Akademik Veri Yönetim Sistemi
18.Ulusal Acil Tıp Kongresi 9th intercontinental Emergency Medicine Congress 9th international Critical Care And Emergency Medicine Congress, Antalya, Türkiye, 27 Ekim 2022
ABSTRACT: The most common paraganglioma of the middle ear is called glomus tympanicum. Glomus tympanicum is the most common benign neoplasm of the middle ear. Symptoms are usually localized and often do not give clinical signs when they do not reach sufficient size. Glomus tympanicum should be considered as a rarer cause in patients presenting with tinnitus and hearing loss. KEYWORDS: Glomus tympanicum, emergency department, benign neoplasm INTRODUCTION: The most common paraganglioma of the middle ear is called glomus tympanicum. They are benign neoplasms of the middle ear. They usually originate from the glomus bodies on the Jacobson nerve. They can often be located on the promontorium, or they can completely fill the middle ear and extend into the eustachian or mastoid cavity (1). As a result of this extension, they cause various symptoms. Among these, pulsatile tinnitus, hearing loss, and a feeling of fullness in the ear are common symptoms. CT is very useful for the evaluation of localization and changes in the ossicular chain in the diagnosis, and embolization, radiotherapy and surgical methods are used in the treatment (2). CASE: A 72-year-old female patient is referred to the emergency department of our hospital and then to the Otolaryngology polyclinic with complaints of fullness and ringing in the ear. In the otoscopic examination of the patient with known DM, using oral antidiabetics and no history of operation, the right ear was observed naturally, and a pulsatile red reflective mass was observed behind the left tympanic membrane, completely filling the tympanic cavity
Systemic examination was normal, fever was 36.4 degrees, TA was 132/70. Routine blood tests were normal. In pure tone audiogram, right ear airway: 48 decibel(db) bone conduction:
21db, left ear airway: 63 db bone conduction: 41 db hearing threshold levels were present. Tympanometric examination did not show, while Type A curve was observed in the left ear, Type
B curve was observed in the right ear. A 7x3x3 mm mass compatible with the glomus tympanicum was reported in thin-section Temporal CT. The middle ear was entered into the patient by
transcanal route under ETGA. The pulsatile mass in front of the promontorium was excised. Bleeding was controlled and the operation was terminated. No complications were observed in the
perioperative and postoperative period. The histopathological examination of the mass was reported to be compatible with the glomus tympanicum. In the postoperative control audiometry
of the patient, right ear airway: 46db bone conduction: 20 db, left ear airway: 49db bone conduction: 40db hearing threshold levels were observed. An improvement of 13 db was observed
in the amount of gap in the left ear.
DISCUSSION: Glomus tympanicum is the most common benign neoplasm of the middle ear. Symptoms are usually localized and often do not give clinical signs when they do not reach
sufficient size. Symptoms include pulsatile tinnitus, aural fullness, and conductive hearing loss. Otoscopy examination, audiogram, tympanometry, CT, MRI and angiography are very useful
in diagnosis. In addition, other causes of paraganglioma and vascular malformations should be investigated in patients diagnosed with glomus tympanicum. Treatment should be decided by
considering criteria such as tumor size, location, patient’s age and hearing loss. Embolization and Radiotherapy are alternative treatments, and surgical methods should be used if possible
(3).
CONCLUSION: Glomus tympanicum should be considered as a rarer cause in patients presenting with tinnitus and hearing loss. In the selection of the most appropriate treatment for the
patient, the clinical condition of the patient should be prioritized, and high jugular bulb, abberane carotid artery localization, the patient’s expectation of hearing, ossicular chain destruction
and other a-v malformations should be considered in the selection of surgery (4). In the postoperative period, one should be very careful in terms of bleeding and other complication risks.
REFERENCES
1.Ear-Nose-Throat-and-Head-Neck-Surgery-Specialty-Training-2019-2.book
2.Nihat Ayan, Ebru Stone. Ethem Şahin, Ahmet Şirin, Eminenur Dağtekin, Yusuf Eren, Mehmet Uhri’, A.Okan Gursel, Glomus Timpanikum: Case report,Bakırkoy Dr. Sadi Konuk Training and
Research Hospital, ENT and Pathology Clinic’, Istanbul, 2005
3.Jack.son CG, Glasscock ME, Nissen AJ. Schwaber MK: Glomus tumor surgery, The approach, results and problems. Otolaryngol Clin North Am 1982; 15,897-916.
4.Makek M, Franklin DJ. Zhao JC, Fisch U, Neural infiltration of glomus temporale tumors. Am J Otol 1990;1 U-5.