Ear tumours are rare and most ear symptoms have common, benign causes. However, asymmetric hearing loss, one-sided or pulsatile tinnitus, and persistent ear lesions warrant assessment. Early recognition helps establish the appropriate diagnostic and treatment pathway.
Outer ear and ear canal
The outer ear is exposed to sunlight and can develop skin lesions, including skin cancers and, more rarely, melanoma. Lesions that do not heal, bleed or grow should be assessed. When indicated, Dr Dehgani-Mobaraki performs biopsy or removal of small outer-ear skin lesions under local anaesthesia.
The canal can develop benign growths such as exostoses, common in water-sport participants; malignant lesions are much rarer. Otitis externa that does not heal despite treatment, particularly with persistent pain, discharge or bleeding, needs reassessment and sometimes biopsy.
Middle ear
Cholesteatoma is a form of chronic ear disease, not a tumour. Rare paragangliomas are distinct middle-ear lesions. Pulsatile tinnitus that follows the heartbeat, especially on one side, requires investigation.
Vestibular schwannoma (acoustic neuroma)
Vestibular schwannoma is a benign tumour arising from cells surrounding the balance nerve in the internal auditory canal. It usually grows slowly but needs follow-up. Possible symptoms are unilateral or asymmetric hearing loss, sometimes sudden; one-sided tinnitus; and imbalance.
Contrast-enhanced MRI with gadolinium is the reference investigation, guided by ENT assessment and audiometry documenting asymmetry. These symptoms are much more often caused by other conditions and do not mean that a schwannoma is present.
Treatment options
Options include observation with periodic MRI for small, stable tumours; surgery; radiotherapy or radiosurgery. Choice depends on size, growth, symptoms, age, patient preferences and the centre’s experience. Dr Dehgani-Mobaraki refers patients to multidisciplinary specialist centres.
When to seek assessment
Assessment is needed for one-sided hearing loss or tinnitus; pulsatile tinnitus; a growing, bleeding or non-healing outer-ear or canal lesion; persistent severe painful otitis externa despite treatment; or facial weakness associated with ear symptoms.
Frequently asked questions
Should I worry about tinnitus in one ear?
Most causes are benign, but one-sided tinnitus warrants ENT examination and audiometry.
Is vestibular schwannoma malignant?
No. It is benign, but its location can cause symptoms, so follow-up or treatment in experienced centres is needed.
Is MRI always necessary?
No. It is requested when examination and investigations indicate it, for example with asymmetric hearing loss.
Author: Dr Puya Dehgani-Mobaraki, specialist in Otorhinolaryngology and Head and Neck Surgery. Clinical review: October 2026. This information is educational and does not replace medical diagnosis or a prescription.