. The reviewers made specific and valuable recommendations and corrections that improved the quality of my publication. I strongly recommend this Journal.
Dr. Katarzyna Byczkowska My testimonial covering: "The peer review process is quick and effective. The support from the editorial office is very professional and friendly. Quality of the Clinical Cardiology and Cardiovascular Interventions is scientific and publishes ground-breaking research on cardiology that is useful for other professionals in the field.
Thank you most sincerely, with regard to the support you have given in relation to the reviewing process and the processing of my article entitled "Large Cell Neuroendocrine Carcinoma of The Prostate Gland: A Review and Update" for publication in your esteemed Journal, Journal of Cancer Research and Cellular Therapeutics". The editorial team has been very supportive.
Testimony of Journal of Clinical Otorhinolaryngology: work with your Reviews has been a educational and constructive experience. The editorial office were very helpful and supportive. It was a pleasure to contribute to your Journal.
Dr. Bernard Terkimbi Utoo, I am happy to publish my scientific work in Journal of Women Health Care and Issues (JWHCI). The manuscript submission was seamless and peer review process was top notch. I was amazed that 4 reviewers worked on the manuscript which made it a highly technical, standard and excellent quality paper. I appreciate the format and consideration for the APC as well as the speed of publication. It is my pleasure to continue with this scientific relationship with the esteem JWHCI.
This is an acknowledgment for peer reviewers, editorial board of Journal of Clinical Research and Reports. They show a lot of consideration for us as publishers for our research article “Evaluation of the different factors associated with side effects of COVID-19 vaccination on medical students, Mutah university, Al-Karak, Jordan”, in a very professional and easy way. This journal is one of outstanding medical journal.
Dear Hao Jiang, to Journal of Nutrition and Food Processing We greatly appreciate the efficient, professional and rapid processing of our paper by your team. If there is anything else we should do, please do not hesitate to let us know. On behalf of my co-authors, we would like to express our great appreciation to editor and reviewers.
As an author who has recently published in the journal "Brain and Neurological Disorders". I am delighted to provide a testimonial on the peer review process, editorial office support, and the overall quality of the journal. The peer review process at Brain and Neurological Disorders is rigorous and meticulous, ensuring that only high-quality, evidence-based research is published. The reviewers are experts in their fields, and their comments and suggestions were constructive and helped improve the quality of my manuscript. The review process was timely and efficient, with clear communication from the editorial office at each stage. The support from the editorial office was exceptional throughout the entire process. The editorial staff was responsive, professional, and always willing to help. They provided valuable guidance on formatting, structure, and ethical considerations, making the submission process seamless. Moreover, they kept me informed about the status of my manuscript and provided timely updates, which made the process less stressful. The journal Brain and Neurological Disorders is of the highest quality, with a strong focus on publishing cutting-edge research in the field of neurology. The articles published in this journal are well-researched, rigorously peer-reviewed, and written by experts in the field. The journal maintains high standards, ensuring that readers are provided with the most up-to-date and reliable information on brain and neurological disorders. In conclusion, I had a wonderful experience publishing in Brain and Neurological Disorders. The peer review process was thorough, the editorial office provided exceptional support, and the journal's quality is second to none. I would highly recommend this journal to any researcher working in the field of neurology and brain disorders.
Dear Agrippa Hilda, Journal of Neuroscience and Neurological Surgery, Editorial Coordinator, I trust this message finds you well. I want to extend my appreciation for considering my article for publication in your esteemed journal. I am pleased to provide a testimonial regarding the peer review process and the support received from your editorial office. The peer review process for my paper was carried out in a highly professional and thorough manner. The feedback and comments provided by the authors were constructive and very useful in improving the quality of the manuscript. This rigorous assessment process undoubtedly contributes to the high standards maintained by your journal.
International Journal of Clinical Case Reports and Reviews. I strongly recommend to consider submitting your work to this high-quality journal. The support and availability of the Editorial staff is outstanding and the review process was both efficient and rigorous.
Thank you very much for publishing my Research Article titled “Comparing Treatment Outcome Of Allergic Rhinitis Patients After Using Fluticasone Nasal Spray And Nasal Douching" in the Journal of Clinical Otorhinolaryngology. As Medical Professionals we are immensely benefited from study of various informative Articles and Papers published in this high quality Journal. I look forward to enriching my knowledge by regular study of the Journal and contribute my future work in the field of ENT through the Journal for use by the medical fraternity. The support from the Editorial office was excellent and very prompt. I also welcome the comments received from the readers of my Research Article.
Dear Erica Kelsey, Editorial Coordinator of Cancer Research and Cellular Therapeutics Our team is very satisfied with the processing of our paper by your journal. That was fast, efficient, rigorous, but without unnecessary complications. We appreciated the very short time between the submission of the paper and its publication on line on your site.
I am very glad to say that the peer review process is very successful and fast and support from the Editorial Office. Therefore, I would like to continue our scientific relationship for a long time. And I especially thank you for your kindly attention towards my article. Have a good day!
"We recently published an article entitled “Influence of beta-Cyclodextrins upon the Degradation of Carbofuran Derivatives under Alkaline Conditions" in the Journal of “Pesticides and Biofertilizers” to show that the cyclodextrins protect the carbamates increasing their half-life time in the presence of basic conditions This will be very helpful to understand carbofuran behaviour in the analytical, agro-environmental and food areas. We greatly appreciated the interaction with the editor and the editorial team; we were particularly well accompanied during the course of the revision process, since all various steps towards publication were short and without delay".
I would like to express my gratitude towards you process of article review and submission. I found this to be very fair and expedient. Your follow up has been excellent. I have many publications in national and international journal and your process has been one of the best so far. Keep up the great work.
We are grateful for this opportunity to provide a glowing recommendation to the Journal of Psychiatry and Psychotherapy. We found that the editorial team were very supportive, helpful, kept us abreast of timelines and over all very professional in nature. The peer review process was rigorous, efficient and constructive that really enhanced our article submission. The experience with this journal remains one of our best ever and we look forward to providing future submissions in the near future.
I am very pleased to serve as EBM of the journal, I hope many years of my experience in stem cells can help the journal from one way or another. As we know, stem cells hold great potential for regenerative medicine, which are mostly used to promote the repair response of diseased, dysfunctional or injured tissue using stem cells or their derivatives. I think Stem Cell Research and Therapeutics International is a great platform to publish and share the understanding towards the biology and translational or clinical application of stem cells.
I would like to give my testimony in the support I have got by the peer review process and to support the editorial office where they were of asset to support young author like me to be encouraged to publish their work in your respected journal and globalize and share knowledge across the globe. I really give my great gratitude to your journal and the peer review including the editorial office.
I am delighted to publish our manuscript entitled "A Perspective on Cocaine Induced Stroke - Its Mechanisms and Management" in the Journal of Neuroscience and Neurological Surgery. The peer review process, support from the editorial office, and quality of the journal are excellent. The manuscripts published are of high quality and of excellent scientific value. I recommend this journal very much to colleagues.
Dr.Tania Muñoz, My experience as researcher and author of a review article in The Journal Clinical Cardiology and Interventions has been very enriching and stimulating. The editorial team is excellent, performs its work with absolute responsibility and delivery. They are proactive, dynamic and receptive to all proposals. Supporting at all times the vast universe of authors who choose them as an option for publication. The team of review specialists, members of the editorial board, are brilliant professionals, with remarkable performance in medical research and scientific methodology. Together they form a frontline team that consolidates the JCCI as a magnificent option for the publication and review of high-level medical articles and broad collective interest. I am honored to be able to share my review article and open to receive all your comments.
“The peer review process of JPMHC is quick and effective. Authors are benefited by good and professional reviewers with huge experience in the field of psychology and mental health. The support from the editorial office is very professional. People to contact to are friendly and happy to help and assist any query authors might have. Quality of the Journal is scientific and publishes ground-breaking research on mental health that is useful for other professionals in the field”.
Dear editorial department: On behalf of our team, I hereby certify the reliability and superiority of the International Journal of Clinical Case Reports and Reviews in the peer review process, editorial support, and journal quality. Firstly, the peer review process of the International Journal of Clinical Case Reports and Reviews is rigorous, fair, transparent, fast, and of high quality. The editorial department invites experts from relevant fields as anonymous reviewers to review all submitted manuscripts. These experts have rich academic backgrounds and experience, and can accurately evaluate the academic quality, originality, and suitability of manuscripts. The editorial department is committed to ensuring the rigor of the peer review process, while also making every effort to ensure a fast review cycle to meet the needs of authors and the academic community. Secondly, the editorial team of the International Journal of Clinical Case Reports and Reviews is composed of a group of senior scholars and professionals with rich experience and professional knowledge in related fields. The editorial department is committed to assisting authors in improving their manuscripts, ensuring their academic accuracy, clarity, and completeness. Editors actively collaborate with authors, providing useful suggestions and feedback to promote the improvement and development of the manuscript. We believe that the support of the editorial department is one of the key factors in ensuring the quality of the journal. Finally, the International Journal of Clinical Case Reports and Reviews is renowned for its high- quality articles and strict academic standards. The editorial department is committed to publishing innovative and academically valuable research results to promote the development and progress of related fields. The International Journal of Clinical Case Reports and Reviews is reasonably priced and ensures excellent service and quality ratio, allowing authors to obtain high-level academic publishing opportunities in an affordable manner. I hereby solemnly declare that the International Journal of Clinical Case Reports and Reviews has a high level of credibility and superiority in terms of peer review process, editorial support, reasonable fees, and journal quality. Sincerely, Rui Tao.
Clinical Cardiology and Cardiovascular Interventions I testity the covering of the peer review process, support from the editorial office, and quality of the journal.
Clinical Cardiology and Cardiovascular Interventions, we deeply appreciate the interest shown in our work and its publication. It has been a true pleasure to collaborate with you. The peer review process, as well as the support provided by the editorial office, have been exceptional, and the quality of the journal is very high, which was a determining factor in our decision to publish with you.
The peer reviewers process is quick and effective, the supports from editorial office is excellent, the quality of journal is high. I would like to collabroate with Internatioanl journal of Clinical Case Reports and Reviews journal clinically in the future time.
Clinical Cardiology and Cardiovascular Interventions, I would like to express my sincerest gratitude for the trust placed in our team for the publication in your journal. It has been a true pleasure to collaborate with you on this project. I am pleased to inform you that both the peer review process and the attention from the editorial coordination have been excellent. Your team has worked with dedication and professionalism to ensure that your publication meets the highest standards of quality. We are confident that this collaboration will result in mutual success, and we are eager to see the fruits of this shared effort.
