Understanding ear cancer: Types, symptoms and treatment

Ear cancer can develop in any part of the ear. It often starts on the outside of the ear as a skin cancer, but it can also form inside the ear canal.

Cancers of the ear canal are rare. They can be hard to diagnose because of their location but are generally curable if caught early enough.

At MD Anderson, we have doctors who specialize in these types of cancer. Here, I’ll share more about ear cancer, including the different types, common symptoms and how we treat it. 

What is ear cancer?

Ear cancer can affect the:

• Outer ear (includes the pinna, which collects sound waves)
• Ear canal
• Eardrum
• Middle ear (includes the bones called malleus, incus and stapes)
• Inner ear (contains organs for hearing and balance)
• Temporal bone, which houses the ear canal, middle ear and inner ear

Most cancers of the ear start as skin cancer on the outer ear or the surrounding skin. 

• The most common type is squamous cell carcinoma.
• The second most common type of skin cancer in the ear is basal cell carcinoma.
• The third most common is adenoid cystic carcinoma. This rare cancer arises from the glands that produce earwax.
• In rare cases, melanoma can occur in the ear canal. 

The parotid gland, the largest salivary gland, is located right in front of the ear canal. Tumors in the ear canal can grow into the parotid gland, and tumors in the parotid gland can also grow into the ear canal.

What causes ear cancer?

We don’t know exactly what causes ear cancer. But these factors can increase your risk of developing it:

Sun exposure

Getting too much exposure to the sun’s harmful UV rays raises your risk for skin cancer. The external part of the ear gets more sun exposure than other parts of the body. Skin cancer often develops on the outer ear.

Chronic ear infections

In past decades, many people who reported having 20 to 30 years of infection and drainage from chronic middle ear infections later developed cancer in the middle ear or mastoid. This was because the infections often went untreated. We don’t see this as much in the U.S. anymore because people often see a doctor to treat ear infections with either antibiotics or surgery.

Prior radiation therapy

Some head and neck cancer patients who receive radiation therapy to the parotid or nasopharynx can later develop cancer in the ear canal.

Misuse of cotton swabs

People often try to clean their ears using cotton swabs. But doctors advise against this. If you constantly dig in your ear with a cotton swab, it can create a chronic wound. Over time, that wound can change from being benign to cancerous.

What are the symptoms of ear cancer?

Ear cancer symptoms depend on where the tumor is located.

The most common symptom of cancer of the outer ear is a sore on the ear. It may itch, and it can bleed if you scratch it. Other symptoms include scaly patches or tiny white bumps on the outer ear or in the skin around the ear. 

The three main symptoms of ear canal cancer are:

• Hearing loss
• Ear pain
• Bleeding or drainage from the ear

These symptoms generally are non-specific and can be seen with other conditions, like ear infections. That’s why some types of ear cancer can be hard to diagnose.

How is ear cancer diagnosed?

We diagnose ear cancer by doing a biopsy of the tumor and sending it to a pathologist to review under a microscope. The biopsy will tell us whether it’s cancer, and if it is, what type of cancer.

Then, we’ll do imaging tests, such as a CT scan, MRI or PET-CT scan. These will help us determine the cancer’s stage and if it has spread.

You can get ear cancer at any age, but it is typically diagnosed in people older than 65.

Ear cancer is often misdiagnosed as an ear infection because the symptoms are similar. It’s important that we make the correct diagnosis as soon as possible, so you get the right treatment.

Where can ear cancer spread?

Ear cancer can spread. Squamous cell cancers tend to be more aggressive and have a higher chance of spreading.

Cancers starting on the outer ear or in the ear canal can spread to lymph nodes in the neck or the parotid gland.

Sometimes, tumors in the ear canal grow big enough that they destroy the temporal bone, which separates the ear canal from the brain. When that happens, the tumor is usually stopped by the dura, a thick membrane that covers the brain. In very rare cases, though, the tumor breaks through the dura, and the cancer spreads to the brain.

How is ear cancer treated?

Early-stage outer ear or ear canal cancer is usually treated with surgery. More advanced-stage tumors often require a combination of surgery, chemotherapy and radiation therapy. We now use immunotherapy as the first-line treatment for many cases of ear canal cancer. If the tumor responds to immunotherapy, you may not need surgery or radiation at all.

The most common surgery we perform for tumors affecting the ear canal is a lateral temporal bone resection. During this procedure, we remove the ear canal, eardrum and two of the three small bones (malleus and incus) in the middle ear. The cochlea, the organ used for hearing, remains, and hearing is usually retained. But the ear canal and middle ear are what conduct the sound to the cochlea; without those structures, you may have muffled or blocked hearing. A special implant called an osseo-integrated auditory device or bone-anchored hearing aid can be used to overcome hearing loss caused by the surgery.

We often work with our head and neck surgeons to help with surgeries of the parotid gland and lymph nodes in the neck. Our plastic surgeons help in reconstructing the soft tissue that is lost due to cancer. Our team also includes radiotherapists and medical oncologists who have experience in treating these rare tumors.

Ear cancer is curable. Treatment is more successful when the cancer is found early. That’s why it’s so important that we catch ear cancer early when it’s easier to treat and before it spreads.

What are the possible side effects of ear cancer surgery?

After ear cancer surgery, you may have the following side effects:

• Hearing loss
• Ringing sound in the ear
• Dizziness
• Facial weakness or paralysis
• Loss of taste on one side of the tongue

Your care team will help you manage any side effects from surgery.

What else should we know about ear cancer?

Ear cancer symptoms are vague. People are often misdiagnosed with and treated for ear infections. If you have an ear infection that is not getting better after two weeks of treatment, go back to your doctor and ask if it might be something else. On average, many patients have symptoms of ear canal cancer for about six months before a correct diagnosis is made. We want to diagnose these cancers much earlier, so we can start treating them before they grow big and cause problems.

Paul Gidley, M.D., is a neurotologist at MD Anderson specializing in ear cancer and skull base tumors.

Request an appointment at MD Anderson online or call 1-877-632-6789.