Treatment for cancer of the ear canal, middle and inner ear

The main treatment for cancer that starts in the ear canal, middle and inner ear or the bone is surgery.

Radiotherapy is often given after surgery. Some people may have it instead of surgery if the cancer cannot be removed.

Depending on the stage of your cancer you may also have chemotherapy.

The ear canal is actually part of the outer ear. But it is included in this section about middle and inner ear cancer. This is because the treatment of ear canal cancer is different from outer ear cancer. 

Cancers that start inside the ear are rare. 

How your doctor decides on treatment

The treatment you have depends on:

• where in the ear the cancer is
• the type of cancer
• the size of the cancer
• 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 radiotherapy
• specialists in cancer drugs
• dentists
• specialist nurses, physiotherapists and dieticians

Stages

The stage tells you how big the cancer is and whether it has spread. Developing a staging system is difficult when there are not many people with the cancer. There are different staging systems for cancer of the ear. Working out the stage of the cancer helps your doctor to decide about treatment.

Generally an early stage cancer is small and 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. 

TNM staging

For cancers of the ear canal and middle ear doctors can use the TNM staging system.

• T describes the size of the tumour
• N describes whether there are any cancer cells in the lymph nodes
• M describes whether the cancer has spread to a different part of the body

The T 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

Surgery

The type and amount of surgery you need depends on where the cancer is and whether it has spread into surrounding tissues or nearby structures like bone.

Your surgeon will remove the cancer together with an area of tissue surrounding it that is completely free of cancer cells. The area is called a clear margin. It helps lower the risk of the cancer coming back.

Your surgeon might remove some or all of the following:

• the ear canal
• part or all of the temporal bone
• the middle ear
• the inner ear
• lymph nodes around the 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 might need to remove the facial nerve. This runs down the side of the face and through the salivary gland.

After your operation

Risk of a wound infection

Tell your doctor or nurse if your wound:

• looks red or swollen
• feels warm
• is painful
• leaks fluid (discharge)

These are signs of infection. You may also feel unwell and have a temperature.
If you have an infection, your doctor will give you antibiotics.

Your wound and operation scar

You will have stitches or clips and a dressing over your wound. Your stitches or clips might need to stay in for up to 10 days.

Your scar line is likely to be behind your ear or in a natural crease on your face. Surgeons are particularly skilled in removing the cancer and rebuilding the area. So most people won’t look any different afterwards.

Before your operation, ask your surgeon how the surgery will affect your appearance. It can help if you know what to expect.

Drains and tubes 

When you wake up you might have a drip (intravenous infusion) into your arm to give you fluids until you are eating and drinking again.
There will also be 1 or 2 small tubes near your wound to drain any fluid. The tubes help to reduce swelling. They take a couple of days to stop draining fluid before your nurse or doctor takes them out.

Pain relief 

You will have some pain after most types of surgery, but this is usually well controlled. Your doctors and nurses give you painkillers by drip, tablets, or liquids if you need them.

You get painkillers to take home. Follow the instructions your nurse gives you about how often and when to take them. Contact your doctor if you still have pain or if it gets worse.

Hearing and balance

It is unlikely that you will be able to hear on that side if the surgeon removes your middle and inner ear. You might find that your balance is affected and you feel dizzy.

It might be possible for the surgeon to rebuild (reconstruct) some of the ear so that you can hear.

Nerve damage

The nerves controlling movement and feeling in your face and mouth can be affected by the cancer or by surgery. The symptoms you might have depend on the type of surgery you have. You may have:

• numbness around the wound
• problems moving the lower lip
• numbness and loss of sensation in the tongue
• problems closing your eye

These are often temporary, but sometimes they may not fully recover. Rarely they may be permanent.

How long you need to spend in the hospital depends on your operation. Your doctor or nurse will tell you what to expect beforehand.

Radiotherapy

Radiotherapy uses high energy rays to treat cancer.

You might have radiotherapy called intensity modulated radiotherapy (IMRT). This is a type of conformal radiotherapy. Conformal radiotherapy shapes the radiation beams to closely fit the area of cancer.

You might have radiotherapy:

• as your main treatment
• after surgery, if your surgeon hasn’t been able to remove a clear margin of tissue from around the tumour
• with chemotherapy (chemoradiotherapy)

Radiotherapy after surgery can lower the risk of the cancer coming back.

You usually have radiotherapy daily from Monday to Friday. Your specialist will tell you how long you will have radiotherapy treatment. It might be between 4 and 7 weeks.

At your first appointment, your radiotherapy doctor plans your treatment. This planning appointment takes a couple of hours but after that, each treatment only takes a few minutes.

Chemotherapy

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

Researchers are looking at giving chemotherapy with radiotherapy before or after surgery. They want to find out how well this works and when it is best to have chemotherapy.

The chemotherapy drugs you might have include fluorouracil and cisplatin.

Follow up

You 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

Coping with a diagnosis of a rare cancer can be especially difficult. Being well informed about your cancer and its treatment can help. It can make it easier to make decisions and cope with what happens.

Talking to other people who have the same thing can also help.

Our discussion forum Cancer Chat is a place for anyone affected by cancer. You can share experiences, stories and information with other people.

You can call our nurse freephone helpline on 0808 800 4040. They are available from Monday to Friday, 9am to 5pm. Or you can send them a question online.

The Rare Cancer Alliance offer support and information to people with rare cancers. It has a forum where you might be able to meet others with the same cancer as you.