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Glomus tumors (benign) of the middle ear| types, manifestations, diagnosis, treatment

Definition: Locally invasive, highly vascular tumor.
Incidence: 40 – 50 y. more in females.
synonyms: paraganglioma, chemodectoma.

Pathology and types of glomus tumors:

 Arise from non chromafin paraganglionic cells in relation to nerves.
Glomus jugular: in relation to Arnold’s nerve on the dome of jugular bulb.
Glomus tympanicum: in relation to jacobson’s nerve on the promontory.
glomus-tumor-middle-ear-tympanicum

Clinical picture (symptoms and signs)

A. Otological manifestations of Glomus tumors

  1. Unilateral progressive deafness.
  2. Unilaterl pulsatile tinnitus (characteristic).
  3. Bloody otorrhea (Bloody ear discharge).
  4. Deep seated ear pain (otalgia).
  5. Vertigo (+ or -).
  6. Doctor examination: Reddish mass behind intact drum (rising sun appearance) blanches by sieglization (Brown’s sign) + Vascular polyp that bleeds on touch.

B. Cranial manifestations (Cranial nerve palsies)

  1. LMNL facial palsy.
  2. 9, 10, 11, 12 palsies in glomus jugular.
  3. Manifestations of increased intracranial tension (Severe headache, Projectile vomiting, Papilloedema (blurring of vision), Drowsiness and coma).

Investigations to confirm diagnosis

  • CT: widening of jugular foramen, enhancing soft tissue mass destroying bone.
  • Angiography: tumor blush & feeding vessels. (see figure).
  • MRI, MR angiography.
  • Audiogram & tympanometry.

Treatment of Glomus tumors of middle ear:

A. Surgery
Glomus tympanicum: transcanal, post. tympanotomy, radical mastoidectomy.

Glomus jugular: infratemporal fossa approach type A.
Preoperative embolization 2-3 days before surgery to decrease bleeding.

B. Inoperable cases: 
Radiotherapy or embolization or both.
References

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