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Glomus faciale, glomus jugulare, glomus tympanicum, glomus vagale, carotid body tumors, and simulating lesions. Role of MR imaging.

In summary, MR imaging characteristics of a case of paraganglioma of the facial nerve are reported. The relationship of paragangliomas and the chromaffin system have been discussed. There are many reports of cases of synchronous paragangliomas and pheochromocytomas. These reports, along with simultaneous involvement in familial MEN syndromes, and the common embrylogic origin (neural crest) and similar histopathologic relationships between paragangliomas and pheochromocytoma, all support the fact that they are part of the chromaffin system.

Adrenal Gland Neoplasms↗

[Diagnosis and therapy of glomus tympanicum and glomus jugulare tumors].

OBJECTIVE: To report on a series of patients with glomus tympanicum or glomus jugulare tumors, and to focus on its diagnosis, treatment, and outcomes. METHODS: Ten patients with glomus tympanicum or glomus jugulare tumors at Peking Union College Hospital during a 17-year period were reviewed retrospectively. RESULTS: There were 7 patients with glomus tympanicum, 3 with glomus jugulare tumors, 1 patient with familial paraganglioma and 1 with functioning glomus jugulare tumors. The most common presenting symptoms were pulsatile tinnitus and hearing loss. Other symptoms included facial nerve paralysis, vertigo, otalgia, dysphagia, hoarseness, throat sore, episodic hypertension with headaches and tachycardia. The most common physical sign was a vascular middle ear mass. The other physical signs included Brown sign, upper neck mass, pharyngeal plump, Collet-Sicard syndrome, Homer's syndrome as well as deficit of cranial nerve V. The radiographic evaluation included computed tomograph (9 cases), angiography (4 cases) and magnetic resonance imaging (1 case). Eight patients initially refered to ENT department, and 2 patients initially consulted neurology or endocrinology specialists. The treatment included preoperative embolization in 2 cases, simple surgery in 4 cases and surgery followed by radiation therapy in 6 cases. No significant complications occurred. Nine of the 10 patients were followed up, but 1 was lost. The mean follow-up time was 12 years (ranged, 2-19 years). No tumor recurrence occured in the 6 cases with total tumor removal. Three cases with subtotal tumor resection had no tumor progression. CONCLUSIONS: The diagnosis and treatment of glomus tympanicum and glomus jugulare tumors is particularly challenging. Typical clinical manifestations and radiographic evaluation should be considered together to establish the diagnosis. The primary treatment for glomus tympanicum is surgery, if necessary, followed by radiotherapy. Subtotal tumor resection followed by radiation yields satisfying outcome for glomus jugulare tumors.

Adult↗

Epistaxis as a rare presenting feature of glomus tympanicum.

Glomus tumours are the most common primary neoplasms of the middle ear, typically benign and slowly progressive. Pulsatile tinnitus and ipsilateral hearing loss are the most common symptoms at presentation by far; otalgia, aural fullness and otorrhoea being less frequent. A case of primary glomus tympanicum presenting with recurrent epistaxis, previously unreported in the literature, is described and associated imaging presented.

Adult↗

Glomus tympanicum and glomus jugulare tumors.

The ideal management of most paragangliomas is complete surgical excision. Because of technical advances, issues of resectability have given way to issues of functional outcome and postsurgical quality of life. This article reviews the surgical strategy for craniocervical paragangliomas. Intracranial extension, defect reconstruction, and cranial nerve rehabilitation are addressed.

Cerebral Angiography↗

[High-resolution and dynamic computed tomography in the diagnosis of glomus tympanicum and glomus jugulare tumors].

In order to differentiate residual or recurrent tumour from scar tissue, high resolution computer tomography was combined with dynamic scanning. In 19 patients examined, glomus tumours were found in eight and lymph node metastases in one. This non-invasive method, which can be used on an outpatient basis, is essential for follow-up and is useful as an addition in primary tumour staging.

Female↗

NdYAG laser treatment of a glomus tympanicum tumour.

Glomus tympanicum tumours are highly vascular tumours of the middle ear. Their removal by conventional surgical methods requires an extensive procedure in many cases, often with ossicular disarticulation to allow adequate exposure prior to the 'chaotic' and haemorrhagic event of tumour removal. This paper reports on the use of an NdYAG laser in a case of a large glomus tympanicum tumour. The laser facilitated a transcanal approach, avoided ossicular disarticulation and allowed accurate and almost bloodless ablation of the entire tumour. The NdYAG laser appears to be a very useful treatment modality in the management of these highly vascular tumours. Care should be taken to avoid accidental energy transmission to the cochlea.

Angiography, Digital Subtraction↗

Sonographic findings in glomus tympanicum tumor.

A glomus tympanicum tumor that is associated with a visible retrotympanic mass is the most frequent cause of pulsatile tinnitus. The preoperative diagnostic approach to this lesion includes a meticulous physical examination as well as high-resolution CT, magnetic resonance angiography, and digital angiography, which can also be used for preoperative embolization. We report the use of color transcranial Doppler sonography in the evaluation of glomus tympanicum tumor in a 67-year-old woman with a 3-year history of left tinnitus. An otoscopic examination revealed a reddish pulsatile mass behind an intact tympanic membrane. No lesions were visualized on gray-scale sonography. Contrast-enhanced color transcranial Doppler sonography showed a vascular ovoid mass that measured 2 x 1 x 1 cm; spectral analysis of the lesion revealed arterial flow with a low resistance index. Color transcranial Doppler sonography helped define the dimensions and vascular characteristics of the lesion.

Aged↗

Long-term control of surgically treated glomus tympanicum tumors.

OBJECTIVE: The glomus tumor is an enigmatic middle ear neoplasm commonly delayed in diagnosis. Frequently grouped with its skull base counterpart, surgery and radiation are often recommended as therapy. The objective of this report is to highlight the diagnosis and surgical treatment of this neoplasm in a large series. Tumor control in the long term is defined. STUDY DESIGN: Retrospective case review. SETTING: Private practice-tertiary referral center. PATIENTS: All patients surgically treated for glomus tympanicum tumors from May 25, 1972 to July 3, 1998 (N = 80). INTERVENTIONS: Surgical excision of glomus tympanicum tumors. MAIN OUTCOME MEASURE: Total tumor control in the long term. RESULTS: Surgical treatment resulted in long-term tumor control for the vast majority of the patients studied. CONCLUSIONS: Surgery provides excellent control of glomus tympanicum tumors. It is safe and well tolerated, with minimal morbidity.

Adult↗

Beyond the promontory: the multifocal origin of glomus tympanicum tumors.

PURPOSE: We examined other middle ear locations of glomus tympanicum tumors, which arise from glomus bodies accompanying the tympanic (Jacobson's) nerve through the middle ear. Most descriptions place these tumors on the promontory over the basal turn of the cochlea. METHODS: We identified seven patients (all women) with small surgically confirmed glomus tympanicum tumors (not completely filling the middle ear) for whom CT scans were available for retrospective review. Patients' ages ranged from 23 to 78 years at the time of the high-resolution CT study (1.0- to 1.5-mm-thick sections). RESULTS: All tumors arose on the medial wall of the middle ear. One was anterior to the promontory, beneath the cochleariform process and the semicanal of the tensor tympani. Two were inferior to the promontory, in the recess beneath the basal turn of the cochlea. Four were anteroinferior. None was actually on the apex of the promontory. CONCLUSION: Glomus tympanicum tumors may arise in various locations on the medial wall of the middle ear, where Jacobson's nerve runs. The promontory is only one middle ear location in which glomus tympanicum tumors may arise. Familiarity with the course of the tympanic nerve helps tailor the search for, and facilitates accurate identification of, tiny glomus tympanicum tumors.

Adult↗

Glomus tympanicum chemodectomas: radiographic and clinical characteristics.

Glomus tympanicum chemodectomas are benign neoplasms that develop from normal glomus bodies located along the Jacobson (tympanic) nerve in the middle ear. The medical charts and radiographic studies of 55 patients with these tumors were reviewed. Women outnumbered men in a ratio of 3.5:1, and the patients' average age when they initially reported symptoms was 52 years. Tinnitus, ear pulsations, and diminished hearing were the most frequent symptoms. No patient had a second chemodectoma, and none of seven patients who were tested had elevated neuroendocrine compounds. Review of the radiographic examinations showed that direct coronal, thin-section computed tomography (CT) was the most sensitive means of demonstrating glomus tympanicum chemodectomas. Magnification angiography was also a sensitive diagnostic study, typically depicting a trapezoidal, hypervascular, middle-ear mass that appeared initially in the middle-to-late arterial phase and quickly disappeared in the venous phase. Differentiation from an aberrant internal carotid artery is critical to prevent arterial biopsy.

Adult↗

Glomus tympanicum in infancy.

A glomus tympanicum tumor, limited to the cochlear promontory, was excised from the middle ear of a 6-month-old girl. To our knowledge, there have been no reports of temporal bone paragangliomas occurring at a younger age. Diagnosis, therapy, and the special characteristics of pediatric glomus tumors are discussed.

Ear Neoplasms↗

Glomus tympanicum tumour: an alternative surgical technique.

Glomus tympanicum tumour is one of the commonest neoplasms of the middle ear. It is more common in females. The most common presenting symptom is pulsatile tinnitus. A retrotympanic mass is found in the middle ear in all the cases. Computed tomography (CT) scan is the investigation of choice, however in difficult cases magnetic resonance imaging (MRI) can be helpful. Surgery is regarded as the gold standard of treatment in spite of the fact that radiation therapy has also been advocated in the literature. In this series 17 cases of glomus tympanicum treated at Gruppo Otologico Piacenza - Rome (Italy) were analysed retrospectively. A simple and safe technique has been described. All the cases were female and treated by surgery. The tumour was removed completely in all the cases and the ossicular chain kept intact. Recurrence was encountered in only one case after nine years. Surgical removal of the tumour is recommended as the treatment of choice with the following advantages: complete removal, a low complication rate, a low recurrence rate, acceptable hearing level and minimum morbidity.

Adult↗

Glomus tympanicum tumors: contemporary concepts in conservation surgery.

The management of glomus tympanicum tumors is not a new subject. A review of the contemporary management concept is, however, needed for two reasons: 1. the recent literature has suggested radiation therapy as a treatment option in this surgical disease, and 2. patients who are referred to us for management of these tumors continue to exhibit errors in diagnosis and surgical approaches that are unnecessarily radical. The purpose of this paper is to review the diagnosis of these lesions and to prospectively differentiate them from the more extensive jugulare tumors. When type and extent of the tumor are properly determined, a surgical procedure can be planned that conserves as much normal ear anatomy and function as possible. Between May 1970 and July 1988, 60 patients with glomus tympanicum tumors were treated at the Otology Group, P.C., in Nashville, Tennessee. In 47 patients (78%), the tumors were removed using an extended facial recess approach. The external auditory canal wall was removed in seven patients (12%), and six patients underwent a transcanal approach. Total tumor removal was obtained in 90% of patients. Surgical management remains the mainstay of treatment for glomus tympanicum tumors.

Adult↗

Glomus tympanicum tumors: a clinical perspective.

Since Guild first discovered glomus bodies in the middle ear, the diagnostic evaluation and therapy of glomus tympanicum tumors have remained challenging. This study describes 73 cases diagnosed as glomus tympanicum tumors over the past 30 years. During this period, imaging techniques have markedly improved, and surgical approaches have evolved and been refined. These 73 cases were reviewed from a clinical perspective involving presentation, diagnostic evaluation, and therapeutic management. Pulsatile tinnitus was the primary symptom in over half the patients, followed by hearing loss in one third. The physical exam rarely revealed a circumferential view of the lesion, emphasizing the necessity of further diagnostic evaluation. High-resolution computerized tomography (CT) is currently the radiographic study of choice. A transmastoid surgical approach with extended facial recess was most commonly employed. Extension to the jugular bulb or internal carotid was rare, and no intraoperative complications of catecholamine secretion were noted. Postoperative complications were few, and the overall residual/recurrence rate was less than 5%. Additional clinical insights may assist in the management of these rare but fascinating tumors.

Adult↗