Management of Glomus Tumors in a Single Referral Center

Background: Glomus tumor is the most common primary tumor of the middle ear. A typical glomus tumor presents with pulsatile tinnitus and unilateral hearing loss. This study provides a clinical perspective of glomus tumor.

Methods: A prospective study was performed on 26 patients (10 glomus tympanicum and 16 glomus jugulare) from January 2009 to January 2011 in Amir Alam hospital (tertiary referral center). All patients underwent neurological examination, audiometry and radiological survey before and after surgery. A questionnaire was completed by patients to evaluate the postoperative quality of life. Fisch classification was used in this study.

Results: The mean age was 45.4 years. Hearing loss was the most common symptom and pulsatile tinnitus was the most common symptom lead to seek medical care. 10 glomus tympanicum underwent surgery via transcanal or transmastoid approach and 16 glomus jugulare underwent preop embolization and surgery via infratemporal approach. One patient underwent adjuvant radiotherapy due to incomplete resection. In small tumors, we removed tumor without rerouting of facial nerve. In large tumor (class C, D and sometimes B), our approach was anterior rerouting of the nerve. When the nerve was involved, we transected the involved part and grafted it with greater auricular nerve. Vertigo and tinnitus significantly decreased postoperatively. Air-bone gap increased in jugulare patients and reduced slightly in tympanicum. 42.3% of patients had preoperative lower cranial nerve deficits and 38.5% found new deficits after surgery. Eight patients with glomus jugulare found facial nerve paralysis postoperatively that all resolved to grade I-II House-Brackmann in follow up. We found one recurrence. The most common cause of depressive mood and anxiety after surgery was facial nerve dysfunction.

Conclusions: Surgical removal is an acceptable approach to reach total tumor removal. Although immediate postoperative morbidities (esp. facial nerve palsy) in infratemporal approach were considerable, follow up showed improvement of nerve dysfunctions. High percentage of preoperative cranial deficits (42.3%) suggests majority of deficits were related to the late diagnosis of tumor, not treatment modality or surgical approach. This fact highlights importance of attention to the red flags of this disease by physicians.