The incidence of the external and middle ear squamous cell carcinoma (SCC) is extremely rare in thehead and neck cancer with less than 1%. Therefore, the correlation between the staging classification and theprognosis has not been clear. Prognostic factors for patients with the external and middle ear SCC wereassessed in the initial clinical symptoms and radiographic imaging. 13 patients with the external and middle ear SCC (5 male and 8 female) that had been treated at the Department of Otorhinolaryngology, Kanazawa University hospital from 2000 to 2006 were selected for this study. The radiation therapy followed surgery inten patients. One patient received the radical cure irradiation before surgery. Two patients received a surgicalexcision alone.
The temporal bone involvement and the parotid gland involvement in the radiographic image (computedtomography imaging and/or magnetic resonance imaging) were assessed. Clinical symptoms (otalgia, hearingdisturbance, tinnitus, vertigo and facial nerve palsy) before treatment were reviewed based on the medicalrecord. The correlation of those clinical factors and T staging in the Pittsburgh classification with overall survivalwas statistically assessed. The temporal bone involvement significantly correlated with worse prognosis. However, parotid gland involvement did not influence the prognosis. Moreover, statistically significant differencein T staging of the Pittsburgh classification (Tl·T2vs. T3·T4) was not found. The temporal boneinvolvement in the radiographic image was a prognostic factor for patients with the external and middle ear SCC. Pittsburgh classification needs to be modified because the bony part of the external auditory canalinvolvement is considered as T2 stage and the soft tissue involvement is defined as T4 stage.
