Evolution in Surgical Management of Glomus Tympanicum over 40 Years: A Review of 114 Cases

Abstract

Objectives: Report surgical management and outcomes among a large cohort of patients with glomus tympanicum (GT) managed by a single tertiary referral group over 4 decades. Methods: Retrospective chart review evaluating all patients that underwent surgical treatment of histopathologically confirmed GT between 1973 and 2013. Pre- and postoperative audiometric outcomes were reported according to American Academy of Otolaryngology—Head and Neck Surgery reporting guidelines and tumor stage was described using the Glasscock-Jackson classification system. Results: A total of 114 patients (90.2% female, mean age 54.0 years) met inclusion criteria. Eleven cases were referred following recurrence, while the remaining 103 patients were treated primarily; 38 (33.3%) GTs were stage I, 52 (45.6%) stage II, 9 (7.9%) stage III, and 15 (13.2%) stage IV. A total of 105 (92.1%) patients underwent gross total removal, while 9 (7.9%) received subtotal resection for advanced disease adherent to the carotid artery and/or facial nerve. Two patients who underwent gross total resection experienced transient facial paresis and one suffered internal carotid injury with stroke. No patients have recurred at a mean follow-up of 39 months. Conclusions: Surgical approach and extent of resection should be tailored to the patient. Gross total resection can be obtained in over 90% of patients, however leaving adherent tumor remnant on the facial nerve or carotid artery should be considered in patients with advanced infiltrative disease in order to prevent unnecessary morbidity. Microsurgical resection remains the treatment of choice for GT providing a high rate of tumor control and improvement in audiologic symptoms.