Glomus tympanicum. A case report
23 April 2019 (online)
A glomus tympanicum (paraganglioma of the tympanic cavity) is the most common primary tumor of the middle ear. Based on nerve cell accumulation, the tumor grows locally-destructive. Women are more affected at the age of 55 years.
A 67-year-old female patient presented with progressive hearing loss and pulse-synchronous ear noises on the left. Ear microscopy revealed a red mass in the lower quadrants of the left eardrum. The rest of the ENT findings were inconspicuous. The tympanogram on the left shows flattened, and there was a high-pitched inner ear hearing loss with 50 dB (HL) at 4 kHz with a 10 dB (HL) sound conduction component. On CT, a space-occupying mass was seen from the glomus jugulare up to the ossicular chain. Bony erosions along the jugular foramen and a high level of the jugular vein were described. The inner ear structures were intact. In MRI and digital subtraction angiography confirmed the suspicion of a vascularized soft tissue finding. Followed by the complication-free surgical removal of the tumor by means of combined transmastoidal-transmeatalen access. Immunohistochemical the suspected diagnosis was confirmed. The postoperative course was uncomplicated. The control 8 weeks postoperatively showed an improvement of the inner ear hearing loss with 40 dB at 4 kHz (HL).
Paragangliomas of the tympanic cavity may be accompanied by pulse-synchronous ear noises, progressive hearing loss and dizziness. Surgical excision is the treatment of choice. 2 – 4% of tumors show malignant tumor characteristics in progress. Clinical follow-up is recommended.