PARAGANGL?OMA
Posted by recep on April 2nd, 2009Tumors of the middle ear and mastoid are rare. Of these, the most common tumors are paragangliomas, derived from paraganglion tissue (eg, the carotid body). Otherwise known as glomus tumors, these benign lesions generally cause a conductive hearing loss and pulsatile tinnitus. Tumors originating in the middle ear (glomus tympanicum) are clinically evident even when small; those arising in the jugular vein at the mastoid (glomus jugulare) become clinically apparent relatively late and may produce symptoms such as paralysis of cranial nerves IX through XII.
Physical examination may reveal a pulsatile red mass in the middle ear. The integrity of the cranial nerves should be assessed. Audiometric evaluation usually documents a conductive hearing loss; in more widespread tumors, a sensorineural component may also be detected. Because of the multicentricity of these lesions, four-vessel cerebral angiography or magnetic resonance angiography may reveal other, occult growths. Glomus tumors may produce catecholamines, resulting in intermittent hypertension.
Treatment depends on the tumor’s size as well as the patient’s general medical condition. In the healthy patient, small tumors can be removed relatively easily. In the infirm patient, extensive tumors are probably best managed more conservatively. Relatively low-dose radiation therapy and arteriographic embolization are palliative and may be more appropriate in the elderly.
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