The most characteristic location of glomus tympanicum tumors is lateral to the cochlear promontory. However, if the tumor is large and involves the hypotympanum, it cannot be distinguished from a glomus tympanicum tumor, and the term glomus jugulotympanicum applies. Our case demonstrates an exaggerated example of this dilemma with intracranial and extracranial locations.

The difficult decision regarding treatment options must be made with careful consideration of the associated morbidities of slow tumor growth and recurrence with conservative management versus the surgical morbidities of aggressive surgical resection. Imaging is arguably the most important component of this decision-making process, with the radiologist contributing significantly to multiple aspects of the management of glomus tumors.