Transcanal Resection of a Type 1 Glomus Tympanicum

Abstract

Objective: To present a case of Type 1 glomus tympanicum, its clinical presentations, surgical management and outcome.
 Methods: 
 Study Design: Case Report
 Setting: Tertiary Government Hospital
 Patient: One
 Results: A 44-year-old woman with pulsatile tinnitus, vertigo, headache, ear fullness and decreased hearing on the right had a pulsatile reddish mass behind the tympanic membrane and Brown sign. Weber test lateralized to the right with mild conductive hearing loss on pure tone audiometry. Contrast CT scan demonstrated a 5x6 mm well-defined enhancing mass in the meso- and hypotympanum. Internal auditory canal MRI showed an avidly enhancing 5x3x4 mm nodule within the right middle ear adjacent to the cochlear promontory and anterior to the lateral semicircular canal. Impression was glomus tympanicum, type 1. The mass was excised via transcanal approach with post-operative resolution of tinnitus, headache, vertigo and improvement of hearing. Final histopathology was consistent with glomus tumor.
 Conclusion: Glomus tympanicum tumors are rare, benign middle ear paragangliomas that arise from Jacobson’s nerve, are slow-growing and locally destructive. CT scan and MRI may detect involvement of other structures. Surgical resection is the primary treatment modality. Type 1 glomus tympanicum tumors are small and limited to the promontory, and a less-invasive transcanal approach may be employed.
 Keywords: glomus, tympanicum, paraganglioma, transcanal approach