Tumor Of Middle Ear Research Articles

Bilateral inverted papilloma of the middle ear with intracranial involvement and malignant transformation: First reported case

Inverted (Schneiderian) papilloma (IP) is a benign but locally aggressive tumor that is typically located in the sinonasal tract. Middle ear involvement and intracranial extension are rare. We present a patient with a history of a completely resected right nasal cavity IP that returned 7 months later with hearing loss, bilateral aural fullness, and right-sided facial weakness. Work-up revealed middle ear IP, and the patient underwent bilateral mastoidectomies. On both sides, the disease caused erosion of the tegmen and was adherent to the underlying dura. There was dehiscence of the carotid canal wall on the left. On the right, the tumor was discovered to have recurred 3 months after initial resection, resulting in complete facial nerve paralysis and trigeminal paresthesias. A right temporal bone resection was undertaken along with neurosurgery. The IP was discovered to have invaded through the dura of the temporal lobe, incase the internal carotid artery, and infiltrate the trigeminal nerve. The facial and vestibulocochlear nerves were sacrificed on the right. Pathology of the right temporal bone revealed malignant transformation to squamous carcinoma. The patient was referred to radiation oncology for postoperative therapy. To our knowledge, this is the first case of bilateral IP of the middle ear with intracranial involvement and malignant transformation. Discussion points include: 1) management of middle ear IP, 2) carotid canal wall dehiscence in erosive middle ear disease, 3) aggressive surgical excision in locally destructive middle ear tumors, and 4) the role of radiation therapy in malignant transformation of IP.

Papillary Endolymphatic Sac Tumor: A Case Report

Glandular tumors involving the middle ear are rare and distinguishing between adenoma and adenocarcinoma remains difficult. A distinct subclass of these tumors demonstrates microscopic papillary architecture and has a propensity to erode the petrous bone and extend intracranially. The term “aggressive papillary middle ear tumor” has recently been proposed to describe this more invasive type of middle ear tumor. These tumors cause symptoms even when microscopic in size. Although histologically benign, they have been locally destructive with frequent intracranial extension and patients may die of uncontrolled local disease. These tumors do not metastasize but there is single case report of drop metastasis to the spine in the literature. Hence this tumor must be distinguished from other benign tumors of the middle ear. These rare neoplasms constitute a distinct pathological entity and deserve wider recognition.

The Dehiscent Facial Nerve Canal

Accidental injury to the facial nerve where the bony canal defects are present may result with facial nerve dysfunction during otological surgery. Therefore, it is critical to know the incidence and the type of facial nerve dehiscences in the presence of normal development of the facial canal. The aim of this study is to review the site and the type of such bony defects in 144 patients operated for facial paralysis, myringoplasty, stapedotomy, middle ear exploration for sudden hearing loss, and so forth, other than chronic suppurative otitis media with or without cholesteatoma, middle ear tumors, and anomaly. Correlation of intraoperative findings with preoperative computerized tomography was also analyzed in 35 patients. Conclusively, one out of every 10 surgical cases may have dehiscence of the facial canal which has to be always borne in mind during surgical manipulation of the middle ear. Computerized tomography has some limitations to evaluate the dehiscent facial canal due to high false negative and positive rates.

Primary Diffuse Large B-Cell Lymphoma Presenting as Chronic Otomastoiditis

Primary Diffuse Large B-Cell Lymphoma Presenting as Chronic Otomastoiditis Primary presentation of lymphoma of the middle ear is rare, with only 18 cases being reported in the literature. Diagnosis of middle ear and mastoid tumors may be delayed because symptoms mimic more common otologic conditions. Only after clinical deteriorationdo patients often undergo further workup and evaluation that iscritical to definitive diagnosis. We describe a case of diffuse largeB-cell lymphoma presenting as unresolved chronic otitis media and mastoiditis. Isolated presentation of primary lymphoma in the middle ear and mastoid without associated cranial nerve deficits or vestibular symptoms has rarely been described previously. Even without advanced symptomatology, it is imperative to exclude the possibility of temporal bone malignancy through proper neurotologic examination and appropriate imaging.

Abstract 2417: A new mouse model for epithelial ear neoplasms based upon expression of mutant EGFRL858R/T790M

Abstract Epithelial neoplasms of the ear are rare and difficult to detect before the development of audiovestibular or facial nerve dysfunction. Complete resection is often difficult because of location and the late stage at diagnosis, so effective chemotherapy is required. No preclinical models exist for these tumors. During the generation of mice using CC10 or surfactant protein C (SP-C) promoters to drive expression of mutant EGFR (EGFRL858R/T790M) in lung tissues, we observed that no SP-C mice developed lung tumors, but approximately 30% of them developed head tilt and a circular gait by 25 wk. MRI scans showed bilateral ear tumors located in the tympanic cavity that partially invaded into temporal bone, which suggested the presence of middle ear tumors or endolymphatic sac tumors (ELSTs). Histology of the ear tumors showed well-differentiated adenocarcinomas with multiple papillary and microcystic structures. Immunohistochemical (IHC) analysis showed that the mutant EGFR was active and selectively expressed in the tumors, and that downstream components of EGFR signaling such as Akt, mTOR and ERK were activated. SP-C expression was also detected, suggesting that surfactant proteins are expressed in ear epithelium at specific times during tumor development. To determine if these tumors were addicted to EGFR signaling, EGFR-based therapies were tested in symptomatic mice. Consistent with the T790M mutation in EGFR conferring resistance to reversible EGFR tyrosine kinase inhibitors (TKI), erlotinib was ineffective. In contrast, the combination of an irreversible EGFR TKI (BIBW-2992) with an antibody against EGFR (cetuximab), or a chemically optimized analogue of BIBW-2992 (WZ4002) used alone, was highly effective. All mice treated with the combination or WZ4002 alone had normalization of gait and complete responses by MRI, suggesting that these tumors are dependent upon mutant EGFR. To assess the possible clinical relevance of this mouse model, 2 human middle ear adenocarcinomas and a human ELST were stained for active EGFR using IHC. 3/3 displayed increased EGFR activation. These studies describe a new mouse model for human epithelial ear tumors based on EGFR activation, and raise the possibility that EGFR-based therapies might have clinical efficacy in these rare neoplasms. Citation Format: {Authors}. {Abstract title} [abstract]. In: Proceedings of the 102nd Annual Meeting of the American Association for Cancer Research; 2011 Apr 2-6; Orlando, FL. Philadelphia (PA): AACR; Cancer Res 2011;71(8 Suppl):Abstract nr 2417. doi:10.1158/1538-7445.AM2011-2417

Endolymphatic sac tumor (aggressive papillary tumor of middle ear and temporal bone): sine qua non radiology-pathology and the University of Texas MD Anderson Cancer Center experience.

Endolymphatic sac tumor (ELST) is a rare lesion of the skull base for which the origin has recently been ascertained. The endolymphatic sac is derived from neuroectoderm and is located subjacent to the posteromedial surface of the temporal bone. Patients characteristically present with hearing loss, tinnitus, and vertigo; facial nerve paralysis occurs less commonly. An indolent clinical course and long-standing symptom history is typical. Endolymphatic sac tumors are known to occur more frequently in patients with von Hippel-Lindau disease, but this is not a prerequisite for diagnosis because sporadic occurrence is common. Morphologically, all of the ELSTs showed a papillary and glandular architecture. The papillary and glandular structures were lined by a single layer of flattened cuboidal-to-columnar cells that were variably ciliated. Surgery is the treatment of choice for small ELST. Remission may last for years, but local recurrence after surgery, likely secondary to incomplete resection, can occur. Radiotherapy has a 50% cure rate with large or residual tumors. Endolymphatic sac tumor is a rare tumor that can easily be confused with other papillary lesions on histopathologic grounds, with significant treatment implications. Precise preoperative anatomic localization and computed tomography and magnetic resonance imaging feature interpretation play a paramount role in achieving an accurate final diagnosis.

A case of middle-ear angiosarcoma

Middle-ear angiosarcoma is a rare malignant tumor that requires early diagnosis to allow satisfactory removal. The objective of the present study was to describe and discuss the diagnosis and treatment of this rare malignant middle-ear tumor. A 12-year-old girl was admitted for a left retroauricular mass and a budding left external auditory canal tumor without associated peripheral facial nerve palsy. CT scan showed a mastoid-region tumor extending to the external auditory canal with mastoid and occipital bone-loss. Tumor removal used a retroauricular approach. Postoperative diagnosis was of angiosarcoma. At 12 months' regular follow-up, there were no signs of local recurrence. Middle-ear angiosarcoma is a rare tumor, in which diagnosis is late because early symptoms are not specific. A multidisciplinary approach is essential for efficient management.

Intensity- and energy-modulated electron radiotherapy by means of an xMLC for head and neck shallow tumors

The purpose of this paper is to assess the feasibility of delivering intensity- and energy-modulated electron radiation treatment (MERT) by a photon multileaf collimator (xMLC) and to evaluate the improvements obtained in shallow head and neck (HN) tumors. Four HN patient cases covering different clinical situations were planned by MERT, which used an in-house treatment planning system that utilized Monte Carlo dose calculation. The cases included one oronasal, two parotid and one middle ear tumors. The resulting dose-volume histograms were compared with those obtained from conventional photon and electron treatment techniques in our clinic, which included IMRT, electron beam and mixed beams, most of them using fixed-thickness bolus. Experimental verification was performed with plane-parallel ionization chambers for absolute dose verification, and a PTW ionization chamber array and radiochromic film for relative dosimetry. A MC-based treatment planning system for target with compromised volumes in depth and laterally has been validated. A quality assurance protocol for individual MERT plans was launched. Relative MC dose distributions showed a high agreement with film measurements and absolute ion chamber dose measurements performed at a reference point agreed with MC calculations within 2% in all cases. Clinically acceptable PTV coverage and organ-at-risk sparing were achieved by using the proposed MERT approach. MERT treatment plans, based on delivery of intensity-modulated electron beam using the xMLC, for superficial head and neck tumors, demonstrated comparable or improved PTV dose homogeneity with significantly lower dose to normal tissues. The clinical implementation of this technique will be able to offer a viable alternative for the treatment of shallow head and neck tumors.

Adenoma del oído medio

Middle ear neoplasms are rare lesions and difficult to diagnose due to limited information about their biology and the lack of standard criteria for their analysis. Herein, a middle ear neoplasm is described that became apparent because of its appearance in the external ear duct as it protruded from the middle ear through the eardrum. Following resection, the specimen was determined to be a benign epithelial tumor. Absence of adequate clinical information complicated the diagnosis; therefore,histochemistry and immunohistochemistry analyses were necessary to reach the final diagnosis of middle ear adenoma. Diagnostic criteria are proposed to properly diagnose these types of lesions.

Endolymphatic Sac Tumor

We present the case of a 48 year old lady with a history of episodic hearing loss and tinnitus of several years duration. One month prior to consult, there was note of left occipital pain. No history of dizziness, vertigo or facial nerve palsy was elicited. She was neither a smoker nor an alcoholic beverage drinker. No other co-morbidities were elicited. Physical examination revealed a 4 cm diameter left posterior auricular mass which was tender. There was note of a bluish bulge on the left posterior wall of the external auditory canal. The tympanic membrane was intact. The MRI revealed a 5 cm diameter, irregular, avidly enhancing mass at the left mastoid bone with permeative bone destruction and indentation of the left cerebellar hemisphere and left superior temporal lobe but without evidence of brain invasion. A biopsy was performed followed by a pre-operative tumor embolization then a sub-total petrosectomy with mastoid obliteration. Histologic sections showed an unencapsulated mass with bony invasion composed of cystically dilated glandular structures containing colloid-like material (Fig. 1) while other areas showed simple and coarse papillae (Fig. 2). The cells were cuboidal to columnar and had a bland cytomorphology with little nuclear pleomorphism (Fig. 3). Mitoses and necrosis were absent. The general histology had a striking resemblance to either normal thyroid tissue or papillary thyroid carcinoma. A TTF-1 immunohistochemical stain however showed negative nuclear staining (Fig. 4). We signed out the case as an Endolymphatic Sac Tumor. This tumor has been known in the past by such synonyms as “Aggressive Papillary Middle Ear Tumor”, “Heffner Tumor” and “Low-grade Adenocarcinoma of the Middle Ear”. It is rare, affects both sexes in roughly equal frequencies and often presents with hearing and vestibular dysfunctions, facial nerve palsy and a mass. It presents radiologically as a multilocular lytic lesion in the petrous area of the temporal bone with bone destruction. Because of the histologic resemblance to thyroid tissue, a metastatic thyroid neoplasm is a differential diagnosis. Metastases to this area are rare, cases invariably have a known primary focus and otologic symptoms are uncommon. Immunohistochemical studies and clinical correlation are helpful in ruling out a metastasis. Treatment is primarily surgical. Prognosis is generally good but is dependent on the extent of the lesion at presentation. It is locally destructive, has the capacity to damage adjacent nerves and is recurrent if incompletely excised. Death may result from a large, destructive lesion in a vital area. To date, there are no reports of metastasis which may make the term “adenocarcinoma” not entirely appropriate. We have limited follow-up information on our present case at this time.

Endolymphatic Sac Tumor

We present the case of a 48 year old lady with a history of episodic hearing loss and tinnitus of several years duration. One month prior to consult, there was note of left occipital pain. No history of dizziness, vertigo or facial nerve palsy was elicited. She was neither a smoker nor an alcoholic beverage drinker. No other co-morbidities were elicited. Physical examination revealed a 4 cm diameter left posterior auricular mass which was tender. There was note of a bluish bulge on the left posterior wall of the external auditory canal. The tympanic membrane was intact. The MRI revealed a 5 cm diameter, irregular, avidly enhancing mass at the left mastoid bone with permeative bone destruction and indentation of the left cerebellar hemisphere and left superior temporal lobe but without evidence of brain invasion. A biopsy was performed followed by a pre-operative tumor embolization then a sub-total petrosectomy with mastoid obliteration. Histologic sections showed an unencapsulated mass with bony invasion composed of cystically dilated glandular structures containing colloid-like material (Fig. 1) while other areas showed simple and coarse papillae (Fig. 2). The cells were cuboidal to columnar and had a bland cytomorphology with little nuclear pleomorphism (Fig. 3). Mitoses and necrosis were absent. The general histology had a striking resemblance to either normal thyroid tissue or papillary thyroid carcinoma. A TTF-1 immunohistochemical stain however showed negative nuclear staining (Fig. 4). We signed out the case as an Endolymphatic Sac Tumor. This tumor has been known in the past by such synonyms as “Aggressive Papillary Middle Ear Tumor”, “Heffner Tumor” and “Low-grade Adenocarcinoma of the Middle Ear”. It is rare, affects both sexes in roughly equal frequencies and often presents with hearing and vestibular dysfunctions, facial nerve palsy and a mass. It presents radiologically as a multilocular lytic lesion in the petrous area of the temporal bone with bone destruction. Because of the histologic resemblance to thyroid tissue, a metastatic thyroid neoplasm is a differential diagnosis. Metastases to this area are rare, cases invariably have a known primary focus and otologic symptoms are uncommon. Immunohistochemical studies and clinical correlation are helpful in ruling out a metastasis. Treatment is primarily surgical. Prognosis is generally good but is dependent on the extent of the lesion at presentation. It is locally destructive, has the capacity to damage adjacent nerves and is recurrent if incompletely excised. Death may result from a large, destructive lesion in a vital area. To date, there are no reports of metastasis which may make the term “adenocarcinoma” not entirely appropriate. We have limited follow-up information on our present case at this time.

Piezosurgery in otologic surgery: Four years of experience

Piezosurgery (Mectron Medical Technology, Genoa, Italy) is a new ultrasound instrument (24.7-29.5 kHz) that is able to cut the bone without necrosis and nonmineralized tissues damage. The aim of this work has been to report our experience with the piezoelectric device in otologic surgery. We have used the piezoelectric device in 50 patients affected by otosclerosis, 50 by chronic otitis media, 20 by posttraumatic facial nerve palsy, 10 by type A glomus tympanicum tumor, and in three patients with a B-cell non-Hodgkin lymphoma. Patients underwent platinotomy, mastoidectomy, antroatticotomy, posterior tympanotomy, facial nerve decompression, and excision of middle ear tumors. Before and 6 months after surgery, all the patients underwent the following instrumental examinations: pure-tone audiometry, tympanometry, transient-evoked otoacoustic emissions, distortion product otoacoustic emissions, auditory brainstem response, and electronystamographic recording. In each surgical technique, the piezoelectric device provided excellent control without side effects on the adjacent structures of the middle and inner ear. The piezoelectric device is a new and revolutionary bony scalpel using the microvibrations at ultrasonic frequency so that soft tissue will not be damaged even on accidental contact with the cutting tip; this renders the piezoelectric device ideal for otologic bone surgery.

Piezosurgery® in Otologic Surgery: Four Years' Experience

Objective Piezosurgery® is a new instrument which is able to cut the bone without necrosis and non-mineralized tissues damage. The aim of this work has been to report our experience with Piezosurgery® in otologic surgery. Methods We have performed Piezosurgery® in platinotomy, mastoidectomy, antroatticotomy, posterior tympanotomy, facial nerve decompression (in its tympanic segment) and excision of middle ear tumours (glomus tympanicum tumour and B-cell non Hodgkin lymphoma). The piezoelectric device uses low frequency ultrasonic waves (24.7–29.5 kHz); the applied power can be modulated between 2.8 and 16W, and is programmed in accordance to the density of the bone. For platinotomy, a specific operative program was created to avoid involuntary error of the power regulation. The equipment consists of two hand-pieces, two inserts, and two peristaltic pumps connected to the control unit; the width, the thickness and the angle of the inserts vary in relation to the power that is applied, the bone density, and the surgical techniques that they are used for. Results In each surgical technique, Piezosurgery® provided excellent control without side effects on the adjacent structures of the middle and inner ear. Conclusions Piezosurgery® is a new and revolutionary osteotomy technique utilizing the microvibrations of scalpels at ultrasonic frequency, so that soft tissue (nerve, vessel) will not be damaged even upon accidental contact with the cutting tip. The vibration frequency of Piezosurgery® is optimal for mineralized tissue and doesn't cut the adjacent soft tissue, minimizing the risk of harming the adjacent tissues: this renders the piezoelectric device ideal for otologic bone surgery.

Endolymphatic sac tumor (aggressive papillary tumor of middle ear and temporal bone): Report of two cases with analysis of the VHL gene

Endolymphatic sac tumor (Heffner tumor) (ELST) is a very rare nonmetastasizing, locally aggressive low-grade adenocarcinoma of endolymphatic sac origin, which is linked to von-Hippel–Lindau disease (VHLD). VHLD is an autosomal dominant disorder characterized by an inherited genetic abnormality of the VHL gene located on the short arm of chromosome 3 (3p26-p25). VHL gene mutations have been shown both in ELSTs associated with VHLD and in sporadic cases. Because of the rarity of ELST, only a small number of cases have been subjected to molecular genetic analysis. We have encountered two patients with ELST, one of whom presented with a medical and family history of VHLD. The second was a sporadic case, the patient having no symptoms of VHLD. The tissues obtained from Heffner tumor and cerebellar hemangioblastoma from the patient with inherited VHLD possess a point mutation in exon 1 of VHL gene. This mutation is a C to T exchange at position 194, resulting in amino acid exchange S65L. No mutation was found in any of the three exons analyzed and in the exon–intron junctions of the VHL gene in the sporadic case.

Piezosurgery in the exeresis of glomus tympanicum tumours

The glomus tumor is a middle ear neoplasm commonly delayed in diagnosis. Surgery and radiation are often recommended as therapy; in the literature are no reported series of piezoelectric excision of glomus tympanicum tumors. This paper reviews a series of ten patients in whom successful resection of the type A glomus tympanicum tumours was achieved with the use of Piezosurgery Piezosurgery is a new instrument able to cut the bone without necrosis and non-mineralized tissues damage. In all the patients Piezosurgery provided excellent control of glomus tympanicum tumors without side effects on the soft tissues.

Transient Facial Palsy in Two Cases of Benign, Very Rare Middle Ear Tumors (Carcinoid Tumor and Myxoma)

Presentation of the clinical features of 2 very rare middle ear tumors in which the guiding symptom was facial palsy. Illustrative case reports about a myxoma and a carcinoid tumor of the middle ear associated with peripheral facial palsy. The facial palsy was transient in either case, and its pathomechanism is open for discussion. In both cases, the initial symptoms were typical for an inflammatory process. Moreover, both tumor entities are typically found in organs other than the ear; if located in the middle ear, those neoplasms grow rather superficially. In those cases, a surgical exposure of the middle ear is indicated. The etiopathology of an acute peripheral facial palsy is often hard to identify. If the facial weakness starts together with symptoms suggesting an inflammatory process, the differential diagnosis may be focused first on diseases like herpes zoster oticus and a severe course of acute purulent otitis media. We report the cases of 2 rare middle ear tumors causing facial palsy. Treatment of choice should be complete surgical excision.

Primary Tumours of the External Auditory Canal. Our Experience in 34 Patients

Malignant neoplasms of the external auditory canal (EAC) and middle ear are rare but have a poor prognosis. The aim of this study is to identify the variables associated with worse prognosis.Thirty-four patients were treated in our department between 1990 and 2006 for EAC and middle ear tumours. The patients were staged according to the 1990 Pittsburgh classification. In most cases, surgery was followed by post-operative radiotherapy.The overall disease-free survival was 49 % after 5 years. It reached 87 % in stages I and II, whereas the survival for stages III and IV was 21 % (P=.001). Pre-operative facial nerve paralysis (P=.03), lymph node metastasis (P=.01) and dural extension (P=.02) were associated with decreased survival rates.In carcinomas of the EAC and middle ear, lymph node involvement, facial nerve palsy, and dural extension were associated with a poorer outcome. For tumours in advanced stages, new therapeutic protocols should be evaluated.

中耳良性腫瘍の免疫病理組織像とその臨床的特徴

The middle ear is a rare site for benign tumors. We report six patients with benign middle ear tumors surgicaly removed: three with carcinoid, one with adenoma, and two with paraganglioma. These tumors showed similar histological features in trabecular and glandular architecture, so further immunohistochemical study was needed to make a definitive histopathological diagnosis. When we analyzed clinical features of patients diagnosed immunohistochemically, the differentiation of two patients with paraganglioma from the remaining four with adenomatous tumors such as adenoma and carcinoid was relatively easy from otomicroscopic findings and enhancement in temporal bone MRI. It was however difficult to differentiate patients with adenomatous tumors from each other because they induced similar clinical symptoms and showed similar findings in images. For a definitive diagnosis, it is necessary to conduct exploratory tympanotomy or removal of the tumors to obtain enough specimen for histological and immunohistochemical studies. Tumors induced no bone destruction or complications. We recommend staged operations for total removal of tumors and for good postoperative hearing.

Carcinoid Tumor of the Middle Ear: Clinical Features, Recurrences, and Metastases

Present four new cases of carcinoid tumor of the middle ear, two of which developed late recurrences and regional metastases. Review the literature to identify the clinical features, rate of recurrence, and incidence of metastasis of carcinoid tumor of the middle ear. Retrospective chart review. Tertiary referral hospital. Eligibility criteria consist of a diagnosis of carcinoid tumor of middle ear. Surgical excision of primary and metastatic disease. Clinical characteristics, rate of recurrence, and incidence of metastasis of carcinoid tumor of the middle ear. Forty-six patients with carcinoid tumor of the middle ear are included in this report, 42 patients were identified from a review of the literature, and 4 new patients are presented. The most common presenting symptom was hearing loss. Surgical excision was the treatment with radical mastoidectomy being the most common procedure. Ten (22%) patients developed locally recurrent disease, and four (9%) developed regional metastases. Carcinoid tumor of the middle ear is an infrequent cause of a middle ear mass, with only 46 cases published. Despite previous assertions of benignancy, the findings of this study suggest that carcinoid tumor of the middle ear is indeed a potential low-grade malignancy with documented metastatic potential. Almost all middle ear adenomatous tumors ("adenoma" and "carcinoid") show evidence of neuroendocrine differentiation, and so at least some middle ear carcinoids ("adenomas") appear to represent well-differentiated neuroendocrine carcinomas. Presentation and symptoms are consistent with a middle ear mass and rarely include carcinoid syndrome. Surgical treatment is recommended and tailored to the extent of disease. Patients with carcinoid tumor of the middle ear require indefinite follow-up for possible recurrence or metastasis.

Middle ear tumours with brainstem extension treated by ventral bulla osteotomy and craniectomy in two cats

Two geriatric domestic shorthaired cats (DSH) were treated surgically with a ventral bulla osteotomy and craniectomy for middle ear tumours that invaded the calvarium. Both cats had a history of vestibular disease. One cat had a normal neurological examination. Both cats underwent computed tomographic imaging of the head. After intravenous injection of an iodinated contrast material, one cat had a ring-enhancing intracranial lesion and the other had a uniform contrast-enhancing intracranial lesion, which either communicated with the bulla or was associated with bulla osseous lysis/production. One cat had a papillary adenoma and the other had an adenocarcinoma. Both cats had prolonged survivals (630 days; alive and lost to follow-up at 840 days), which is longer than reported in cats with middle ear neoplasia. Craniectomy, in addition to ventral bulla osteotomy, may be part of the treatment plan for middle ear tumours that invade the calvarium.