Glomus Tumor of the Middle Ear

If you've experienced recent hearing loss or a pulsing sound in your ear, you may have developed a glomus tumor. These growths are rarely malignant, but you should be familiar with the symptoms and treatment options so you can make an informed decision about dealing with your tumor.

Identification

• Glomus tumor is the common name for a growth technically called a paraganglioma. It's a slow-growing mass with much blood flow through it. If it's confined to the middle ear, it's referred to as a glomus tympanicum. Glomus jugulare and glomus vagale are tumors which begin near the jugular vein or the vagus nerve.

  Glomus tumors are usually benign, but they often need to be removed because they cause unacceptable symptoms. A few glomus tumors are malignant. These grow much faster and need to be removed immediately.

Symptoms

• The major symptom of glomus tympanicum is hearing loss. The mass of the tumor blocks the ear canal so sound isn't transmitted. You may hear a pulsating sound, or tinnitus, which is caused by blood flow within the tumor. As the tumor grows, it may cause dizziness. If it grows large enough, it can press on facial nerves leading to possible facial paralysis.

  A few glomus tumors secrete hormones. This can cause headaches, sweating, flushing or a rapid heartbeat.

Causes

• Glomus tumors form when modified nerve cells called paraganglia multiply abnormally and clump together. Some people have a genetic tendency toward developing glomus tumors, but other tumors appear with no genetic warning. This kind is called a sporadic glomus tumor.

  Women develop glomus tumors more often than men. Most patients develop the tumors in their forties and fifties. Living at low altitude seems to encourage the development of glomus tumors.

Diagnosis

• Your doctor may be able to see your glomus tumor when he examines your eardrum. The tumor is a rounded, reddish mass, and the blood vessels in the area may be enlarged. If he suspects a glomus tumor, he'll request a CT or MRI scan to diagnose it. A biopsy is the only definitive way to diagnose a glomus tumor, but a CT or MRI plus visual signs are fairly clear. Since the procedure to do a biopsy is nearly the same as surgical removal of a glomus tumor, most doctors remove it without performing a biopsy first.

Treatment

• Most glomus tumors are surgically removed. Your doctor can probably remove a glomus tympanicum in a simple, outpatient procedure. He will either lift the eardrum out of the way to remove the tumor through the ear canal or cut from behind the ear. If your tumor extends farther than the middle ear, you'll need more extensive surgery.

  Radiation therapy won't destroy a glomus tumor, but it may stop its growth. Your doctor might recommend radiation if you have a small tumor and don't want to undergo surgery. Realize that scar tissue from radiation makes surgery more difficult if it's eventually necessary. In some cases, your doctor may suggest watching your tumor with regular MRI scans and waiting to see if it grows before you undergo surgery.