Ear

Question 1

Ear

Which portion of the EAM is bony and slightly narrower?

Answer 1

inner 2/3

Question 2

Ear
EAM

organs/landmark located anterior to the EAM at the TMJ

Answer 2

parotid gland

Question 3

Ear
EAM

organs/landmark located posterior to the EAM at the TMJ

Answer 3

mastoid process

Question 4

Ear
EAM

organs/landmark located inferior to the EAM

Answer 4

jugular bulb

facial nerve

Question 5

Ear

Which is TRUE regarding the EAM?

I. The lining of the entire auditory canal is continuous with that of the auricle.

II. the outer 2/3 contains hair follicales and sebaceous and ceruminous glands.

Answer 5

I only.
***

It’s outer 1/3 not outer 2/3

Question 6

Ear

What is the epithelial lining of the tympanic membrane?

Answer 6

squamous

Question 7

Ear

What is the epithelial lining of the eustachian tube?

Answer 7

stratified columnar

Question 8

Ear

The inner ear has no lympahatics.

TRUE or FALSE?

Answer 8

True.

Question 9

Ear

The posterior and superior aspects of the auricle drain into the retroauricular lymph
nodes, and the lobule drains into the superficial cervical group of lymph nodes.

Where do the lymphatics of the tragus and anterior portion of the auricle drain?

Answer 9

superficial parotid nodes.

Question 10

Ear

More women than men have middle ear tumors, but more men have tumors of the external ear.

TRUE or FALSE?

Answer 10

True.

Question 11

Ear

What is a common tumor of the external ear that presents as small ulcerations, mostly on the helix?

Answer 11

BCC

Question 12

Ear

Arrange the following nodes according to the highest frequency of involvement in SCC of the external ear.

parotid
upper deep cervical
postauricular

Answer 12

AS IS

Question 13

Ear

This imaging modality can show abnormal soft tissue, soft tissue enhancement, and distortion of the normal
tissue planes. Most importantly, when evaluating EAC tumor, it can provide
accurate prediction of bone erosion, such as wall of the EAC, middle ear, TMJ,
carotid artery canal, and jugular fossa and thus can help to determine the
extension and the operability of tumors.

Answer 13

CT

Question 14

Ear

A bone scan is usually routinely recommended to determine changes in the temporal bone around the tumor.

TRUE or FALSE?

Answer 14

False.
***
it provides
very nonspecific information and is not a recommended method of evaluation

Question 15

Ear

What type of tumors comprises 85% of auditory canal, middle ear, and mastoid involvement?

Answer 15

SCC

Question 16

Ear

Endolymphatic sac tumor or aggressive papillary middle ear
tumors are distinct from middle ear adenomas and are rarely aggressive. They are
characterized by slow growth. Extensive local invasion and bone destruction are very rare.

TRUE or FALSE?

Answer 16

False.

They are agressive tumors

Question 17

Ear

Lesions of the _____ ear are usually more easily controlled
and are usually diagnosed earlier than are lesions on the other sites.

Answer 17

External

Question 18

Ear

____ cranial nerve palsy associated with middle ear
tumors indicates poor survival showed in pooled-data survival analysis, and have
been adopted into staging system.

Answer 18

Seventh (7th)

CN VII

Question 19

Ear

Spread of tumors to the lymph nodes usually
indicates a poor prognosis because this is often a late event in the natural history
of the disease.

TRUE or FALSE?

Answer 19

True.

Question 20

Ear

Pittsburgh Tumor Staging of the EAC.

Tumor eroding the osseous EAC (full thickness) with limited (<0.5 cm) soft tissue
involvement

Answer 20

T3

Question 21

Ear

Pittsburgh Tumor Staging of the EAC.

Tumor eroding the osseous EAC (not thickness) with limited (<0.5 cm) soft tissue
involvement

Answer 21

T2

Question 22

Ear

Pittsburgh Tumor Staging of the EAC.

Tumor involving the middle ear and/or mastoid.

Answer 22

T3

Question 23

Ear

Pittsburgh Tumor Staging of the EAC.

Tumor with extensive soft tissue involvement (>0.5 cm)

Answer 23

T4

Question 24

Ear

Pittsburgh Tumor Staging of the EAC.

Tumor eroding the cochlea, petrous apex, medial wall of the middle ear, carotid canal,
jugular foramen, or dura, or with extensive soft tissue involvement (>0.5 cm), such as
involvement of TMJ or styloid process, or evidence of facial paresis

Answer 24

T4

Question 25

Ear

Pittsburgh Tumor Staging of the EAC.

Tumor limited to the EAC without bony erosion or evidence of soft tissue involvement

Answer 25

T1

Question 26

Ear

AJCC staging

Tumor >2 cm in greatest dimension or tumor any size with two or more high-risk
features

Answer 26

T2

Question 27

Ear

What are the high-risk features in the AJCC staging?

Answer 27

> 2-mm thickness

Clark level ≥ IV

PNI

anatomic primary on ear or hair-bearing lip

poorly diff/undiff

Question 28

Ear
Management: External Ear

Treatment of draining lymphatics is normally not required for early stages of
external ear tumors.

TRUE or FALSE?

Answer 28

True.

Afzelius et al. indicate that lesions >4 cm and those with
cartilage invasion have an increased risk of nodal spread; they recommend
prophylactic neck dissection.

Most investigators do not agree with this
approach because the overall chance of lymph node involvement in tumors of
the external ear is only 16%.

Question 29

Ear
Management: External Ear

Radical surgery followed by postoperative radiation therapy is an acceptable method of treatment for more advanced lesions of the external auditory canal and lesions in the middle ear and mastoid.
Pfreundner et al. recommended a postoperative radiotherapy dose of __to__ Gy for patients with negative margins.

Positive margins warrant higher doses of __ Gy because of higher recurrence rates.

Except in tumors that are detected early, neither modality alone is considered optimal, and a combination of the two produces the best results.

Answer 29

54 to 60

66

Question 30

Ear
Management: EAC and middle ear

What is the treatment for outer EAC tumor with no invasion of the mastoid?

Answer 30

local excision with at least 1-cm margin between the lesion and TM.
+/- split-thickness skin graft

Question 31

Ear
Management: EAC and middle ear

What is the treatment if EAC tumor involves the bony canal with impingement of the TM?

Answer 31

surgery.

partial temporal bone resection may be necessary.

in this procedure, the auditory canal,
tympanic membrane, malleus, and incus are removed along with the TMJ, and
the defect is grafted with a split-thickness skin graft

+/-RT depending on margin status.

Question 32

Ear
Management

For RT of lesions of the pinna, what is the usual margins using electrons for “small superficial” tumors?

Answer 32

1 cm

Question 33

Ear
Management

For RT of lesions of the pinna, what is the usual margins using electrons for “larger tumors” tumors?

Answer 33

2- to 3-cm

encompass the entire pinna or EAC

Question 34

Ear
Management

What should be the daily dose for the pinna to avoid necrosis?

What is the total dose required to achieve adequate tumor control?

Answer 34

1.8 to 2 Gy

66 Gy

Question 35

Ear
Management

Large lesions of the EAC are treated with RT and surgery. RT portals should encompass the entire ear and temporal
bone with an adequate margin (3 cm).

The volume treated should always include the
ipsilateral preauricular, postauricular, jugulodigastric subdigastric lymph nodes, and levels II & III cervical nodes.

TRUE or FALSE?

Answer 35

False.

Treating lymphatics beyond the jugulodigastric area is usually not necessary

Question 36

Ear
Management

In using IMRT for the definitive treatment of advanced external ear or middle ear cancers, what is the GTV?

Answer 36

clinical and radiographic gross disease

Question 37

Ear
Management

In using IMRT for the definitive treatment of advanced external ear or middle ear cancers, what is the CTV1?

Answer 37

GTV + 0.3 to 0.5 cm margin

Question 38

Ear
Management

In using IMRT for the definitive treatment of advanced external ear or middle ear cancers, what is the CTV2?

Answer 38

CTV1 + 0.5 to 0.7 margin

\+ nodes
preauricular
postauricular
ipsilateral upper neck (II)
parotid gland

Question 39

Ear
Management

In using IMRT for the definitive treatment of advanced external ear or middle ear cancers, what is the CTV3?

Answer 39

CTV3 for advanced and aggressive disease

contralateral upper neck (II)
ipsilateral middle and lower neck (III and IV)

Question 40

Ear
Management

In using IMRT for the definitive treatment of advanced external ear or middle ear cancers, what is the dose for CTV1?

Answer 40

66 to 70/ 2 / 33-35

Question 41

Ear
Management

In using IMRT for the definitive treatment of advanced external ear or middle ear cancers, what is the dose for CTV2?

Answer 41

63/1.8/35

Question 42

Ear
Management

In using IMRT for the definitive treatment of advanced external ear or middle ear cancers, what is the dose for CTV3?

Answer 42

56/1.6/35

Question 43

Ear
Management

In using IMRT for the postoperative treatment of advanced external ear or middle ear cancers, what is the CTV1?
(Chen et al.)

Answer 43

CTV1 includes the original tumor region, surgical bed, soft tissue invasion, areas with positive residual disease, or positive margins to a dose of 60 to 66 Gy at 2 Gy per fraction.

Question 44

Ear

What should be the dose limit for the cochlea when using conventionally fractionated RT to reduce SNHL?

Answer 44

45 Gy mean dose

or more conservatively at 35 Gy

Question 45

Ear

What should be the dose limit for the temporal bone when using conventionally fractionated RT to reduce ORN?

Answer 45

70 Gy