Metastases to temporal bones from primary nonsystemic malignant neoplasms

Objectives: To compare histopathological and clinical findings of metastasi s to the temporal bone with previous reports and to determine the prevalenc e of these metastases in patients with nonsystemic cancer. Study Design: Retrospective. Methods: Autopsy records of 864 patients were screened to select those with primary nondisseminated malignant neoplasms. These were evaluated histopat hologically for metastasis to and site of involvement within the temporal b one, and histological characteristics of the tumor. Clinical records and au topsy reports were reviewed for demographic data, clinical course, otologic and vestibular manifestations, site of primary and its histological featur es, extent of metastasis, and mode of spread. Results: Of 212 patients with primary nondisseminated malignant neoplasms, 47 had metastases to the temporal bone (76 temporal bones). Twenty differen t primary tumors had metastasized, most commonly breast cancer. Hearing los s was the most common otologic symptom (seen in 19 patients [40%]), while 1 7 (36%) had no otologic or Vestibular symptoms. Temporal bone involvement w as bilateral in 29 patients (62%). Most metastases to the temporal bone dem onstrated hematogenous spread in 58 temporal hones (76.7%),and petrous apes was the most common site of metastases in 63 temporal bones (82.9%). Tempo ral bone metastases were not observed in cases where the primary tumor was adequately treated. Conclusions: In the largest series to date, we found temporal bone metastas es more frequently than previously reported, Absence of temporal bone invol vement in cases in which the primary tumor was adequately treated stresses the need for early management of cancer. Metastatic disease must be conside red as a cause of hearing loss in patients with a history of malignant neop lasm.