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Tympanic paragangliomas (TP) arise in the middle ear along the course of Jacobson׳s or Arnold׳s nerve. These lesions can vary from small masses on the cochlear promontory to tumors that extend into the mastoid and external auditory canal. Surgical excision is the treatment of choice for TP with very low-recurrence rates. The various surgical approaches for TP are adapted to the configuration of individual tumors to provide adequate exposure to the margins of the tumor in the mesotympanum, hypotympanum, and mastoid. Using these surgical approaches in combination with meticulous dissection and hemostasis with adjunctive tools such as laser and micro-bipolar instruments allows for safe and effective resection of these vascular tumors from within the confines of the tympanic cavity.

Tympanic paragangliomas are uncommon vascular tumors of neural crest origin. Classically these lesions have been surgically managed via a transcanal or transmastoid approach using binocular microscopy. We describe a case in which a tympanic paraganglioma was removed via a transcanal approach, using the endoscope exclusively. Endoscopic ear surgery enhances visualization, helping to ensure complete tumor removal, while reducing unnecessary dissection and its associated morbidity. For small middle ear neoplasms, a purely endoscopic approach is feasible, with excellent results. Resident education in ear surgery has also been enhanced by the use of endoscopes. The wide field of view provided by the endoscope helps trainees understand the intricate three-dimensional anatomy of the middle ear cleft.

Objetivos Revisar los hallazgos de imagen de los paragangliomas. Determinar la utilidad de la embolizacion preoperatoria. Material y metodo De enero de 1994 a diciembre de 2004, en nuestro hospital se diagnostico a 30 pacientes de 33 paragangliomas de cabeza y cuello. Fueron estudiados mediante ultrasonografia, tomografia computarizada, resonancia magnetica y arteriografia. Resultados Distribucion segun localizacion: 16 carotideos (incluidos 1 caso de bilateralidad y 2 de presentacion multicentrica), 14 en el hueso temporal y 3 vagales. La embolizacion se realizo en 22 casos. Fue paliativa en 2 y adyuvante a la cirugia (18) o a la cirugia y radioterapia (2), y consiguio la reduccion del numero de complicaciones quirurgicas. Se opero a 8 pacientes y 3 rechazaron cualquier tratamiento. Conclusiones Los estudios de imagen son esenciales en el diagnostico diferencial de las masas de cabeza y cuello. La embolizacion preoperatoria es el mayor avance en el manejo quirurgico de los paragangliomas porque disminuye las potenciales hemorragias intraoperatorias.

Glomus tympanicum (GT) tumors are benign arising from paraganglion cells of the tympanic plexus in the middle ear. Although surgical resection remains the best option for definitive treatment of these tumors, the diagnostic and management algorithms have evolved considerably with the introduction of high-resolution computed tomography, MRI, and genetic testing.

Objectifs Evaluer la prise en charge des patients traites d’un paragangliome tympanique. Patients et methodes De 1996 a 2003, nous avons pris en charge neuf patients porteurs de paragangliomes tympaniques. On comptait 8 femmes et 1 homme (âge moyen : 65 ans). Ces 9 patients furent operes. Cette etude retrospective s’est interessee aux signes revelateurs, aux moyens diagnostiques utilises, a la technique chirurgicale, ainsi qu’aux resultats fonctionnels a court-, moyen-, et long-termes. Resultats L’intervention chirurgicale fut toujours bien supportee. Il n’y eut aucun cas de mastoidite post-operatoire. Aucun patient n’eut de trouble de l’equilibre post-operatoire. La resection tumorale fut obtenue dans 7 cas. Dans un cas, la resection fut incomplete afin de preserver la motricite faciale. Tous les patients sauf un furent soulages de leurs acouphenes apres chirurgie. Toutefois, dans quatre cas, la surdite fut aggravee par la resection chirurgicale, essentiellement par une augmentation de la composante transmissionnelle. Conclusion Le diagnostic de paragangliome tympanique, a evoquer devant tout acouphene pulsatile, est fortement oriente par l’imagerie. Il doit etre le plus precoce possible pour minimiser la morbidite post-operatoire. Si le traitement chirurgical permet la guerison et supprime l’acouphene, il comporte un risque auditif eleve.

The so-called glomus tumor in the temporal bone region is paraganglioma from a histopathological viewpoint. We report a case of tympanic paraganglioma and describe terminological validity to understand this disease clearly.A 34 year old male, complained of left pulsating tinnitus. Tympanic paraganglioma was suspected from visualization through the tympanic membrane, and computed tomography and magnetic resonance image. During surgery, the existence of a tumor was confirmed in the region from the mesotympanum to the hypotympanum adjacent to the promontory. The tumor was surgically removed and the pulsating tinnitus ceased postoperatively.For better understanding of the character of the tumor, we propose to call it not the glomus tumor but paraganglioma. If we use the term “glomus tumor” in the temporal bone region from a clinical viewpoint, we should recognize the histopathological difference between the so-called glomus tumor in the temporal bone region and the glomus tumor in the extremities.

The light microscopy and immunohistochemical findings of a jugulo-tympanic paraganglioma occurring in a 29-year-old man are reported. Diagnostic difficulties from frozen sections are stressed and selected literature is briefly commented upon.