Carcinoma Of Middle Ear Research Articles

Middle ear squamous cell carcinoma: a case report

<p class="abstract">Squamous cell carcinoma of middle ear is a rare entity. We present a case of 77 year old male, with squamous cell carcinoma of middle ear. Patient presented with blood tinged otorrhoea. Oto-endoscopy examination revealed a soft tissue lesion in middle ear which bled on touch. Histopathological study of this soft tissue lesion gave a diagnosis of well differentiated squamous cell carcinoma. Radical clearance of the tumour achieved after removal of the malleus and incus. Tumour was seen extending into the eustachian tube orifice and it was removed in toto. Uderlying bone was ablated using diode laser to confirm the radical clearance. Later patient was given radiotherapy 6 weeks after surgery to allow the healing of the operative site. The objective to report this case was to emphasize the importance of early diagnosis and prompt treatment for a better survival. Long standing history of ear discharge with soft tissue lesion bleeding on touch should always be evaluated by histopathological study to exclude malignancy.</p>

Analysis of the effect of one-stage revascularization with internal carotid artery resection on cervical metastatic carcinoma in advanced head and neck carcinomas

Objective:To analyze the therapeutic effect of internal carotid artery resection and one-stage revascularization in advanced cervical metastatic carcinoma. Method:Twenty-one patients with advanced head and neck malignant tumors who underwent internal carotid artery resection and one-stage revascularization were analyzed retrospectively. Among those, 11 patients suffered from hypo-pharyngeal carcinomas, 5 laryngeal carcinomas, 2 external auditory carcinomas, 1 middle ear carcinoma, and 2 parotid gland carcinomas. All patients received CT, MRI, DSA and other examinations before operation. It was found that all the internal carotid artery walls had been invaded by tumors, and there were different degrees of lumen stenosis. Autogenous saphenous vein grafts were used in 18 cases; artificial vessels were used in 3 cases. After revascularization, pedicled or free flaps were used to protect the anastomotic areas. All patients were treated with radiotherapy and chemotherapy according to different situations. Result:Among the 21 cases, 16 cases underwent reconstruction of cervical segment internal carotid and 5 cases were the skull base segment internal carotid. Twenty patients were successfully reconstructed in the first stage, and no vascular reconstruction-related nervous system complications occurred after operations. Postoperative imaging showed that the reconstructed blood vessels were well recanalized, with a success rate of 95.2%（20/21）. Only 1 case received ligation of internal carotid artery after the failure of vascular reconstruction. Among all the cases, the 1-year survival rate and 3-year survival rate were 90.5% and 40.4%, respectively. Conclusion:In patients with advanced head and neck malignant tumors with cervical metastatic cancer invading the internal carotid artery, one-stage revascularization after radical resection of the tumor and the internal carotid can achieve good therapeutic effect. Careful preoperative evaluation, proficient vascular anastomosis technology, adequate risk assessment and prevention are the key to the success of the operations.

Prognostic Factors and Management of Squamous Cell Carcinoma of External Auditory Canal and Middle Ear – A Single Institutional Experience.

Prognostic Factors and Management of Squamous Cell Carcinoma of External Auditory Canal and Middle Ear – A Single Institutional Experience.

A retrospective multicenter study of carbon-ion radiotherapy for external auditory canal and middle ear carcinomas.

BackgroundWe conducted a retrospective multicenter study to assess the clinical outcomes of carbon‐ion radiotherapy (CIRT) for head and neck malignancies (Japan Carbon‐Ion Radiation Oncology Study Group [J‐CROS] study: 1402 HN). We aimed to evaluate the safety and efficacy of CIRT in patients with external auditory canal (EAC) and middle ear (ME) carcinomas.MethodsThirty‐one patients treated with CIRT at four Japanese institutions were analyzed. Fourteen patients (45.2%) had squamous cell carcinomas, 13 (41.9%) had adenoid cystic carcinomas, and four (12.9%) had other types. Nineteen (61.3%), six (19.4%), three (9.7%), and three (9.7%) patients had T4, T3, T2, and T1 disease, respectively. All patients had N0M0 status. The median radiation dose was 64 Gy (relative biological effectiveness) in 16 fractions. The median gross tumor volume was 33.3 mL.ResultsThe median follow‐up period was 18.4 months (range, 5.1‐85.6). The 1‐ and 3‐year local control and overall survival rates were 75.0% and 55.0% and 79.3% and 58.7%, respectively. Regarding grade 3 or higher toxicities, three patients (9.7%) had grade 3 dermatitis, one (3.2%) had grade 3 mucositis, and two (6.5%) had grade 3 central nervous necrosis (ie, radiation‐induced brain necrosis). No grade 4 or worse reactions were observed.ConclusionCIRT was effective for EAC and ME carcinomas.

Tumor Stage-Related Role of Radiotherapy in Patients with an External Auditory Canal and Middle Ear Carcinoma.

PurposeThe purpose of this study was to evaluate the clinical outcomes of patients treated with radiotherapy (RT) for a carcinoma of the external auditory canal (EAC) and middle ear.Materials and MethodsThe records of 32 patients who received RT from 1990 to 2013 were reviewed retrospectively. The Pittsburgh classification was used to stage all the cancers (early stage, T1/T2 [n=12]; advanced stage, T3/T4 or N positive [n=20]). Twenty-one patients (65.6%) were treated with postoperative RT and 11 patients (34.4%) were treated with definitive RT. The median radiation doses for postoperative and definitive RT were 60 Gy and 64.8 Gy, respectively. Chemotherapy was administered to seven patients (21.9%).ResultsThe 5-year overall survival and disease-free survival rates for all patients were 57% and 52%, respectively. The disease control rates for the patients with early stage versus advanced stage carcinomawere 55.6% (5/9) and 50% (6/12) in the postoperative RT group and 66.7% (2/3) and 37.5% (3/8) in the definitive RT group, respectively. Overall, 15 cases (14 patients, 46.7%) experienced treatment failure; these failures were classified as local in four cases, regional in one case, and distant in 10 cases. The median follow-up period after RT was 51 months (range, 7 to 286 months).ConclusionPatients with early stage carcinoma achieved better outcomes when definitive RT was used. Advanced stage carcinoma patients experienced better outcomes with postoperative RT. The high rate of distant failure after RT, with or without surgery, reflected the lack of a consensus regarding the best therapeutic approach for treating carcinoma of the EAC and middle ear.

Outcomes of 18 cases with squamous cell carcinoma of middle ear who underwent both surgery and post-operative radiotherapy

Conclusions: Early diagnosis and treatment were critical to prevent recurrence, and the long-term outcomes were satisfactory after surgery and post-operative radiotherapy. Objectives: To present outcomes of 18 cases with squamous cell carcinoma of the middle ear who underwent both surgery and post-operative radiotherapy. Methods: Eighteen cases with squamous cell carcinoma of the middle ear (two cases of T1, five of T2, and 11 of T3) underwent surgery and post-operative radiotherapy, and a surgical approach was determined by tumour sites. Extended mastoidotympanectomy was performed on two cases, with subtotal temporal bone resection on 12 cases and temporal bone resection on four cases. The patients who had cervical metastasis underwent additional radical neck resection and post-operative radiotherapy at the neck. The patients were followed-up after surgery. Results: During the follow-up, no cases of T1 recurred, and six cases of T2 or T3 recurred, with the total recurrence rate of 37.5% among the patients of T2 and T3. At the fifth year after surgery, 15 patients were still alive, and the actual 5-year survival rate was 83.3% among all patients.

Carcinoma Middle Ear with Facial Nerve Palsy and Temporal Lobe Abscess

Carcinoma of middle ear is very rare condition being one in 20,000 new patients. The commonest primary middle ear malignancy is usually squamous cell carcinoma. A 36-year-male presented with right sided severe earache with blood stained aural discharge, associated with headache and deviation of angle of the mouth to the opposite side. He had ear discharge since childhood. On examination he had bleeding polypoidal mass in the right external auditory canal & tympanic membrane was not visualized. He also had features of facial nerve palsy. CT scan of brain finding was chronic right mastoiditis & right temporal lobe abscess causing significant mass effect. The patient was undergone Burr-hole operation. After 2 weeks right radical mastoidectomy was done. There was huge granulation tissue involving middle ear, attic & mastoid antrum and ossicles was eroded. Histopathology report revealed infiltrating squamous cell carcinoma grade-I. The patient was sent for radiotherapy & asked for follow up monthly. In long standing chronic suppurative otitis media with blood stained discharge & facial nerve palsy, middle ear malignancy should be suspected. Anwer Khan Modern Medical College Journal Vol. 4, No. 2: July 2013, Pages 49-51 DOI: http://dx.doi.org/10.3329/akmmcj.v4i2.16943

Computed tomography and magnetic resonance imaging findings for primary middle-ear carcinoma

This study aimed to investigate the computed tomography and magnetic resonance imaging findings of primary middle-ear carcinoma. In this retrospective study of 13 patients with primary middle-ear carcinoma, we collected pre- and post-contrast magnetic resonance images for all 13 cases, high-resolution computed tomography scans for 11 cases, and conventional computed tomography scans with contrast for 2 cases. Soft-tissue masses were mainly located in the tympanum, tympanic sinus and deep within the external auditory canal, and involved the jugular fossa (9 of 13 patients), middle cranial fossa (5/13), parotid gland (2/13) and temporomandibular joint fossa (1/13). An irregular, 'moth-eaten' bone destruction pattern was seen on high-resolution computed tomography images, most commonly in the eustachian tube (9/13), jugular foramen (9/13) and facial nerve canal (7/13). On non-contrast magnetic resonances images, masses were isointense or slightly hypointense on T1-weighted images, and isointense or slightly hyperintense on T2-weighted images. On post-contrast images, lesions were moderately and homogeneously enhanced in seven cases and inhomogeneously enhanced in six. High-resolution computed tomography precisely detects regions of bone destruction, whereas MRI can better assess soft-tissue tumour margins, intracranial extension and vessel patency. Eustachian tube erosion is an important characteristic of primary middle-ear carcinoma.

A Case of Bilateral Middle Ear Squamous Cell Carcinoma Treated with the Cyberknife

Patients with carcinoma of the middle ear usually have a poor prognosis even after multidisciplinary treatment. We describe the rare case of a patient with bilateral middle ear carcinoma who was treated by stereotactic radiosurgery using the Cyberknife, and remained tumor free for more than five years after the therapy. The patient was sorely afflicted with persistent left otorrhea despite having undergone surgery for bilateral chronic otitis media and was diagnosed (confirmed by histopathological examination) as having carcinoma of the middle ear on the left side. FDG-PET imaging revealed accumulation in the right side ear also, however, the diagnosis of right middle ear carcinoma was finally made after five months by histopathological examination. He underwent stereotactic radiosurgery using the Cyberknife on two occasions, had no remarakable complications, and survived without tumor recurrence for more than five years. We suggest that stereotactic radiosurgery using the Cyberknife may be useful for the treatment of middle ear carcinoma, especially bilateral middle ear carcinoma, because of the reservation around the restriction by the surrounding organs.

Middle Ear Carcinoma Masquerading as an Aural Polyp

Objective: To present a case of middle ear carcinoma masquerading as an aural polyp and describe our experience with the clinical presentation, management and outcome of an elderly patient with this pathology.
 Methods:
 Design: Case Report
 Setting: Tertiary Public Hospital
 Patients: One
 Result: A 63-year-old female presented with an aural polyp and preceding symptoms of inner ear disturbances followed by otorrhea and otalgia. CT scans revealed an erosive lesion occupying the entire middle ear cleft, external ear canal and mastoid cavity with involvement of inner structures. A repeat biopsy subsequently revealed malignancy leading to a diagnosis of middle ear carcinoma. The patient was offered surgical treatment but opted for radiotherapy and subsequently defaulted follow-up.
 Conclusion: Middle ear carcinoma is rare and can masquerade as a benign aural polyp. Symptoms of severe otalgia and inner ear disturbances are indicators of possible malignancy, as are recent-onset symptoms of otitis media developing over a relatively short course later in life. A high index of suspicion is needed to avoid late diagnosis. Repeat deeper aural tissue biopsy is needed to exclude malignancy. Computed tomography imaging is indispensable in delineating tumor extent and aids in tumor staging as well as prognostication. Surgical resection with clear tumor margins, followed by postoperative radiotherapy, is the preferred choice of treatment. Sole radiotherapy is reserved for tumors of small volume as well as in cases where surgery is not feasible.
 Keywords: Middle ear carcinoma; aural polyp; temporal bone carcinoma

Expression of Reversion-Inducing Cysteine-Rich Protein with Kazal Motifs and Matrix Metalloproteinase 9 in Middle Ear Squamous Cell Carcinoma

Objective: Reversion-inducing cysteine-rich protein with kazal motifs (RECK) may negatively regulate matrix metalloproteinase 9 (MMP9) activity and suppress tumor invasion and metastasis. The aim of this study was to investigate whether RECK and MMP were involved in regulating middle ear carcinoma invasion and metastasis. Methods: RECK and MMP9 were measured in 30 middle ear squamous cell carcinoma tissues and 20 adjacent normal external ear canal skin tissues using immunohistochemical analysis. Results: The positive rate of RECK expression in the middle ear squamous cell carcinoma was much lower than that in the normal external ear canal skin. In contrast, the positive rate of MMP9 expression was higher in middle ear squamous cell carcinoma tissue than that in normal external ear canal skin tissue. The expressions of RECK and MMP9 were correlated with the histological grade and tumor stage, but not with patient age or gender. Conclusions: RECK and MMP9 are involved in middle ear squamous cell carcinoma and may serve as markers to evaluate progression and metastasis.

CT and MRI diagnosis of primary middle ear carcinoma invading jugular foramen

Objective To study the CT and MRI features of primary middle ear carcinoma invading jugular foramen.Methods CT and MRI images of 7 patients with surgically and pathologically confirmed primary middle ear carcinoma invading jugular foramen were analyzed retrospectively,including high resolution CT (HRCT) scan in 6 cases,CT enhancement scan in 1 case and MR plain and enhancement scan in 7 cases.Results On HRCT,the soft tissue lesions mainly located in tympanum,tympanic sinus,the deep of external auditory canal and jugular foramen,and irregular “moth-eaten” bone destruction could be seen,including the destruction of jugular foramen in 7 cases,eustachian tube in 7 cases,facial nerve canal in 4 cases,carotid artery canal in 4 cases,external auditory canal wall in 3 cases,auditory ossicles in 2 cases,vestibular window and horizontal semicircular canal in 1 case.CT plain scan showed the density of soft tissue mass was uniform in 4 cases with CT value of 30-55 HU,and heterogeneous in 2 cases,in which small pieces high density lesions could be found.CT enhancement scan in 1 case revealed moderate and homogeneous enhancement.On MR plain scan,the soft tissue masses with hazy margins could be seen,and compared to the gray matter of brain,the lesions were isointense or slightly hypointense on T1 WI and isointense or slightly hyperintense on T2 WI.The signal was homogeneous in 5 cases and inhomogeneous in 2 cases with small pieces of hypointensity both on T1WI and T2WI.After enhancement,the lesions were enhanced moderately and homogeneously in 5 cases and inhomogeneously in 2 cases with small pieces of nonenhanced area.MRI also showed the erosion of carotid artery in 4 cases,sigmoid sinus in 1 case.Conclusion The primary middle ear carcinoma can invade the jugular foramen area extensively,which may lead to misdiagnosis.HRCT can precisely depict the bone destruction and the invasion of the important anatomic structures in the primary middle ear carcinoma,and the destruction of eustachian tube can help to reduce misdiagnosis.MRI can more clearly show the extent of tumor and the mass signal and enhancement pattern. Key words: Ear,middle; Ear neoplasms; Jugular foramen; Diagnostic imaging

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.

Adenomatous Neoplasia Presenting as Aural Polyp

Adenomatous neoplasia or glandular tumours in the ear are very rare to occur. We are reporting two patients who presented with polypoid mass in external auditory canal of whom one patient was diagnosed to have ceruminous adenoma of external auditory canal and the other adenomatous carcinoma of middle ear based on histopathology findings of biopsied specimen. Review of available literature shows that both ceruminous adenoma of external auditory canal and adenocarcinoma of middle are very rare to occur and are even difficult to diagnose histopathologically. We would like to emphasize the importance of considering even such rare pathologies while evaluating aural polyps.

Treatment Outcomes of Squamous Cell Carcinoma of External Auditory Canal and Middle Ear

Treatment Outcomes of Squamous Cell Carcinoma of External Auditory Canal and Middle Ear

Middle ear cancer: A population‐based study

Primary carcinoma of the middle ear is a rare clinical entity, best suited for evaluation using a population-based database. The objective of this study was to utilize the Surveillance, Epidemiology, and End Results (SEER) database to determine the incidence, treatment, and survival of middle ear carcinoma. Analysis of national cancer database. Using SEER*Stat software, records for patients diagnosed with middle ear carcinoma between 1973 and 2004 were extracted from the SEER database. Five-year, observed survival was analyzed, with significant differences determined by the Wilcoxon statistic. The 5-year observed survival rate for the 215 patients in this study was 36.4%. Histologic subtypes included squamous cell carcinoma (62.8%), adenocarcinoma (18.2%), other carcinomas (13.0%), and noncarcinomas (6.0%), with 5-year survival rates of 23.9%, 65.0%, 60.0%, and 38.6%, respectively (P = .003). Of the 123 patients with known stage, 23.6% had local, 69.1% had regional, and 7.3% had distant disease, with their 5-year survival rates being 64.9%, 34.2%, and 0%, respectively (P < .001). Treatment included surgery (31.2%), radiation (16.3%), surgery and radiation (38.6%), or no treatment (8.4%) with 5-year survival of 69.2%, 14.6%, 26.4%, and 0%, respectively (P < .001). Patients with primary middle ear carcinoma have a relatively poor prognosis. However, subsets of patients, such as those with adenocarcinomas and with localized tumors, demonstrated significantly better survival. Surgery alone had significantly better survival than the other treatment groups, presumably due to less advanced disease in this treatment group. These data are useful in counseling patients and understanding the natural history of middle ear carcinoma.

S231 – Middle Ear Carcinoma: A Population-based Study

Objectives Carcinoma of the middle ear is a rare clinical entity, best suited for evaluation using a large, population-based database. The objective of this study was to utilize the National Cancer Institute's Surveillance, Epidemiology, and End Results (SEER) database to determine the incidence, treatment patterns, and survival of middle ear carcinoma. Methods Using SEER*Stat software, data for patients diagnosed between 1973–2004 were extracted based on the middle ear's anatomic code (C30.1). 5-year observed survival was analyzed with SPSS software, with significant differences determined by the Wilcoxon statistic. Results The 5-year survival rate for the 215 patients in this study was 36.4%. Histologic subtypes included squamous cell carcinoma (62.8%), adenocarcinoma (18.2%), other carcinomas (13.0%), and non-carcinomas (6.0%), with 5-year survival rates of 23.9%, 65.0%, 60.0%, and 38.6%, respectively (p=0.003). Of the 123 patients with known stage, 23.6% had local, 69.1% had regional, and 7.3% had distant disease, with their 5-year survival rates being 64.9%, 34.2%, and 0%, respectively (p=&lt;0.001). Treatment included surgery (31.2%), radiation (16.3%), surgery and radiation (38.6%), or no treatment (8.4%) with 5-year survival of 69.2%, 14.6%, 26.4%, and 0%, respectively (p&lt;0.001). Conclusions Patients with middle ear carcinoma have a relatively poor prognosis, reflected by a 5-year survival rate of 38.6%. However, subsets such as those with adenocarcinomas (65.0%) and with localized tumors (64.9%), demonstrated significantly better survival. Surgery alone had significantly better survival than the other treatment groups, presumably due to less advanced disease. These data are useful in counseling patients and understanding the natural history of middle ear carcinoma.

Carcinoma of the External Auditory Canal and Middle Ear: Staging and Management Dilemma

Objectives: This study aims to figure out more accurate staging and proper therapeutic strategy for carcinoma of external auditory canal and middle ear. Study Design: Retrospective review of medical records of patients who were diagnosed as squamous cell carcinoma or adenoid cystic carcinoma of external auditory canal and middle ear between 1989 and 2006. Materials and Methods: 34 patients were enrolled in this study. First, treatment outcomes according to pathologies and stages were investigated. Second, surgical outcomes according to different tumor extent and surgical methods in the same stage were investigated . Third, survival rate according to local invasion to adjacent structures such as parotid gland, facial nerve, temporomandibular joint, infratemporal fossa, dura and intracranium, all of which had been frequently used in other staging systems was investigated. Fourth, the effect of adjuvant radiotherapy in advanced stage (stage III, N) was investigated by comparing the survival rate between the patients who underwent radiotherapy with the patients who did not undergo radiotherapy. Results: Patients of stage I and II showed 90% disease control rates with lateral temporal bone resection (LTBR). However, the survival rates were significantly decreased in stage III and IV. In stage III, LTBR was performed in patients whose tumor was confined to the external auditory canal and middle ear and subtotal temporal bone resection was performed in patients with tumor extending into the mastoid. The difference in disease control rates of the two groups were not significant (p > 0.05). The disease control rates were significantly decreased in the patients with ACC where parotid gland invasion was present (p = 0.007) and in the patients with SCC where dural and intracranial invasion was present (p = 0.001). There was no significant survival difference between the patients who underwent adjuvant radiotherapy and the patients who did not (p > 0.05). Conclusions: For the staging system of carcinoma of external auditory canal and middle ear, it can be concluded that staging system needs to be modified. Stage I and II can be put together since the tumors of those stages showed excellent disease control rates . And stage III tumors confined to the external auditory canal and middle ear can be subdivided into two groups, some of which could be included in earlier stage. For the treatment, LTBR seems to be sufficient for stage I, II and limited cases of stage III where tumor is confined to the external auditory canal and middle ear only. In more advanced stages, adjuvant radiotherapy hardly showed any benefit, and therefore initial surgical treatment is more important.

Middle Ear Carcinoma Originating from a Primary Acquired Cholesteatoma: A Case Report

To describe middle ear carcinoma originating from the matrix of primary acquired cholesteatoma in a 43-year-old man and to discuss the relationship between middle ear carcinoma and cholesteatoma. Case report. Department of Otolaryngology, Head and Neck Surgery of Niigata University Medical and Dental Hospital, which is a tertiary care center, Niigata, Japan. A 43-year-old man demonstrated symptoms resembling those of cholesteatoma: facial palsy, gradually progressive hearing loss, and chronic draining of the right ear. Other objective findings also supported a finding of cholesteatoma, but a computed tomographic scan and magnetic resonance imaging scan showed a well-enhanced mass and extensive bony erosion in the middle ear. At surgery, a granulous tumor in the mastoid cavity was diagnosed as squamous cell carcinoma, and closely coexisting cholesteatoma was found. Surgical specimen demonstrated carcinoma and cholesteatoma in the same field. Radiation and chemotherapy were performed followed-up by mastoidectomy. Because middle ear carcinoma has a poor prognosis, it is important to detect lesions early. It is necessary to consider that middle ear carcinoma arises from not only chronic otitis media or surgical invasion but also from primary acquired cholesteatoma.

放射線治療を行った中耳癌の３例

Three cases of middle ear carcinoma treated at our hospital are reported. All cases had histories of chronic otitis media or middle ear surgery. According to Stell's classification, staging was T3N0M0, T2N0M0 and T3N0M0, respectively. Because of advanced age or tumor extension around the carotid artery or the dura mater, irradiation, but not surgery, was indicated in all cases. Two of three cases also received Stereotactic Radiosurgery (SRS) to residual tumors. To date, both patients treated with SRS have survived for two years without recurrence. Another patient with a residual tumor with a volume beyond SRS indication died of disease one year after irradiation. We suggest that adding SRS therapy to irradiation is effective in the treatment of middle ear carcinoma.