Small RNA Deep Sequencing Uncovers microRNAs Associated with Hearing Loss in Vestibular Schwannoma.

OBJECTIVE: To analyze the correlation between the miRNA expression profile in vestibular schwannoma (VS) tumor tissue and preoperative patient's hearing status, using the RNA-seq technique. METHODS: Nineteen tumor samples were collected from patients operated for VS in a Tertiary Academic Center. Samples were classified into "good hearing" and "poor hearing" study group based on the results of audiometric studies. Tumor miRNA expression was analyzed using high-throughput RNA sequencing (RNA-seq) technique, using NovaSeq 6000 Illumina system. Functional analysis was performed with the use of DIANA miRpath v. 4.0 online tool. RESULTS: The most overexpressed miRNAs in VS samples derived from poor hearing patients belonged to miR 449a/b, miR 15/16-1, and hypoxamiR families. Functional analysis showed that the differentially expressed miRNAs regulate cellular pathways associated with hypoxia, adherence junction functions, and signaling pathways such as Hippo, FOXO, MAPK, and Wnt signaling pathway. CONCLUSION: Our study identified a specific miRNA expression profile in VS tumor tissues that correlates with hearing impairment. These results suggest potential new molecular mechanisms related to hearing loss in the course of VS. LEVEL OF EVIDENCE: 3 (cohort study) Laryngoscope, 2024.

Effect of stapes demineralisation on the development of cochlear otosclerosis.

Objective: The involvement of the inner ear in otosclerosis may lead to the development of cochlear otosclerosis. The aim of this study was to analyse changes in the chemical composition and microstructure of the stapes in the course of otosclerosis compared to healthy stapes. Materials and methods: This analysis included 31 patients with otosclerosis and 9 patients without otosclerosis. Microanalytical and diffraction techniques were used to assess the elemental distribution and orientation topography of the stapes. Results: The concentration of Ca2+ in the study group was significantly lower in the area of the anterior crus of the stapes than in the posterior crus. A reduction in the Ca2+/P3+ ratio in the anterior crus was associated with deteriorated bone conduction and tinnitus. Degradation of the stapes microstructure in the area of otosclerotic lesions was observed with scanning electron microscopy. Conclusions: Bone remodelling is most significant at the closest location to typical otosclerotic lesions with hydroxyapatite porosity and scale-like bone formation according to scanning electron microscopy. There is a relationship between the disturbance of calcium metabolism and the development of clinical symptoms of cochlear otosclerosis.

High-throughput RNA sequencing identifies the miRNA expression profile, target genes, and molecular pathways contributing to growth of sporadic vestibular schwannomas.

PURPOSE: To assess the differences in the miRNA expression profile between small (stage I Koos classification) and large solid vestibular schwannoma (VS) tumors, using the RNA-seq technique. METHODS: Twenty tumor samples (10 small and 10 large tumors) were collected from patients operated for VS in a Tertiary Academic Center. Tumor miRNA expression was analyzed using high-throughput RNA sequencing (RNA-seq) technique, with NovaSeq 6000 Illumina system. Bioinformatics analysis was done using statistical software R. Gene enrichment and functional analysis was performed using miRTargetLink 2.0 and DIANA miRpath 3.0 online tools. RESULTS: We identified 9 differentially expressed miRNAs in large VS samples: miR-7, miR-142 (-3p and -5p), miR-155, miR-342, miR-1269, miR-4664, and miR-6503 were upregulated, whereas miR-204 was significantly down-regulated in comparison to small VS samples. Gene enrichment analysis showed that the most enriched target genes were SCD, TMEM43, LMNB2, JARID2, and CCND1. The most enriched functional pathways were associated with lipid metabolism, along with signaling pathways such as Hippo and FOXO signaling pathway. CONCLUSION: We identified a set of 9 miRNAs that are significantly deregulated in large VS in comparison to small, intracanalicular tumors. The functional enrichment analysis of these miRNAs suggests novel mechanisms, such as that lipid metabolism, as well as Hippo and FOxO signaling pathways that may play an important role in VS growth regulation.

3D-printed custom ossicular prosthesis - methodology of design and LDV measurements in a cadaver study.

OBJECTIVE: In tympanoplasty, surgical reconstruction of the tympanic membrane and ossicular chain is well-established; however, its hearing results still require improvement. Custom 3D printing of individualized ossicular prostheses seems to be an attractive solution for optimal prosthesis adjustment and better hearing results. AIM: The aim was to design a custom ossicular prosthesis using a 3D printing method based on Cone-beam Computed Tomography (CBCT) scans and assess the acoustic conduction properties of such prosthesis. MATERIAL AND METHODS: A cadaver fresh frozen temporal bone was used. Based on CBCT images, a new incus prosthesis was designed and 3D printed. Next, canal wall-up tympanoplasty was performed. The intact ossicular chain and reconstructed 3D-printed prosthesis chain movements/vibrations were measured with Laser Doppler Vibrometer (LDV) system and analyzed in detail. RESULTS: The CBCT scans provided enough information about the anatomical structures. For frequencies 500 and 1000 Hz and 80 dB SPL sound intensity, collected velocities were higher for the intact ossicular chain than the 3D-printed ossicular prosthesis. The intensity thresholds for movement at 500 and 1000 Hz were lower in the intact ossicular chain than in the 3D-printed ossicular prosthesis. At 2000 Hz, there was the same intensity threshold value in the two measured circumstances. CONCLUSION: It is possible to design a custom individually fitted ossicular prosthesis using a 3D printing method based on CBCT scans. The acoustic conduction properties of such 3D-printed prosthesis showed differences in movability pattern between the intact and reconstructed ossicular chain. More data are needed to analyze the acoustic properties of such designed prostheses in detail. The results of our experiment showed the 3D-printed prosthesis presents the potential to be an interesting option for conductive hearing loss treatment caused by chronic otitis media and the ossicular chain defects.

Sinus tympani revisited for planning retrofacial approach-radiologic study in pneumatized temporal bones and its surgical implications.

BACKGROUND AND PURPOSE: Retrofacial approach (RFA) is an access route to sinus tympani (ST) and it is used in cholesteatoma surgery, especially when type C ST is encountered. It may also be used to gain an access to stapedius muscle to assess the evoked stapedius reflex threshold. The primary object of this study was to evaluate the morphology of sinus tympani and its relationship to facial nerve (FN) and posterior semicircular canal (PSC) in context of planning retrofacial approach in pneumatized temporal bones. METHODS: CBCT of 130 adults were reviewed. The type of sinus tympani was assessed according to Marchioni's classification. Width of entrance to sinus tympani (STW), depth of ST (STD), distance between the posterior semicircular canal and facial nerve (F-PSC), distance between the latter plane to the floor of ST at the right angle (P-ST) were measured at level of round window (RW) and pyramidal ridge (PR). RESULTS: All of the bones were well-aerated and classified in Dexian Tan pneumatization group 3 or 4. Type B of ST is dominant (70.8%) in adult population with no history of inflammatory otologic diseases, followed by type C (22.7%) and then type A (6.5%). The depth of ST (STD) presented significant deviations (ANOVA, p < 0.05) among all three types. STW reaches greater values on the level of PR. F-PSC does not correlate with type of ST. In over 75% of examined type C sinus tympani the distance P-ST was less than 1 mm. CONCLUSIONS: The qualitative classification of the sinus tympani into types A, B and C, introduced by Marchioni is justified by statistically significant differences of depth between individual types of tympanic sinuses. The STW distance reaches greater values inferiorly-it may suggest that RFA should be performed in infero-superior manner rather than opposite direction. Preoperative assessment of temporal bones CT scans gives very important information about size of sinus tympani and distance between FN and PSC.

Solitary breast cancer metastasis to the facial nerve.

Facial nerve (FN) palsy, as a solitary symptom, resulting from metastatic tumor is not frequent. In this article, we report an unusual case of the breast cancer metastasis to the labyrinthine segment of a facial nerve.

Detailed insight into transtympanic electrocochleography (TT-ECochG) and direct cochlear nerve action potential (CNAP) for intraoperative hearing monitoring in patients with vestibular schwannoma - methodology of measurements and interpretation of results.

<b>Background:</b> The aim was to present the methodology and interpretation of intraoperative hearing monitoring with simultaneous Transtympanic Electrocochleography (TT-ECochG) and direct Cochlear Nerve Action Potential (CNAP) measurements during vestibular schwannoma removal. <br><b>Materials and Methods:</b> Detailed methodology of measurements and interpretation of results are presented in three exemplary patients who underwent tumor removal via middle fossa approach (MFA) with the use of intraoperative monitoring of hearing with TT-ECochG and direct CNAP performed in real time. In addition, all responses were automatically recorded and stored along with surgical information and subjected to detailed analyses and calculation after surgery. <br><b>Results:</b> The following changes in TT-ECochG and direct CNAP responses were observed: Patient #1 - TT-ECochG and CNAP responses with minor, but transient, morphology changes (hearing was preserved); Patient #2 - CNAP responses changed significantly but, temporarily, from triphasic into biphasic responses later, with marked but partially reversible desynchronization of CNAP; changes in TT-ECochG responses were also observed but, at the end, returned to baseline (surgery-related deterioration of hearing); Patient #3 - irreversible changes of TT-ECochG and direct CNAP (complete loss of hearing). <br><b>Conclusions:</b> A combination of TT-ECochG and direct CNAP allows for real-time monitoring of auditory function during vestibular schwannoma resection and surgical manipulation which contribute to the risk of hearing loss. Therefore, the surgeon can be instantly informed about changes which could increase the possibility of preserving the patient's hearing.

A rare case of benign teratoma of the facial fronto-temporal region in adult male.

Teratoma is a germ cell neoplasm composed of tissue derived from at least two of three blastodermic embryonic layers (ectoderm, mesoderm and endoderm). The incidence of teratoma in the head and neck region is rare, in particularly in adults. A CASE REPORT: We reported an uncommon case of teratoma in a 30 years male with a mass in the right fronto-temporal region of the face. Magnetic resonance imaging revealed a well encapsulated heterogenous mass with solid-cystic component extending from the fissure zygomatofrontal and the fissure zygomato-temporal. Serum alfa-fetoprotein levels were not elevated. Surgery was performed, the mass was completely removed, and microscopical analysis confirmed a diagnosis of mature benign teratoma. The patients showed no clinical signs of recurrence in 10 years follow-up. This case of teratoma is extraordinary due to three reasons: the location, the age of patient and benign nature of the tumor in patient at this age. Because such tumors occur exceptionally, each case should be studied with a long-term follow-up and reported.

Skull base osteomyelitis: factors implicating clinical outcome.

Skull base osteomyelitis is a serious disease with a high risk of complications including neuroinfection. Typically, the inflammation of the skull base results from infection from neighboring tissues. In case of malignant otitis externa, inflammation disseminates from the external auditory canal. In this study, we present our experience with seven patients diagnosed with skull base osteomyelitis that began with otitis externa and have been treated in our department for the last 10 years. Department Patient Database was searched for the diagnosis skull base osteomyelitis. The search covered the last 10 years. The search revealed seven patients who met the above-described criteria. Medical records of those patients were carefully analyzed including age, gender, symptoms and signs, diagnostics details, treatment, performed procedures, number of hospitalization days, comorbid diseases, and complications including any cranial nerve palsy. Detailed analysis of medical records of patients included in this study showed that skull base osteomyelitis presents a challenge for diagnosis and treatment. Treatment strategy requires prolonged aggressive intravenous antibiotic therapy, and in some cases combined with surgical intervention. Cranial nerve paresis indicates progression of the disease and is associated with longer hospital stay. Similar relationship is observed in patients with skull base osteomyelitis that required surgery. Diabetes in patient's medical history may complicate the healing process. Diabetes, neural involvement, and surgery may overlap each other resulting in longer hospital stay. Cranial nerve paresis may not resolve completely and some neural deficits become persistent.

Intraoperative endoscopy of the anterior epitympanum recess through the posterior tympanotomy.

INTRODUCTION: The anterior epitympanum recess (AER) is a common place of the development of the cholesteatoma, which is why removal of the matrix from this area plays a key role in the surgical treatment of chronic otitis media. AIM: To evaluate the intraoperative visibility of AER in endoscopic optics in comparison to microscopic optics and to determine the prevalence of cholesteatoma in various types of construction of the AER. Study design: retrospective analysis of intraoperative search. MATERIAL AND METHODS: The study included 55 patients treated in the Department of Otolaryngology, Medical University of Warsaw within the years 2009-2011, who underwent endoscopy-assisted canal wall up tympanoplasty with posterior tympanotomy. The type of construction of the AER - cellular or dome-shaped - was determined. RESULTS: Cellular type of recess was found intraoperatively in 32% of ears and dome-shaped in 68% of the study group. The population with chronic otitis media does not differ significantly compared to the general population in terms of the construction of the anterior epitympanum recess (p = 0.668108; χ2 = 0.1838235, df = 1). Among the ears with cholesteatoma a cellular AER was found in 48.3% of cases and a dome-shaped AER was found in 51.7%. CONCLUSIONS: The cellular type of AER was significantly more frequent in ears with cholesteatoma (p < 0.01, χ2 = 29.86492, df = 1). Level of evidence: 1b.

Methodology for Intraoperative Laser Doppler Vibrometry Measurements of Ossicular Chain Reconstruction.

OBJECTIVES: Despite the increasing number of research concerning the applications of the Laser Doppler Vibrometry (LDV) in medicine, its usefulness is still under discussion. The aim of this study is to present a methodology developed in our Department for the LDV intraoperative assessment of ossicular chain reconstruction. METHODS: Ten patients who underwent "second look" tympanoplasty were involved in the study. The measurements of the acoustic conductivity of the middle ear were performed using the LDV system. Tone bursts with carrier frequencies of 500, 1,000, 2,000, and 4,000 Hz set in motion the ossicular chain. The study was divided into four experiments that examined the intra- and interindividual reproducibility, the utility of the posterior tympanotomy, the impact of changes in the laser beam angle, and the influence of reflective tape presence on measurements. RESULTS: There were no statistically significant differences between the two measurements performed in the same patient. However, interindividual differences were significant. In all cases, posterior tympanotomy proved to be useful for LDV measurements of the ossicular prosthesis vibrations. In most cases, changing the laser beam angle decreased signal amplitude about 1.5% (not significant change). The reflective tape was necessary to achieve adequate reflection of the laser beam. CONCLUSION: LDV showed to be a valuable noncontact intraoperative tool for measurements of the middle ear conductive system mobility with a very good intraindividual repeatability. Neither a small change in the angle of the laser beam nor performing the measurements through posterior tympanotomy showed a significant influence on the results. Reflective tape was necessary to obtain good quality responses in LDV measurements.

[Tuberculoma mimicking the tumor of ponto-cerebellum angle as complication after postvaccinated tuberculous otitis media]. / Poszczepienne gruzlicze zapalenie ucha srodkowego i jego powiklania - opis przypadku.

INTRODUCTION: Tuberculosis is a major problem of constant importance all over the world. Notably, in the developed countries it is due to immunosuppressive therapy and AIDS. Primary otological tuberculosis constitutes a very small share of cases of this disease. Moreover, the appearance of tuberculomas remains unique to even greater extent. CASE REPORT: Clinical history of a patient who has already been infected tuberculosis for 60 years in result of the BCG vaccination. Ponto-cerebellum angle tumour appeared in his brain as complication ensuing the disease. The first therapeutic method used was based on antituberculous drugs, subsequent surgical intervention (cerebello-pontine angle tumor removal via translabirynthin approche) was necessary however. We suspected another cause of this lesion - cholesteatoma or facial nerve neurinoma. Correct diagnosis give only histopatological examination. Because of facial nerve palsy, facial nerve reconstruction was necessary (connection of n. VII and n. XII) CONCLUSION: This case reminds us that correct diagnosis of tuberculosis remains a serious problem despite the long experience and the development of diagnostics and treatment methods. Nowadays we observe the unusual clinical manifestations of the disease (e.g. such as ear pain, tinnitus, rapid hearing loss) more frequently.

[Facial nerve neurinomas]. / Nerwiaki nerwu twarzowego.

INTRODUCTION: Evaluation of diagnostic, surgical technique, treatment results facial nerve neurinomas and its comparison with literature was the main purpose of this study. METHOD AND MATERIALS: Seven cases of patients (2005-2011) with facial nerve schwannomas were included to retrospective analysis in the Department of Otolaryngology, Medical University of Warsaw. All patients were assessed with history of the disease, physical examination, hearing tests, computed tomography and/or magnetic resonance imaging, electronystagmography. Cases were observed in the direction of potential complications and recurrences. RESULTS: Neurinoma of the facial nerve occurred in the vertical segment (n=2), facial nerve geniculum (n=1) and the internal auditory canal (n=4). The symptoms observed in patients were analyzed: facial nerve paresis (n=3), hearing loss (n=2), dizziness (n=1). Magnetic resonance imaging and computed tomography allowed to confirm the presence of the tumor and to assess its staging. Schwannoma of the facial nerve has been surgically removed using the middle fossa approach (n=5) and by antromastoidectomy (n=2). Anatomical continuity of the facial nerve was achieved in 3 cases. In the twelve months after surgery, facial nerve paresis was rated at level II-III° HB. There was no recurrence of the tumor in radiological observation. CONCLUSION: Facial nerve neurinoma is a rare tumor. Currently surgical techniques allow in most cases, the radical removing of the lesion and reconstruction of the VII nerve function. The rate of recurrence is low. A tumor of the facial nerve should be considered in the differential diagnosis of nerve VII paresis.

[Application of the endoscopy in the middle ear surgery]. / Zastosowanie endoskopii w operacjach ucha srodkowego.

Endoscopy is used in the middle ear surgery for above twenty years when decrease of cholesteatoma recurrence due to employing endoscope was revealed in comparison to standard microscopic only visualisation. Endoscopy may be the only way of visualisation in transcanal myringoplasty for the retraction pocket, stapedoplasty and transcanal ossiculoplasty. In canal wall up or second look tympanoplasty with mastoidectomy and posterior tympanotomy endoscopy may serve as an additional point of view supported the classical microscopical technique. In result of many manners in surgical treatment of chronic otitis media, there are very concept for endoscopy application. In the ENT Department at Medical University of Warsaw were performed 53 procedures by aid of endoscopy in period from September 2009 to December 2010. In this study there were 18 canal wall up tympanoplasties, 12 second look tympanoplasties and 8 canal wall down tympanoplasties. According to authors' experience endoscopy is the most useful in: There were three cases of cholesteatoma recurrence in the study found only due to endoscope support. In authors' opinion, the endoscopy is the useful tool in surgical treatment of chronic otitis media. Application of endoscopy during the middle ear surgery results in decrease in frequency of cholestatoma recurrence and increase in the effectiveness of the ossiculoplasty.

[The methodology of measurements of ossicular chain movability during tympanoplasty using Laser Doppler vibrometry]. / Metodologia pomiarów ruchomosci elementów ucha srodkowego za pomoca laserowej wibrometrii dopplerowskiej.

INTRODUCTION: Laser Doppler vibrometry can potentially be applied in the measurement of the acoustic conductivity of the middle ear during tympanoplasty. Its usefulness in estimating the accuracy of ossiculoplasty requires experimentally verified. AIM: The article presents the test procedure developed at the Department of Otolaryngology, Medical University of Warsaw for the displacement measurement of the conductive elements of the middle ear. MATERIALS AND METHOD: In the study were used 14 fresh-frozen temporal bones. In the initial stage was performed antrotomy with posterior tympanotomy. During the measurements, ER-2 speakers generated a signal with a frequency of 1000 Hz, 2000 Hz, 4000 Hz, 8000 Hz. Acoustic conductivity of the middle ear was measured on the back branch of the stapes, round window. Laser Doppler Vibrometer was used to measure velocity of each selected elements of the ear. In four experiments were assessed the intraoperative availability of measurement points, the impact of laser beam angle changes and the presence of reflective tape on the amplitude of vibration measured point, intra- and interindividual variability of the method. RESULTS: For all measured frequencies intra-individual differences were no statistically significant. There were observed large differences between the velocity values in various temporal bones. Changing the angle of the laser beam does not significantly affect the results. Mucosal surface of the tympanic cavity does not reflect the laser beam. CONCLUSION: Laser Doppler vibrometry can be used to measure motion of the middle ear sound conductivity with very good repeatability of measurements. Changing the angle of the laser beam should not vary amplitude of measurement during surgery. To maintain the sensitivity of response, it is necessary to use part of reflective tape.

Hemihypoglossal-facial nerve anastomosis for facial nerve palsy.

BACKGROUND AND PURPOSE: Commonly used classic hypoglossal (CN XII) to facial nerve (CN VII) anastomosis has the disadvantage of tongue hemiatrophy. Thus, various attempts have been made to modify this method to reduce the tongue damage. The aim of this report was to present the results of hemihypoglossal-facial nerve anastomosis (HHFA) technique in relation to facial muscles reanimation and hemitongue atrophy. MATERIAL AND METHODS: The first 7 consecutive patients who underwent CN VII anastomosis with half of the CNXII, for which the follow-up period exceeded 12 months, were analysed. During the procedure, CN VII was transected as proximally as possible after drilling the mastoid process. CN XII was separated longitudinally into two parts at a short distance to allow suture of the stumps without any tension. One half of CN XII was transected and sutured to the distal stump of CN VII. Recovery from facial palsy was quantified with the House-Brackmann grading system (HB). Tongue function was assessed according to the scale proposed by Martins. RESULTS: Features of initial reinnervation of facial muscles were visible after 6 months in all 7 patients. All patients achieved satisfactory outcome of CN VII regeneration (HB grade III) until the last control examination (12-27 months after surgery, mean 16). No or minimal tongue atrophy without deviation (grades I-II according to the Martins scale) was found in 4 patients. Mild hemiatrophy with tongue deviation < 30 degrees (grade III) was visible in 3 patients. CONCLUSIONS: In our experience, HHFA is effective treatment of facial palsy and gives a chance to reduce damage of the tongue.

[Treatment results of temporal bone area paragangliomas]. / Wyniki leczenia przyzwojaków kosci skroniowej.

INTRODUCTION: Temporal bone paragangliomas are rare, benign neuroendocrine tumors. Depend on their location at skull base, they can extend intracranially and extracranially. They characterize by slowly growth and late nonspecific clinical manifestation. Location of tumor and anatomical condition require suitable operational technique and cause related complications. AIM: The aim of this study was analysis of surgical procedure and evaluation of treatment results of patients with paragangliomas of the temporal bone hospitalized in Department of Otolaryngology of Warsaw Medical University in years 2000-2010. MATERIAL AND METHODS: 34 cases of patients were retrospectively studied. Clinical data, level of tumor advancement according to Glasscock & Jackson and Fisch classification were analyzed. Intraoperative and imaging studies data were used to evaluate extent of lesions. Suitable operative approaches and outcome of treatment were also analyzed. CONCLUSION: In group of 34 patients 26 of them had monocentric and 8 multicentric neoplasms. Age ranged 15-73-years-old. Most common symptoms were: loss of hearing, tinnitus and headache. Preoperative embolization was carried in 10 cases. Most common surgery technique: tympanotomy and hypotympanotomy posterior and infratemporal fossa of Fisch type A approaches. Radiotherapy was used in 2 cases and surgery with radiation therapy in 7 cases. Most commonly observed complication in surgical treatment was intermittent paresis.

[Ear carcinomas in Department of Otolaryngology of the Medical University of Warsaw in years 2004-2008]. / Raki ucha w materiale Kliniki Otolaryngologii Warszawskiego Uniwersytetu Medycznego w latach 2004-2008.

Ear carcinoma constitutes 0.5% of all cancers of the head and neck hardly, however with poor prognosis. In the study we use University of Pittsburgh Staging System. This study is retrospective analysis of the surgical treatment outcomes of the patients with external and middle ear carcinomas in the ENT Department at the Medical University of Warsaw in years from 2004 to 2008. Histopatologicallly, there were:18 squamous cell carcinoma, 17 basal cell carcinoma, 2 neuroendocrine carcinoma, basal cell adenocarcinoma and 1 metatypical carcinoma. Tumors were localised: ear concha in 19 patients, external auditory canal in 6 patients, middle ear in 3 patients, temporal bone and skull base in 9 patients. Among 19 tumors of the auricle, basal cell carcinoma occured the most often (12 patients - 63%), following squamous cell carcinoma (6 patients - 31%), in one case (6%) metatypical carcinoma was confirmed. There were 18 tumors of external auditory canal and tumors with temporal bone involvement in stage T1-T4. In this group 8 subtotal temporal bone resection were performed, however in 5 cases tumor was not totally excised. Additional radiotherapy was performed in 5 patients, 5 died of the disease, three had recurrence in the period of the study and 8 had confirmed metastasis into the breast, lung, cervical and mediastinal lymph nodes. Generally, in this group of patients, 6 died (33%) of the disease in the period from one month to 2 years after surgery. In 6 tumors with no evidence of bone involvement resection limited to the tumor was performed. In 2 tumors of external auditory canal the resection was totally and the patients have no recurrence (100%). Squamous cell carcinoma has poor prognosis, but early diagnosis gives the chance for long-term survival.