Glomus tympanicum paraganglioma
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Glomus tympanicum paragangliomas (chemodectomas) are the most common middle ear tumor.
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There is a female predominance (M: F = 1:3); presentation is most common when patients are more than 40 years old 1,2.
May be incidental but symptomatic masses produce pulsatile tinnitus, otalgia, or conductive hearing loss 1,3.
Glomus tympanicum paragangliomas arise from the Jacobson nerve at the cochlear promontory.
CT is usually the best modality to assess these masses.
- soft tissue mass lateral to the cochlear promontory
- if large may fill the middle ear cavity, and invade the Eustachian tube or mastoid
- ossicles may or not be destroyed and may simply be encased
- surrounding bony destruction may be present in aggressive tumors
- intact jugular bulb
The Glasscock-Jackson and Fisch classifications of glomus tumors 5 are based on the local extension of the tumor and their effect on mortality and morbidity. Glomus tympanicum paragangliomas are considered type A tumor, as they are limited to the middle ear cavity.
Treatment and prognosis
Surgical resection is the treatment of choice 4.
On imaging consider:
glomus jugulare paraganglioma
- permeative destruction of the floor of the middle ear
- involving the jugular foramen
- presents with a dehiscent jugular bulb
facial nerve schwannoma
- pedunculated mass arising from the facial nerve
- involving the tympanic segment of the facial nerve
- no enhancement on post-contrast T1 MRI
- 1. Lee KY, Oh YW, Noh HJ et-al. Extraadrenal paragangliomas of the body: imaging features. AJR Am J Roentgenol. 2006;187 (2): 492-504. doi:10.2214/AJR.05.0370 - Pubmed citation
- 2. Larson TC, Reese DF, Baker HL et-al. Glomus tympanicum chemodectomas: radiographic and clinical characteristics. Radiology. 1987;163 (3): 801-6. doi:10.1148/radiology.163.3.3033738 - Pubmed citation
- 3. Lum C, Keller AM, Kassel E et-al. Unusual eustachian tube mass: glomus tympanicum. AJNR Am J Neuroradiol. 2001;22 (3): 508-9. AJNR Am J Neuroradiol (full text) - Pubmed citation
- 4. Radiology of the Petrous Bone. Springer. ISBN:354042394X. Read it at Google Books - Find it at Amazon
- 5. C. Gary Jackson, Michael E. Glasscock, Perry F. Harris. Glomus Tumors: Diagnosis, Classification, and Management of Large Lesions. (1982) Archives of Otolaryngology. 108 (7): 401. doi:10.1001/archotol.1982.00790550005002 - Pubmed