Abstract
Objective: To characterize the clinical presentation, surgical management, and outcomes of a consecutive cases of patients with tympanomastoid paraganglioma (TMP) tumors managed at a single tertiary referral center with 5 years’ experience.
 Study Design: Retrospective review.
 Setting: Bangabandhu Sheikh Mujib Medical University, a tertiary referral center in Bangaldesh.
 Methods: Between November 2014 and May 2019, 10 patients with histologically confirmed TMP tumor underwent surgical treatment. Tumor stage was described using the Sanna modified Fisch and Mattox’s classification system.
 Results: Distribution of tumors according to modified Fisch and Mattox classification was as follows: type A2 1 case (10%); B1 2 cases (20%), B2 6 cases (60%) and B3 1 case (10%). Class A2 tumour was safely removed via postauricular-transcanal approach. Two patients with Class B1 tumors were operated on through canal wall up mastoidectomy approach. Six patients including five Class B2 and one Class B3 tumors were managed by canal wall down mastoidectomy approach. One Class B2 underwent a subtotal petrosectomy with blind sac closure of the external auditory canal and middle ear obliteration. Gross total tumor removal was achieved in 9 cases (90%). One patient developed facial weakness (HB grade III) after one week of postoperative period which recovered completely by conservative treatment. No recurrence was noted in follow-up period.
 Conclusion: Early diagnosis of tympanomastoid paragangliomas are very rare because of its benign and slow-growing nature. Clinical differentiation between tympanojugular and tympanomastoid paragangliomas are difficult. Surgery is the recommended primary modality of treatment for tympanomastoid paragangliomas with minimum morbidity and recurrence rate.
 Bangladesh J Otorhinolaryngol; October 2019; 25(2): 66-75
Highlights
Paragangliomas are tumors that arise from proliferation of paraganglionic chief cells derived embryologically from the neural crest and found throughout the body associated with vascular and neuronal adventitia
Paragangliomas arise from glomus body along the Jacobson’s nerve and Arnold’s nerve are known as glomus tympanicum or tympanomastoid paraganglioma(TMP), and those arise from paraganglionic tissue along the adventitia of jugular bulb are known as glomus jugulare or tympanojugular paraganglioma (TJP).[3]
In the present study we report our experience of surgical treatment of 10 cases of tympanomastoid paraganglioma from Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh
Summary
Paragangliomas are tumors that arise from proliferation of paraganglionic chief cells derived embryologically from the neural crest and found throughout the body associated with vascular and neuronal adventitia. Paragangliomas of the head and neck accounts for 0.6% of head and neck tumors with most frequent carotid body tumour followed by vagal, tympanojugular and tympanomastoid paraganglioma.[1] Stacy R.Guild first noticed the presence of paraganglionic tissue or glomus formation within the temporal bone.[2] Paragangliomas arise from glomus body along the Jacobson’s nerve and Arnold’s nerve are known as glomus tympanicum or tympanomastoid paraganglioma(TMP), and those arise from paraganglionic tissue along the adventitia of jugular bulb are known as glomus jugulare or tympanojugular paraganglioma (TJP).[3] The term glomus is a misnomer. When the growing tumour touches the umbo, it begins to transmit pulsations to tympanic membrane and patient develops pulsating tinnitus.[6]
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