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Glomus Tumour

  1. Definition :
    Glomus jugulare is a collection of ganglionic tissue within the temporal bone in close relation with the jugular bulb. Commonest benign tumor of the middle ear.
    Origin from Glomus Bodies found along Jugular bulb and Jacobson’s nerve.
  2. Types
    1. GL Jugulare - from Jugular bulb
    2. GL Tympanum - from Promontory (Tymp plexus- Jacobson’s nerve)
  3. Features: 90% pertain to the ear
    1. Slow growing locally invasive, causing destruction of the bone and facial nerve
    2. Highly vascular: blood supply: ascending pharyngeal artery
    3. Sex : Female: male =5:1
    4. Age group: Middle age (40- 50 Yrs)
    5. Autosomal dominant
    6. Malignant transformation : is rare
    7. Some show endocrine activity: secrete catecholamine --> upt ot 5%
  4. Clinical symptoms;
    1. Conductive deafness
    2. Pulsatile tinnitus - stopped by pressure on carotid is the commonest presentation
    3. Otorrhoea - when as a polyp in EAC
    4. Facial palsy
    5. Endocrine symptoms
    6. Cranial nerve deficits; (IX, X, XI nerves)
      1. Hoarseness                    
      2. Dysphagia
    7. Headache
    8. Visual disturbance
  5. Sign:
    1. Bleeding - when it presents in EAC as a polyp
    2. Rising sun sign
    3. Otoscopy shows a red reflex through intact tympanic membrane. “Rising sun” appearance is seen when tumour arises from the floor of middle ear. Sometimes, tympanic membrane appears bluish and may be bulging.
    4. “Pulsation sign” (Brown’s sign) is positive, i.e. when ear canal pressure is raised with Siegle’s speculum, tumour pulsates vigorously and then blanches; reverse happens with release of pressure.
    5. VII, IX, X, XI palsy may be seen - late features
    6. Audible bruit on auscultation over mastoid
    7. If tumor in canal
      1. Vascular polyp               
      2. Bleeds on manipulation  
  6. Investigation:
    1. Examination under microscope: Pulsatile mass
    2. Blanching on siegalization - Brown’s sign/ Pulsation Sign
    3. C.T. scan: The most valuable investigation - MRI, skull/mastoid X-Rays
    4. PHELP’S SIGN: absence of normal crest between the carotid canal and Jugular fossa on lateral tomography. --> Is a radiological sign.
    5. Urinary VMA (Vanillyl mandelic acids) : (n) level= 7 mg/day

Blue drum is seen in hemotympanum (due to temporal bone fracture), glue ear, glomus tumour or haemangioma of middle ear.


No treatment and continuous observation
  1. If patient has minimal symptoms       
  2. Repeat CT scan does not extensive spread
Used for inoperable tumors
  1. Rarely curative
  2. Has some effect on slowing the tumor growth
  3. Often the intra-cranial extensions of the tumor regress
  4. Vertigo and tinnitus: Improve
  5. Deafmess and cranial nerve palsies persist
  1. Trans-meatal approach
  2. Extended facial recess approach: for tympanomastoid tumor
  3. Infratemporal fossa approach (for tumors in the infra labyrinthine compartment with little intracranial extension)
  4. Posterolateral approach
    (For tumor with large intra-cranial extension)
Embolization -Before surgery to decrease vascularily and in inoperable tumors

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