[Imaging evaluation of the cases with tympanicum and pulsatile tinnitus]

OBJECTIVE

To analyze the CT and MRI features of glomus tympanicum tumors accompanied with tympanitis and evaluate the diagnostic value of CT and MRI in order to improve the cognition for the disease.

METHODS

The clinical materials and images of 8 patients with the symptoms of pulsatile tinnitus and hearing loss in whom glomus tympanicum tumors with tympanitis surgically and pathologically confirmed were retrospectively reviewed. The characteristics and diagnostic value of CT and MR imaging were summarized.

RESULTS

By CT examination the lesions in middle ear and mastoid were preoperatively diagnosed as tympanitis in five cases and only in three cases the glomus tympanicum tumors were suspected. In six patients underwent MR examination the lesions were all preoperatively diagnosed as glomus tympanicum tumors accompanied with tympanitis. HRCT scanning of the temporal bone in all patients showed the soft tissue lesions in the tympanic cavity and mastoid, and the caritas tympanic were mostly (n = 3) or completely (n = 5) occupied by soft tissue lesions, but the auditory ossicles were all without destruction. Contrast-enhanced axial CT scanning performed in five cases showed less soft tissue mass on the cochlear promontory, and the size of mass was less than that observed in MR imaging. MR T(1)-weighted imaging showed the presence of isointense lesions in middle ear and isointense (n = 3) or hyperintense (n = 3) lesions in mastoid. On T(2)-weighted imaging the lesions with slight hyperintense were viewed in the middle ear and the lesions with hyperintense in mastoid. T(1)-weighted gadolinium-enhanced MRI showed the masses in tympanum were markedly increased enhancement, but the lesions in mastoid without enhancement. MRI and CT imaging revealed the masses in six cases of eight extending to the eustachian tube.

CONCLUSION

When the glomus tympanicum tumor was accompanied with tympanitis the tumor could be misdiagnosed or missed only by CT examination. The patients with pulsatile tinnitus should be taken seriously. MRI with contrast-enhancement is superior to CT in the preoperative diagnosis and accurately evaluation for the glomus tympanicum tumors with tympanitis.

[Multiple paragangliomas: about two cases]

The multiple paragangliomas are rare tumours, with slow evolution, posing diagnostic and therapeutic problems. The carotid and jugulo-tympanic localization are the most frequent, and the aortic localization is very infrequent. The association of two, three and four localization is possible in the multiple forms. These multiple localizations are more frequent in familial forms. Surgical removal is the first intention treatment of these tumours. In the multiple forms, the therapeutic strategy must be adapted to each case: usually, the intervention begins by the carotid localization. We report two cases of chemodectoma with multiple localizations. The first case is a 44 years-old woman, who presented a double localization: carotid (bilateral) and aortic (arch). The second case is a patient with a double aortic localization, carotid and aortic, associated to a tympano-jugular localization. Surgical treatment was performed for all these localization, except for the tympano-jugular localization, treated by embolization. The post-operative periods were uneventful. The first case had adjunctive radiotherapy.

Nasopharyngeal extension of glomus tympanicum: an unusual clinical and imaging manifestation

Nasopharyngeal extension of the glomus tympanicum is rare. Only 2 cases have been reported in the literature to date. We present a reported case of a large nasopharyngeal extension of recurrent glomus tympanicum, with various kinds of imaging and histopathology and a review of the literature.

[Glomus caroticum, jugulare and vagale--problems in diagnosis and treatment]

INTRODUCTION

The paraganglia tissue in 80% is located in suprarenal glands. The rest (20%) are with close association with autonomic nerves and some cranial nerves. Paraganglioma, being tumors arising from the paraganglion cells of the parasympathetic system, were first reported in man in 1935. Although histologically these tumors have been shown to contain neurosecretory granules, they are rarely functional. There are four kinds of paragangliomas: deriving from carotid artery baroreceptors (glomus caroticum), internal jugular vein (glomus jugulare); placed along vagal nerve (glomus vagale) and paragangliomas of tympanic cavity (glomus tympanicum). The first three of them are clinically recognized as tumor of the neck.

MATERIAL AND METHODS

Authors present group of 7 patients with paragangliomas treated in ENT Department in Poznań in the years 1994-2004. There were treated 4 patients with glomus caroticum, two with glomus vagale and one patient with glomus jugulare.

RESULTS

All patients were treated surgically. In one case in group with glomus caroticum in histological examination tendency to infiltration of internal carotid artery was stated (chemodectoma malignum). The tumor was removed totally with partial excision of communis, external and internal carotid artery. The internal carotid artery was closed by the tumor.

CONCLUSION

Authors underline three aspects of process of treatment in whole group of patients: diagnostic problems, way of treatment and long term results.

Glomus tympanicum: a report of two cases

Two cases of glomus tympanium tumor of the middle ear stage 'type A' according to Fisch classification, are presented due to their rarity in this part of the world. These tumors were excised by end aural tympanotomy approach and there has been no recurrence in both patients to date.

[Three kinds of chemodectoma in one patient--a rare case]

Tumors arising from paraganglioma tissue are properly called paragangliomas. Preferentially these tumors are named for their site of origin. In the head and neck they are most commonly found arising from the carotid body (glomus caroticum), the jugular bulb (glomus jugulare), the tympanic cavity (glomus tympanicum) and the vagal ganglia (glomus vagale). Mutiple paragangliomas may occur in 2-10%. The purpose of this study was to present the rare case of patient with three kinds of chemodectoma: glomus tympanicum, jugulare i vagale.

[Diagnosis and therapy of glomus tympanicum and glomus jugulare tumors]

OBJECTIVE

To report on a series of patients with glomus tympanicum or glomus jugulare tumors, and to focus on its diagnosis, treatment, and outcomes.

METHODS

Ten patients with glomus tympanicum or glomus jugulare tumors at Peking Union College Hospital during a 17-year period were reviewed retrospectively.

RESULTS

There were 7 patients with glomus tympanicum, 3 with glomus jugulare tumors, 1 patient with familial paraganglioma and 1 with functioning glomus jugulare tumors. The most common presenting symptoms were pulsatile tinnitus and hearing loss. Other symptoms included facial nerve paralysis, vertigo, otalgia, dysphagia, hoarseness, throat sore, episodic hypertension with headaches and tachycardia. The most common physical sign was a vascular middle ear mass. The other physical signs included Brown sign, upper neck mass, pharyngeal plump, Collet-Sicard syndrome, Homer's syndrome as well as deficit of cranial nerve V. The radiographic evaluation included computed tomograph (9 cases), angiography (4 cases) and magnetic resonance imaging (1 case). Eight patients initially refered to ENT department, and 2 patients initially consulted neurology or endocrinology specialists. The treatment included preoperative embolization in 2 cases, simple surgery in 4 cases and surgery followed by radiation therapy in 6 cases. No significant complications occurred. Nine of the 10 patients were followed up, but 1 was lost. The mean follow-up time was 12 years (ranged, 2-19 years). No tumor recurrence occured in the 6 cases with total tumor removal. Three cases with subtotal tumor resection had no tumor progression.

CONCLUSIONS

The diagnosis and treatment of glomus tympanicum and glomus jugulare tumors is particularly challenging. Typical clinical manifestations and radiographic evaluation should be considered together to establish the diagnosis. The primary treatment for glomus tympanicum is surgery, if necessary, followed by radiotherapy. Subtotal tumor resection followed by radiation yields satisfying outcome for glomus jugulare tumors.

Laser excision of glomus tympanicum tumours: long-term results

The purpose of this study was to evaluate the long-term results of laser excision of glomus tympanicum tumours in a series of patients who had been referred to the senior author (DAM) in a retrospective case review. Nine patients underwent complete excision of their glomus tympanicum tumours using a Diode or KTP laser. There were no cases of tumour recurrence. There were no complications during the peri- or postoperative period. Follow-up time was 31.8 months. In our experience, laser excision can be performed with minimal bleeding and morbidity, and it provides excellent tumour control in glomus tympanicum surgery.