Endoscopic Versus Microscopic Transcanal Resection of Glomus Tympanicum: A Retrospective Comparative Study.

OBJECTIVE: Comparison of outcomes of microscopic and endoscopic resection of glomus tympanicum (GT) tumors. STUDY DESIGN: Retrospective case review. SETTING: Single tertiary referral center. PATIENTS: All adult patients undergoing transcanal GT resection without mastoidectomy from 2007 to 2021. INTERVENTIONS: Surgical resection-endoscopic versus microscopic approach. MAIN OUTCOME MEASURES: Primary outcomes were tumor recurrence at 1 year and presence of residual tumor at conclusion of surgery. Secondary outcome measures included operative time, postoperative air-bone gap, postoperative symptom resolution, and surgical complications. RESULTS: Thirty-eight patients underwent resection of GT (74% female; mean age, 59 years). Twenty-nine cases were performed microscopically, and nine cases were performed endoscopically. Both endoscopic and microscopic approaches yielded high rates of complete tumor resection (27/29 microscopic cases, 7/9 endoscopic cases). There was no significant difference in mean operative time (2.3 hours for microscopic; 2.6 hours for endoscopic). On average, air-bone gaps (ABGs) decreased by 6.3 dB after endoscopic resection compared with 1.0 dB after microscopic resection ( p = 0.064). No patients were found to have tumor recurrence during an average follow-up interval of 21 months. CONCLUSIONS: These results suggest comparable outcomes with both endoscopic and microscopic approaches for GT resection, and decisions regarding preferred approach should be dictated by surgeon preference.

Mucosa-associated Lymphoid Tissue Misdiagnosis as Glomus Tympanicum.

Middle ear tumors are diverse, but relatively uncommon. The most frequent tumor in the middle ear is glomus tumor, followed by others such as schwannoma and cholesteatoma. We experienced a case of Mucosa-associated lymphoid tissue hyperplasia as a middle ear tumor. The mass behind tympanic membrane appeared a hypervascular tumor, mimicking a glomus tumor, but the form of multiple separate masses in middle ear and mastoid cavity was the distinguishing feature that set it apart from a glomus tumor. Additionally, another characteristic was its tendency to easily shrink under pressure. This characteristic should be considered when encounter a hypervascular looking middle ear mass. Laryngoscope, 134:1894-1896, 2024.

Transcanal endoscopic ear surgery for glomus tympanicum removal: A case series on the necessity of preoperative embolization.

BACKGROUND: Transcanal endoscopic ear surgery (TEES) has become popular in recent years in the treatment of glomus tympanicum tumors (GTT). The most significant risk for TEES is bleeding. In some cases, preoperative vascular embolization is performed to mitigate bleeding during TEES. However, guidelines regarding the necessity and efficacy of preoperative vascular embolization have not been established yet. CASE PRESENTATION: This report aimed to assess the necessity and usefulness of preoperative vascular embolization in TEES for GTT by comparing the surgical findings of TEES without preoperative vascular embolization (Case 1) and TEES with preoperative vascular embolization (Case 2). Compared to Case 1, Case 2 included less bleeding and a more convenient procedure. However, no significant difference was observed. CONCLUSIONS: For GTT confined to the middle ear cavity (Glasscock-Jackson Grade II or less), when performed by a proficient otolaryngologist, TEES alone is sufficient without preoperative vascular embolization.

Nuances in transcanal endoscopic approach to benign middle ear tumours in adult patients.

BACKGROUND AND OBJECTIVE: Minimally invasive surgery of benign middle ear tumours is possible by using the endoscope. The optimal lighting and the broadest vision it offers, allow a transcanal approach to these rare tumours. The objective of this work is to summarise its key points through a case series. MATERIALS AND METHODS: Retrospective study of benign middle ear tumours that underwent exclusive endoscopic surgery in a third-level adult university hospital between June 2018 and June 2020. Postoperative follow-up was performed by otoendoscopy and audiometry. RESULTS: Six patients underwent surgery during the study period. Five patients were female and one male, with an average age of 57.8 years (±21.9). Four tumours were in the left ear and 2 in the right ear. These included four tympanic paragangliomas (three type I and one type II), a chorda tympani neuroma, and a congenital cholesteatoma. There were no serious postoperative complications. At present, no tumour recurrence has been found in either case, with a minimum follow-up of 7 months. CONCLUSIONS: The present study adds evidence on the safety and efficacy of endoscopic transcanal ear surgery, as a minimally invasive technique, for the treatment of benign middle ear tumours confined to the tympanic cavity.

A carcinoid tumor of the middle ear masquerading as a glomus tympanicum presenting with temporal lobe hemorrhage in a 70-year-old woman: Case report and review of the literature.

BACKGROUND: Paragangliomas in the central nervous system account for 0.6% of all head and neck neoplasms, with glomus tympanicum being the most common middle ear tumor. Carcinoid tumors are neuroendocrine tumors, representing less than 1% of neuroendocrine neoplasms in the middle ear. Misdiagnoses have been reported in the literature regarding glomus and carcinoid tumors, however, none have been in the central nervous system or middle ear. CASE DESCRIPTION: A 70-year-old female with a history of left temporal lobe tumor underwent unsuccessful resection due to intraoperative bleeding at an outside institution. However, biopsy prior to aborting the case led to the diagnosis of paraganglioma. Eight years postoperatively, the patient presented at our institution with acute confusion, aphasia, and altered mental status. Imaging revealed a 4cm left temporal intraparenchymal hematoma at the known tumor site with concern for intracranial tumor extension. Surgical resection was performed and previous symptoms resolved. Final pathology revealed a Grade II atypical carcinoid tumor with an unusually high Ki-67 of 50%. CONCLUSIONS: Carcinoid tumors of the middle ear constitute a differential diagnosis for patients presenting with temporal lobe hemorrhage. A combination of immunohistochemical staining with electron microscopy can assist in differentiating the tumor types. This atypical presentation for a carcinoid tumor in the middle ear suggests the need to consider carcinoid as the diagnosis in patients with a middle ear tumor invading into the temporal lobe and causing hemorrhage. These tumors may demonstrate an unusually high Ki-67 rate, in which case they should be treated aggressively.

Transcanal Endoscopic Management of Glomus Tympanicum: Multicentric Case Series.

OBJECTIVE: The aim of this study was to report a multicentric surgical experience in the exclusive endoscopic management of glomus tympanicum (GT). STUDY DESIGN: Retrospective case series review at two institutions. SETTING: Tertiary referral centers. PATIENTS: The study included 30 patients who underwent exclusive transcanal excision of GT between 2010 and 2017 at the two referral centers. INTERVENTIONS: Exclusive endoscopic transcanal excision of GT type A1, A2, and B1 (modified Fisch-Mattox classification). All surgical procedures were performed by two senior surgeons (L.P.; M.B.). MAIN OUTCOME MEASURES: For each procedure, intraoperative features of the disease, postoperative complications, and functional outcomes were evaluated. Recurrent or residual diseases were clinically and radiologically assessed during the follow-up period. RESULTS: None of the patients treated with transcanal endoscopic approach (TEA) experienced intraoperative complications, nor required conversion to microscopic approach. Gross total resection (GTR) was obtained in 90% of the cases, while a near total resection was advocated when the residual pathology had a close relationship with the internal carotid artery. Mean hospitalization time was 1.6 (±0.8 SD) days and no postoperative complications were reported. No recurrences were reported in the GTR group after a mean follow-up period of 38.1 (±28.7 SD) months. CONCLUSIONS: Middle ear paragangliomas with no mastoid involvement (Class A1, A2, and B1) can be safely managed by means of a transcanal endoscopic approach. Low rate of postoperative complications, short hospitalization, and high rate of gross total resection demonstrate that TEA is a safe and effective procedure.

Transcanal endoscopic excision of glomus tympanicum: A case report.

Glomus tympanicum is a highly vascular tumour traditionally treated surgically via a post-auricular approach. We present here the first published case in Malaysia where total excision was achieved transcanal endoscopically. The procedure was safe, quick and effective due to the better visualisation of the surgical field with the endoscope. Haemostasis was achieved with a modified suction catheter that performed as a functioning suction diathermy.

Glomus tympanicum: a review of 115 cases over 4 decades.

OBJECTIVE: To characterize the clinical presentation, surgical management, and outcomes of a large consecutive cohort of patients with glomus tympanicum (GT) tumors managed at a single tertiary referral group over 4 decades. STUDY DESIGN: Retrospective review. SETTING: Tertiary neurotological referral center. SUBJECTS AND METHODS: All patients underwent surgical treatment of histopathologically confirmed GT between January 1973 and March 2014. Audiometric outcomes were reported according to AAO-HNS guidelines, and tumor stage was described using the Glasscock-Jackson classification system. RESULTS: There were 115 patients (90.4% women; mean age, 55.2 years) who met the inclusion criteria; 38 (33.0%) cases of GT were stage I, 51 (44.3%) stage II, 10 (8.7%) stage III, and 16 (13.9%) stage IV. There were 108 (93.9%) patients who underwent gross total removal, while 7 (6.1%) received less than complete resection for advanced disease that was adherent to the petrous carotid artery, facial nerve, stapes footplate, or round window. Two patients who underwent gross total resection experienced transient facial paresis, and 1 had internal carotid injury with stroke. No patients had been diagnosed with recurrent disease at a mean follow-up of 30.4 months. CONCLUSION: Surgery remains the treatment of choice for GT, providing a high rate of tumor control and resolution of aural symptoms with a low risk of complications. The surgical approach and extent of resection should be tailored to the patient. Gross total resection can be performed in over 90% of patients; however, leaving a limited adherent tumor remnant on the facial nerve or carotid artery should be considered with advanced infiltrative disease to prevent unnecessary morbidity.

Promontory hemangioma mimics glomus tympanicum in the middle ear (promontory hemangioma).

Hemangiomas, common benign vascular tumors, have been well reported in the head and neck region. They have rarely been reported in the ear. Ear involvement hemangiomas are usually seen in the together with external auditory channel and middle ear. We presented a 62-year-old woman of capillary promontory hemangioma which was mimicking as glomus tympanicum with a review of the literature.

[Temporal paragangliomas. A 12-year experience]. / Paragangliomas temporales. Experiencia de 12 años.

OBJECTIVE: Our objective was to perform a retrospective analysis of patients with jugulotympanic paragangliomas. We present the results according to the surgical approach applied in each case. MATERIALS AND METHODS: This retrospective study presents the findings in 21 patients with jugulotympanic paragangliomas who were observed and treated in our department over a 12-year period (1999 to 2011). We performed a general otolaryngology exam, systemic evaluation and radiological exam. Surgical treatment was performed in 20 cases out of 21. In 1 case, treatment with stereotactic radiosurgery was carried out. RESULTS: The surgical approaches were: endaural, retroauricular transcanal, radical or modified mastoidectomy through facial recess and infratemporal fossa approach. Preoperative embolization was used in 12 cases. In all cases the diagnosis of paraganglioma was confirmed. The most frequent postoperative complications found were transitory palsy of the facial nerve, sensorineural hearing loss, imbalance, paralysis of the cranial nerves IX and XI and salivary fistula. No recurrences were found after 12 years of follow-up. One case of persistence was found in the case treated with radiosurgery. CONCLUSIONS: In our series surgery was found to be the elective therapy for patients with paraganglioma, with no recurrences after 12 years of follow-up. Preoperative embolization decreases surgery time and intraoperative bleeding. Stereotactic Radiotherapy cannot eliminate the tumour..

Middle ear adenomatous tumor: a not so rare glomus tympanicum-mimicking lesion.

BACKGROUND AND PURPOSE: Middle ear adenomatous tumors (MEAT) are rare tumors which can be begin or malignant and can present a neuroendocrine differentiation. Their radiological aspect is very similar to glomus tympanicum (GT) which are the most common tumoral lesions of the middle ear. We present several radiological and clinical findings that could help radiologists to accurately identify MEAT. MATERIAL AND METHODS: We retrospectively reviewed the radiological and clinical findings of three patients with MEAT and of eight patients with GT. Diagnostic was obtained after surgical resection in all cases. All patients had high resolution CT and MR of the middle ear associated with a subtracted digital carotid angiography. Tumor location, size, extension, signal intensity, and enhancement were analysed. From the medical records of the patients, clinical manifestations (hearing loss, tinnitus), evolution length and recurrences were noted. RESULTS: MEAT and GT appeared as tissular lesion with significant enhancement on CT and MR. A vascular blush was present on angiography in all cases of GT and absent from all cases of MEAT. A close relationship between the tumor and the Jacobson's nerve or its branches was identified in all cases of GT. Pulsatile tinnitus was present in all patients with GT and absent in all patients with MEAT. CONCLUSION: A middle ear tissular lesion clearly separated from the Jacobson nerve or its branches, showing significant enhancement after contrast medium injection but with a normal angiography, should make one suspicious for MEAT.

[Surgical treatment of temporal, tympanic and jugular paragangliomas. Indications and surgical technique]. / Tratamiento quirúrgico de los paragangliomas temporales timpánicos y yugulares. Indicaciones y técnica quirúrgica.

Today's imaging studies accurately delineate the extent of glomus tumors of the temporal bone. Microsurgical techniques allow total removal of even the largest tumors with acceptable morbidity. While surgical management is the principal treatment of glomus tumors, stereotactic fractionated radiation therapy may be used as an alternative treatment when there is a risk of cranial neuropathy with surgical management. We should be aware of the full range of management options and base treatment choice on the age and medical condition of the patient and location and size of the tumor.

Intraoperative monitoring of intraarterial paraganglioma embolization by indocyaningreen fluorescence angiography.

Preoperative arterial embolization (AE) of paraganglioma (PG) is widely used to diminish intraoperative blood loss. Thereby conditions for a resection of the tumor shall be improved and risks for facial, vagal or hypoglossus nerve injuries are reduced. The vascularization of jugular and tympanic PGs is particularly complex due to collaterals with the vertebral and internal carotid arteries. Thus AE is often not complete and intraoperative blood loss may still be considerable. The postinterventional perfusion is of interest for the surgeon. We evaluated the arterial perfusion after AE using indocyaningreen (ICG) angiography. Six patients with PG, two carotid PGs, two jugular PGs, one vagal PG and one tympanic PG underwent surgery 1 day after AE. After tumor was exposed, ICG was intravenously applied followed by fluorescence angiography. Residual perfusion was assessed on the video clip and the perfusion index was automatically calculated by the IC-CALC software. This index was compared with the radiologist's assessment of arteriographic control after AE. Two of the six patients showed only marginal residual perfusion. These were patients with carotid PGs. The patient with the vagal PG showed 20%, the patients with jugular PGs 80 and 60% and the patient with the tympanic PG had 70% residual blood flow. The preoperative AE is rarely complete in PGs of the petrous bone. Intraoperative fluorescence angiography is a reliable procedure to evaluate the efficiency of preoperative embolization and can help the surgeon to estimate intraoperative bleeding favouring risks.

Impact of Jacobson's (tympanic) nerve sectioning on middle ear functions.

OBJECTIVE: The purpose of this study was to evaluate the influence of sectioning of the Jacobson's (tympanic) nerve on middle ear functions. METHOD: Twenty-five adult New Zealand rabbits were included in this study. The Jacobson's nerve was cut in the left ear of the rabbits (study group), whereas only a small mucosal incision was performed while keeping the Jacobson's nerve intact in their right ear (control group). After the operation, the ears were assessed both otomicroscopically and histopathologically on Days 30, 60, and 90. RESULTS: On otomicroscopy, retraction pockets were observed in 48 and 4% of the ears in the study and control groups, respectively (p < 0.001). Middle ear effusion was observed in 56 and 12%, respectively (p < 0.01). Histopathologically, an inflammation in the middle ear mucosa was present in all ears in the study group, whereas it was present only in 20% of the control ears (p < 0.001). Goblet cells were observed in 48 and 20% in the study and control groups, respectively (p < 0.04). In the study group, the otomicroscopic and histopathologic findings were more prominent on Day 60 compared to Day 90 (p < 0.05). CONCLUSION: Tympanic glomus cells seem to act as middle ear chemosensory organs and are involved in the regulation of middle ear aeration. Disruption of these neural elements such as Jacobson's nerve negatively impacts on middle ear functions and may result in atelectasis.

Paragangliomas de cabeza y cuello / Parangangliomas of the head and neck

Los parangangliomas son tumores altamente vascularizados que se originan de células provenientes de la cresta neural. El tratamiento de elección es la resección quirúrgica completa, lo cual se ve dificultado por su abundante irrigación y por su estrecha relación anatómica con importantes estructuras vásculo-nerviosas. En el presente estudio se revisa retrospectivamenete la experiencia del Departamento de Otorrinolaringología de Clínica Las Condes en el manejo quirúrgico de estas neoplasias. Entre los años 1998 y 2003 se trataron 5 pacientes portadores de paragangliomas de cabeza y cuello: un glomus yugular (GY), 2 glomus carotídeo (GC) y 2 glomus timpánicos (GT). El estudio imagenológico consistió en tomografía computarizada (TC) para todos los casos, complementada con resonancia nuclear magnética (RNM) y/o angiografía en algunos pacientes. El abordaje quirúrgico fue el indicado para cada lesión: timpanotomía retroauricular (GT), cervicotomía (GC) y abordaje infratemporal tipo A de Fisch (GY). En todos se logró una resección tumoral completa, sin presentarse complicaciones perioperatorias de consideración ni recurrencias hasta la fecha. Contando con un adecuado estudio imagenológico y una cuidadosa planificación quirúrgica, la resección de los paragangliomas de cabeza y cuello puede realizarse con un bajo índice de complicaciones, reservando la radioterapia como alternativa terapéutica únicamente en aquellos casos inoperables.