Glomus tumour

    • It is the most common benign neoplasm of middle ear
    • originates from the glomus bodies. (MCQ)
    • Glomus bodies
      • resemble carotid body in structure
      • found in the
        • dome of jugular bulb
        • on the promontory along the course of tympanic branch of IXth cranial nerve (Jacobson’s nerve).
    • The tumour consists of paraganglionic cells derived from the neural crest.
    • Aetiology and Pathology
      • The tumour is often seen in the middle age (40-50 years).
      • Females are affected five times more.(MCQ)
      • It is a benign, non-encapsulated
      • extremely vascular neoplasm.
      • Its rate of growth is very slow
      • Tumour is locally invasive.
      • There is abundance of thin-walled blood sinusoids with no contractile muscle coat, accounting for profuse bleeding from the tumours.
    • Glomus jugulare
      • They arise from the dome of jugular bulb
      • invade the hypotympanum and jugular foramen
      • cause neurological signs of IXth to XIIth cranial nerve involvement.
      • They may compress jugular vein or invade its lumen.
    • Glomus tympanicum
      • They arise from the promontory of the middle ear
      • cause aural symptoms, sometimes with facial paralysis.
      • Metastatic lymph node enlargement can also occur.(MCQ)
    • Clinical Features
      • Earliest symptoms are hearing loss and tinnitus.
      • Hearing loss is conductive and slowly progressive.
      • Tinnitus (MCQ)
      • pulsatile and of swishing character, synchronous with pulse
      • can be temporarily stopped by carotid pressure.
      • Otoscopy (MCQ)
        • red reflex through intact tympanic membrane.
        • "Rising sun" appearance is seen when tumour arises from the floor of middle ear.
        • Sometimes, tympanic membrane appears bluish and may be bulging. (MCQ)
        • "Pulsation sign" (Brown’s sign) is positive
          • when ear canal pressure is raised with Siegle’s speculum, tumour pulsates vigorously and then blanches; reverse happens with release of pressure.(MCQ)
      • When tumour presents as a polyp
        • In addition to hearing loss and tinnitus, there is history of profuse bleeding from the ear either spontaneously or on attempts to clean it.
        • Dizziness or vertigo and glomus bodies may appear.
        • Earache is less common than in carcinoma of the external and middle ear, and helps to differentiate it.
    • Cranial nerve palsies
        • IXth to XIIth cranial nerves may be paralysed.
    • Audible bruit
        • At all stages, auscultation with stethoscope over the mastoid may reveal systolic bruit.
    • Some glomus tumours secrete catecholamines
    • Rule of 10s
        • Remember that 10% of the tumours are familial, 10% multicentric and up to 10% functional, i.e. they secrete catecholamines.(MCQ)
    • Investigations
      • Phelp’s sign
        • The absence of the normal crest of bone between the carotid canal and jugular fossa on lateral tomography is virtually diagnostic of a glomus jugulare tumor.
    • CT head and MRI combined together provide an excellent preoperative guidance in the differential diagnosis of petrous apex lesions.
    • Four-vessel angiography
      • It is necessary when CT head shows involvement of jugular bulb, carotid artery or intradural extension
    • Brain perfusion and flow studies
      • They are necessary when tumour is pressing on internal carotid artery.
    • Embolization
      • In large tumours, embolization of feeding vessels 1-2 days before operation helps to reduce blood loss.
    • Biopsy
      • Preoperative biopsy of the tumour for diagnosis is never done.
    • Treatment (MCQ)
    • Surgical removal.
    • Radiation.
    • Embolisation.

    Glomus Tumor Of The Finger – Everything You Need To Know
    Educational video describing the condition of glomus tumor in the finger.
    Glomus Tumor Removal
    Glomus Tumor of the Left Ear MEDtube
    Excision Of Glomus Tumour
    Glomus Tumours are difficult tumors to excise simply because of their vascularity. In this video clip the approach to such a tumor is detailed.
    The Jugulo-Tympanic Glomus Tumor
    Excision of subungal glomus tumour
    Micro dissection of lesion. Note scalloped p3
    Infratemporal Fossa Approach: Glomus Jugulare Tumors
    An instructional video for surgeons that steps through the procedure using the middle fossa approach and points out potntial problems in removing a glomus tumor.
    GLOMUS JUGULARE TUMOR-Rt skull base–microsurgical removal-dr suresh dugani/HUBLI/KARNATAK/INDIA
    This lady 45 yrs ,had vascular large glous jugulare tumor on right side temporal/jugular fossa region with large component extending into C-P ANGLE ,with brain stem compression,with rt 5-11 cranial nerve deficits ,with cerebellar deficits,both lesions were excised completely.with excellent out come
    Surgical Management of Glomus Carotid Tumor
    The surgical technique of surgical removal of glomus of carotid body is presented