Contains about tumors of middle ear. Glomus tumor, carcinomas.

2. CLASSIFICATION
1)Primary Tumours:
Benign Glomus tumour
Malignant Carcinoma ,sarcoma
2)Secondary Tumours:
a) From adjacent areas like nasopharynx ,
external meatus and parotid.
b)Metastatic eg. From ca of bronchus,
breast, thyroid, prostrate, GIT.

3. GLOMUS TUMOUR:
 Most common benign neoplasm of middle
ear and originate from the glomus bodies .
It is found in the jugular bulb or on the
promontory along course of tympanic
branch of IXth cranial nerve(jacobson’s
nerve).
 The tumour consists of paraganglionic cells
derived from the neural crest.

5. AETIOLOGY AND
PATHOLOGY
 Often seen in middle age.(40-50).
 Females>Males.
 It is a benign non encapsulated but
extremely vascular ,slow growing and locally
invasive tumours.
 Microscopically it shows sheets of epithelial
cells with large nuclei and granular

6. Two types of glomus tumours:
1)Glomus jugulare: They arise from dome of jugular
bulb, invade hypotympanum and jugular foramen ,
causing neurological sign of IX th to XII th cranial
nerve involvement . They may compress or invade
lumen of jugular vein.
2)Glomus Tympanicum: They arise from promontory
of middle ear.

8. CLINICAL
FEATURES:
 A)When tumour is intratympanic:
• Earliest symptoms are deafness and
tinnitus.Deafness is conductive type and tinnitus
is pulsatile.
• Otoscopy show red reflex through intact TM.
“Rising sun”appearance is seen.
• “Pulsation sign”(Brown’s sign) is positive.
B) When tumour present as polyp: profuse bleeding
from ear either spontaneously or after cleaning.
• Dizziness or vertigo and facial paralysis may
appear . Earache less common otorrhoea due to
secondary infection.Examionation reveals red
vascular polyp.

10.  Cranial nerve palsies: It is a late feature .IX
th to XII cranial nerves may be
involved.dysphagia , hoarsness with
unilateral paralysis of soft palate, pharynx
and vocal cord.
 Tumours may present as mass over mastoid
or in nasopharynx.
 Audible bruit over mastoid.
 Some glomus tumours secrete
catecholamines and produce their
symptoms.

11. DIAGNOSIS:
1)CT scan head
2)MRI
3)Four vessel angiography
TREATMENT:
 Surgical removal
 Radiation
 Embolisation
 Combination of the above techniques

12. CARCINOMA OF MIDDLE EAR AND
MASTOID
AETIOLOGY:
Age- 40 to 60, females>males, chronic
irritation may be the cause.
PATHOLOGY:
Tumour may arise primarily from middle ear
or be an extension of carcinoma of deep
meatus. Squamous cell variety is most
common.

13. CLINICAL FEATURES:
 CHRONIC FOUL SMELLING DISCHARGE SPECIALLY
BLOOD STAINED.
 PAIN USUALLY SEVER AND COMES AT NIGHT
 FACIAL PALSY
 FRIABLE HAEMORRHAGIC GRANULATIONS OR POLYP
 APPEARANCE OF OR INCREASE IN DEAFNESS OR
VERTIGO.

14. DIAGNOSIS
 DEFINITIVE DIAGNOSIS IS MADE ONLY
ON BIOPSY
 EXTENT OF DISEASE IS JUDGED BY
CLINICAL AND RADIOLOGICAL
EXMINATION.
 CT SCAN & ANGIOGRAPHY ARE
USEFUL IN THE ASSESSMENT OF
DISEASE.

15. TREATMENT:
 Combination of surgery and radiotherapy
gives better results.

16. THANK YOU