Temporal Bone Metastasis Should Be Considered in Certain Symptomatic Patients

What is the frequency, primary site, and associated symptomatology of metastatic pathologies to the temporal bone?

BOTTOM LINE: Temporal bone metastasis (TBM) is uncommon but should be considered in patients with subacute otologic symptoms or facial palsy and history of distant malignancy.

BACKGROUND: Temporal bone malignancy is rare, most often occurring as a result of direct invasion from adjacent cutaneous or parotid malignancies or arising as primary cutaneous carcinoma from the external ear canal. The rate of distant metastatic disease within this group, however, remains unknown. There have been no exhaustive literature reviews of TBM to date.

STUDY DESIGN: Systematic review.

SETTING: Department of Otolaryngology–Head & Neck Surgery, Indiana University School of Medicine, Indianapolis.

SYNOPSIS: Researchers used online databases and a manual search to collect prior reported cases of pathologically confirmed TBM. They analyzed a total of 109 articles published from 1948 to 2019 and extracted data from 255 individual cases on age, sex, otologic symptom profile and duration, tumor primary location and histopathology, and TBM location. The greatest incidence of reported TBM locations affected the petrous portion (72%), followed by mastoid (49%). Of the cases with described otologic symptoms histories and duration, patients most frequently experienced hearing loss (44.3%), facial palsy (31.2%), and otalgia (16.6%) for a median of one month. Patients were asymptomatic in 32% of cases. The most common primary tumor to metastasize to the temporal bone was breast, followed by lung and prostate. Hearing loss, facial palsy, and otalgia were the most prevalent TBM symptoms. Study limitations included a lack of full data available from literature that were all case reports or case series.

CITATION: Jones AJ, Tucker BJ, Novinger LJ, et al. Metastatic disease of the temporal bone: a contemporary review [published online ahead of print September 17, 2020]. Laryngoscope. doi:10.1002/lary.29096.