Glomus Jugulare Tumor

Glomus jugulare tumors are the most common tumors of the middle ear. They arise from the tissues of the glomus bodies located in the ear. These tumors tend to be very vascular and are fed by branches of the external carotid artery.

Who is most likely to have a glomus jugulare tumor?

These tumors are much more prevalent in women, occuring in women six times more frequently than in men.

The symptoms of a glomus jugulare tumor include: hearing loss with pulsatile ringing in the ear, dizziness, and sometimes ear pain. When examined by a physician the patient is found to have a hearing loss due possibly to blockage of the middle ear, but also there can be a loss of hearing due to nerve injury from the tumor mass. Cranial nerve palsies of the nerves which control swallowing, gagging, shoulder shrugging and tongue movement can all be part of the presentation of glomus jugulare tumors. When the tympanic membrane (ear drum) is examined a red/blue pulsatile mass can often be seen (the color is a clue to any physician not to biopsy this mass through the ear!).

The diagnosis of a glomus jugulare tumor is made by neurophysiologic studies as well as imaging which would include MR and CT scan. Endocrine work-up should include evaluation for certain catecholemines (derivatives of adrenaline) which are characteristically found in tumors like glomus jugulare tumors that are of the subclass paraganglioma.

What is the treatment?

Treatment for glomus jugulare tumors include medical therapies with medications that are alpha and beta blockers. X-ray therapy can be used to improve symptoms even if the mass persists. It is also possible to embolize the tumor with materials which block its blood supply, however this procedure has associated problems with causing swelling of the tumor which can compress the brain stem and cerebellum as well as releasing the catecholemines from the cells which die when they lose their blood supply. Surgery can be done for small tumors. The complications of surgery for a glomus jugulare tumor are persistent leakage of cerebrospinal fluid from the ear and also palsy of one of the cranial nerves controlling face movement, sensation or hearing. Even though the surgery may be successful glomus jugulare tumors are somewhat problematic because they have a high recurrence rate and may require multiple operations.