This document discusses glomus tumors, which are rare, hypervascular tumors that arise from glomus bodies. They most commonly occur in the middle ear, jugular foramen, or neck regions. Symptoms depend on location but may include hearing loss, tinnitus, and cranial nerve deficits. Diagnosis involves imaging like MRI and CT. Surgery is the primary treatment and approach depends on tumor size and involvement. Preoperative embolization can help reduce bleeding risk during removal of these vascular tumors.

1. GLOMUS
TUMORS
Dr. AJAY MANICKAM
JR – RG KAR MEDICAL
COLLEGE

2. 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

3. 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

4. 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

5. CLINICAL FEATURES
 Incidence
 Middle aged, female
 Familial with autosomal dominant pattern but can be sporadic
also

6. 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

7. 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

8. 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

9. 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

10. 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