Skull base surgeons help pioneer method of extracting tumors from ear canal

UTSW Head and Neck Surgeons this summer removed acoustic neuromas through small incisions in the ear canals of two patients using an endoscope. They are believed to be the first such operations done in the U.S. since the method was recently developed in Italy. No other U.S. cases have been reported in the medical literature.

Although more study is needed to evaluate the surgery's outcomes compared with more standard procedures, the benefits -- such as less pain and a quicker recovery time -- are often seen with minimally invasive procedures compared to more invasive surgeries, said Dr. Brandon Isaacson, Associate Professor of Otolaryngology -- Head and Neck Surgery who performed the surgeries.

Acoustic neuroma is a rare benign tumor involving the hearing and balance nerve that can cause severe hearing loss, dizziness, or vertigo, affecting fewer than 4 out of every 100,000 people, according to the Central Brain Tumor Registry of the United States. Untreated tumors can grow, causing deafness in the affected ear and in rare cases be fatal.

The slow-growing acoustic neuromas are typically managed through periodic monitoring with MRI, radiation or surgery that has traditionally involved removing large amounts of bone from the skull around the ear.

The new minimally invasive endoscopic procedure could offer an early treatment option for patients who have growing tumors still small enough to extract through the ear canal.

"The bigger it gets, the harder it is to treat," said Dr. Isaacson, Co-Director of UT Southwestern's Comprehensive Skull Base Surgery Program, part of UT Southwestern's Peter O'Donnell Jr. Brain Institute.

One of his patients, Ana Placencia of Temple, Texas, waited seven months to seek treatment after first experiencing muffled hearing in her left ear. By the time she was diagnosed with the tumor and sought help from Dr. Isaacson, the ear had lost all function and could not be fixed.

But by opting for the endoscopic procedure, she avoided the radiation treatment she feared and was released from the hospital in two days -- less than half the time normally required with traditional surgery.

"At first I thought maybe it was just wax" in my ear and not a tumor, said Mrs. Placencia, a 46-year-old mother of three. "It was all of a sudden."

Dr. Isaacson and Dr. Samuel Barnett, Associate Professor of Neurological Surgery and Otolarynology, perform the surgery using a camera attached to an endoscope consisting of a narrow, metal tube filled with fiber optic cables that transmit images to a TV screen. The surgeons make a small incision in the patient's ear canal and use the endoscope to help find and remove the tumor.

The surgeons have been spearheading several endoscopy techniques for minimally invasive approaches to traditional open surgeries, such as fixing ear-drum holes and removing other types of rare tumors.

UT Southwestern has been a pioneer in identifying opportunities for minimally invasive surgery in several other areas, including efforts to develop magnetically controlled surgical instruments to reduce the number of entry ports into abdominal cavities.

For Mrs. Placencia, the decision of which kind of surgery to undergo was an easy one. She's still recovering from lingering side effects of dizziness, but expects to miss only about a month of work and isn't feeling overwhelmed by pain.

"To me, anything that is less invasive is better," she said.