What is ear cancer?

Ear cancer is when abnormal cells in the ear start to grow and divide in an uncontrolled way. 

Most of these cancers start in the skin of the outer ear. Between 6 and 10 out of 100 skin cancers (between 6 and 10%) develop on the outer ear.

Cancers that develop inside the ear (the middle and inner ear) are rare.

The ear

There are 3 parts to the ear:

• the outer ear
• the middle ear
• the inner ear

Another important part is the bone that surrounds and protects the ear (the temporal bone).

The outer ear

The outer ear is the part of the ear we can see. It protects the rest of the ear and helps us collect sound. 

There are 3 parts to the outer ear:

• the ear flap or pinna
• the ear canal (meatus)
• the eardrum (tympanic membrane)

The eardrum vibrates when a sound is made.

The ear canal

The ear canal is the passage running from the outer ear to the middle ear. It is also called the meatus. 

It is part of the outer ear, but the stages, symptoms, and treatment of ear canal cancer are different to other cancers of the outer ear. 

The middle ear

The middle ear is a small cavity that contains 3 small bones: the hammer (malleus), the anvil (incus) and the stirrup (stapes). These pass on the vibrations from the eardrum to the inner 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.

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.

What are the causes of ear cancer?

The cause of ear cancer is largely unknown.

The ear flap

Risk factors for cancer of the ear flap include:

• having fair skin
• exposure to ultraviolet sunlight

The middle ear

People with a history of repeated ear infections over a long time have a higher risk of developing cancer in the middle ear. Doctors are not yet clear why this happens.

Cancer of the temporal bone and inner ear

Cancer of the temporal bone is rare. The possible causes are cancers extending from the ear flap. Or cancers from the parotid gland or lymph nodes around the ear can spread to the temporal bone.

Inner ear cancer is also rare, the causes are not yet fully known.

Other possible risk factors 

Some doctors think that the human papilloma virus (HPV) may be responsible for some middle ear cancers.

Another risk factor is the possibility of cancers developing in the ear after radiotherapy to the head and neck. 

For both of these more research is needed to give doctors more information. 

What are the symptoms of ear cancer?

The symptoms of ear cancer depend on where the tumour is within the ear.

Ear flap

The main symptom is a spot or sore on the ear flap that doesn’t heal within 4 weeks.

Most squamous cell cancers are pink lumps that have a hard scaly surface. They often bleed easily and ulcerate.

You should tell your doctor about any changes to a sore or mole, such as the mole growing, itching, or bleeding.

Ear canal

Symptoms can include:

• pain
• discharge from the ear
• loss of hearing
• a lump in the ear canal
• weakness in your face
• bleeding from the ear

Middle ear

The most common symptom is a discharge from the ear which may be blood stained. Other symptoms include:

• hearing loss
• earache
• you cannot move your face on the side of the affected ear

Inner ear

Symptoms include:

• pain
• headache
• hearing loss
• tinnitus (noises, such a ringing, heard in the ear)
• dizziness

Some people with ear cancer might also have swollen lymph nodes in their neck.

Tests

A biopsy

The only way to confirm a diagnosis of cancer is to take a small amount of tissue (biopsy) from the abnormal area of the ear. A specialist doctor (pathologist) then examines this under a microscope. 

Before your doctor takes the biopsy, you usually have a local anaesthetic to numb the area so you don’t have any pain. Biopsies of the middle ear can be difficult to take. So in this situation, you might have a general anaesthetic instead. 

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.

Scans

You might have an MRI scan or a CT scan if the biopsy shows you have cancer. The scan will show where the cancer is and how big it is. This helps your doctor decide which treatment you need.

Occasionally you might have scans before a biopsy. This may be because it’s not possible to have a biopsy. For example, the cancer is in a difficult place to take a biopsy.

You might have a PET-CT scan to check if the cancer has spread to other parts of the body.

Hearing test 

Your doctor may suggest you have a hearing test before you have your treatment. This is to check how well you can hear in your other ear (the ear that is not having treatment). You may sometimes lose your hearing in the treated ear. So you might need a hearing aid for the other ear if your hearing is not very good.

What types of ear cancer are there?

The most common type of ear cancer is squamous cell cancer. Other types of cancer of the ear canal, middle or inner ear include:

• basal cell cancer
• melanoma
• adenoid cystic
• adenocarcinoma

Treatment

Treatment includes surgery, radiotherapy and sometimes chemotherapy