GLOMUS TUMORSDr. AJAY MANICKAMJR – RG KAR MEDICAL COLLEGE

THE GLOMUS TUMORS These are chemodactomas or non-

chromaffin paragangliomas arise from glomus bodies distributed along the parasympathetic nerve in the skull base, thorax & neck

GLOMUS TUMOURS Glomus tympanicum –

middle ear promontory Glomus jugulare – jugular

foramen Glomus vagale – when

arising from neck extending towards jugular foramen

When arises from carotid bulb – Carotid Body tumors

PATHOGENESIS Hypervascular tumours arising

from glomus bodies Glomus bodies are found within

adventitia of the jugular bulb, course of glossopharyngeal nerve, vagus nerve, tympanic canaliculus, retrofacial air cells, promontory, geniculate ganglion

They secrete catecholamines, although few cases hypersecretion of noradrenaline, dopamine, serotonin have also been described

Few cases may go for malignant changes and metastasis

CLINICAL FEATURES Incidence Middle aged, female Familial with autosomal dominant pattern but can be

sporadic also

SYMPTOMS Hearing loss Pulsatile tinnitus Blocking sensation of ear Blood stained discharge Otalgia Cranial nerve paralysis –

6,7,9,10,11,12 CN weakness – producing symptoms like diplopia, hoarseness, aspiration, inability to lift shoulder

SIGNS RISING SUN – reddish blue

retrotympanic mass – behind the TM Bleeding and polypoidal mass seen

when there is invasion of TM BROWN’S SIGN – smooth dark mass

blanches in response to via pneumatic pressure through seigelization

CLASSIFICATION - FISCH Type A – tumour localized in ME cavity Type B – tympanomastoid tumours with no destruction of

bone in infralabyrinthine compartment in the temporal bone

Type C – tumour invading bone of the infralabyrinthine compartment

Type D – tumours with intracranial extension

INVESTIGATIONS Audiogram – initially conductive – later SNHL MRI with gadolinium contrast – T1 weighed

image shows salt & pepper appearance CT SCAN – PHELP’S SIGN – normal crest

between the carotid canal and jugular foramen lost

Digital subtraction angigraphy – helps us to know feeding arteries for preoperative embolization

24 hour urine Vanillyl mandelic acid level – as tumour secrete catecholamines which can cause increase in BP

TREATMENT Surgery Type A & B – Trans mastoid approach Type C & D – Lateral skull base approach Embolization – preoperative before 48 hours can reduce

intra operative bleeding Radiotherapy & chemotherapy for unresectable tumours LASER assisted excision - gives good results