Schneiderian-Type Papilloma of the Middle Ear: A Review of the Literature

Abstract

Schneiderian-type papilloma of the middle ear is a rare finding. We present a 46-year-old Aboriginal man with a large tympanic membrane perforation and a Schneiderian-type papilloma filling the middle ear. The aim of this study is to familiarize clinicians with this uncommon disease through discussion of its clinical presentation, diagnostic considerations and management. A search of English-language peer-reviewed literature was undertaken using the key words ''Schneiderian-type papilloma,'' ''inverted papilloma,'' and ''middle ear.'' A total of 29 cases (including the present case) of Schneiderian-type papilloma involving the middle ear were reviewed. Common presenting symptoms include hearing loss, otalgia, and otorrhea. Middle ear disease is associated with higher rates of recurrence and malignant transformation than its sinonasal counterpart. Radical surgical resection is the only curative treatment. Schneiderian-type papilloma is a benign, but locally aggressive, epithelial neoplasm most commonly arising in the sinonasal tract. Whilst involvement of the middle ear is extremely rare, knowledge of this condition is important due to its propensity to recur and the high rate of malignant transformation.

Isolated Schneiderian papilloma of the middle ear cleft

“…Aggressive surgery is therefore required. Of the 14 cases of primary middle ear IP published to date, a simple tympanotomy and excision (three reported cases) was associated with 100% recurrence rates, whereas more extensive mastoidectomy and/or temporal bone resection approaches reduced the recurrence rate to 39% 3. This remains higher than published recurrence rates reported in large series of sinonasal IP disease of around 15% 4…”

A rare case of Schneiderian papilloma of the middle ear presenting with pulsatile tinnitus

“…4 Mastoidectomy or temporal bone resection are sufficiently aggressive interventions to reduce recurrence rates by up to 61% when compared with simple excision. 1 Radiotherapy is a valuable treatment option where risk of recurrence after surgery is high or, in the case of inoperable tumours, although there are limited data on which to assess treatment benefit. Resection of the middle ear ISP alone was not sufficient in improving the patient's pulsatile tinnitus in this case; however, more published cases are required to comment on the potential efficacy of this intervention.…”

“…Patients present most commonly with hearing loss, otalgia, otorrhoea, aural fullness and, to a lesser extent, facial nerve paralysis, tinnitus and headaches. 1 These are locally aggressive tumours, which can erode through middle ear structures and invade the mastoid, temporal bone and skull base to cause significant morbidity to cranial nerves, large vessels and middle and posterior cranial fossae contents. 1,2 Malignant transformation has been reported as occurring in 35.3-77% of cases.…”

“…1 These are locally aggressive tumours, which can erode through middle ear structures and invade the mastoid, temporal bone and skull base to cause significant morbidity to cranial nerves, large vessels and middle and posterior cranial fossae contents. 1,2 Malignant transformation has been reported as occurring in 35.3-77% of cases. 3,4 Recurrence rates are high at 32% and depend on the extent of surgical resection of disease.…”

A Case of Inverted Papilloma Originating from the Middle Ear and Review of the Literature

“…Radiotherapy or chemotherapy, two of the most common treatment methods, is applied after surgical excision of IP [3]. To date, the number of reported primary IP cases originating from the middle ear and mastoid cavity is 16 in the English literature [4, 7–18]. In this case report, we present a primary middle ear PA and discuss this along with comparisons to reports in the literature.…”