Neuroendocrine Adenomatous Middle Ear Tumors: Another Use of Laser KTP in Otology Surgery

Objective: Less than 1% of all neuroendocrine neoplasms appear in the middle ear and are defined as middle-ear adenomatous neuroendocrine tumors (MEANT). To date, only 198 patients have been reported. MEANT usually present a benign behavior; however, severe recurrence and distant metastases have been reported. Despite multiple publications, MEANT management effectiveness is not clear, with laser usage a disputed one. Nonetheless, laser usage within middle-ear surgery provides evidence and reports indeed. Thus, the KTP laser is theorized to be an optimal alternative for MEANT management. Patients: Three case reports of MEANT and a literature review on MEANT are presented. Intervention(s): Case 1: A 30-year-old male with hearing loss, ear fullness, and pulsatile tinnitus. Computed tomography and magnetic resonance imaging (MRI) scans show a middle-ear lesion. Total tumor removal was achieved using a KTP laser. A 7-month follow-up MRI scan shows no recurrence. Case 2: A 63-year-old patient with radiological diagnosis of paraganglioma. An exploratory tympanotomy shows a nonconsistent tumor with glomus. A KTP laser was used to aid biopsy and limit damage. Tumor deliberately left between the crura to avoid damaging the inner ear. Histology confirms MEANT. Post MRI scan shows only residual tumor between the stapes. Patient is currently awaiting further excision with the aid of the KTP laser to enable complete excision. Case 3: A 60-year-old patient with hearing aid. A middle-ear tumor bulging the tympanic membrane and protruding toward the ear canal was noted. Biopsy confirmed MEANT. Canal wall down mastoidectomy aided with KTP laser was performed without incidents. A 12-month follow-up shows no recurrence. Main Outcome Measure: Clinical and imagenological recurrence of MEANT. Results: No clinical and imagenological recurrence of MEANT in 6–12 months follow-up. Conclusion: KTP laser usage provides an ideal usage in surgical removal and MEANT recurrence reduction.