Glomus Tympanicum and Glomus Jugulare Tumours
What You Need to Know
Glomus tumours of the ear (known as paragangliomas) are rare, slow-growing, highly vascular tumours. While they are almost always benign (non-cancerous) and do not spread to other parts of the body, their location near critical nerves, blood vessels, and brain structures requires precise diagnosis and careful management.
Because they grow hidden within the temporal bone of the skull, understanding their signs helps prevent delayed diagnosis.
Understanding the Two Types
Glomus Tympanicum: These tumours start inside the middle ear cavity. They are usually smaller, easier to treat, and typically confined to the ear space.
Glomus Jugulare: These tumours arise slightly lower down, near the jugular bulb (the main vein draining blood from the brain). They can invade the skull base, surrounding bone, and nearby nerves.
The Shared Warning Signs
Both types of tumours share a classic triad of early symptoms:
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Pulsatile Tinnitus: A rhythmic thumping, whooshing, or beating sound in the ear that matches the patient's heartbeat.
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Hearing Loss: Usually a gradual, one-sided loss of hearing caused by the tumour blocking sound transmission (conductive hearing loss).
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Ear Fullness: A persistent feeling of pressure or blockage inside the ear.
Advanced Symptoms (Mainly Glomus Jugulare)
As a glomus jugulare tumour grows, it can press on the lower cranial nerves (Nerves IX, X, XI, and XII). This can lead to:
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Difficulty swallowing or regular choking on liquids
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Hoarseness or changes in the voice
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Weakness when shrugging the shoulders
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Weakness or asymmetry in the face or tongue
Clinical Evaluation & Diagnosis
Clinical evaluation for a glomus tumour involves an otoscopic physical exam identifying a vascular, "rising sun" reddish-blue mass, with diagnosis confirmed through audiometry and high-resolution imaging (CT temporal bone/MRI). Clinicians must never perform an incisional biopsy due to risks of severe bleeding from the highly vascular tumor. In cases of suspected functional tumors, a 24-hour urine or plasma metanephrines test will be arranged to screen for catecholamine secretion.
Management Strategies
Treatment is highly individualized. It is determined by our Neurotologists at ENT Associates who may involve the Auckland Skull Base multidisciplinary team, based on the patient's age, overall health, and tumour size.
1. Observation ("Wait and Scan")
Because these tumours grow very slowly, immediate intervention is not always required. For older adults or patients with small, stable, asymptomatic tumours, your specialist may recommend regular monitoring with serial MRIs and physical exams.
2. Surgical Resection
Surgery aims to completely remove the mass.
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Glomus Tympanicum: Frequently treated with surgical removal, which can be highly curative with low complication rates.
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Glomus Jugulare: Surgery is far more complex due to the involvement of the skull base. Specialized endovascular embolization (blocking the blood vessels feeding the tumour) is often performed 24 to 48 hours before surgery to minimize intraoperative bleeding.