Glomus tumors in patients of advanced age: a conservative approach.
OBJECTIVE
Identify and discuss controversies in the management of paragangliomas in elderly patients. Assess and evaluate a conservative treatment strategy involving limited surgical resection and vigilant monitoring of the outcome measures of tumor control, peritreatment morbidity, symptom resolution, and hearing preservation.


METHODS
Retrospective case review.


METHODS
All of the patients in this study were over age 60 with temporal bone glomus tumors. Primary outcome assessment included length of hospitalization, perioperative morbidity, symptom resolution, hearing preservation, and long-term tumor control.


RESULTS
Twelve female patients with mean age of 74.5 years (range 61-85 years) with follow-up from 24 months to 33 years (mean/median: 5/7.8 years) were identified. Nine (75%) of the patients presented with pulsatile tinnitus. Seven patients (58%) underwent surgical excision of the middle ear component of the paraganglioma. Tumors extending to the jugular foramen were purposely not resected. Five patients (45%) had relative or absolute contraindications to surgical resection and were treated with observation or primary radiation therapy. Post-treatment audiometric evaluation confirmed stable or improved hearing. Pulsatile tinnitus resolved in all patients. No patient experienced cranial nerve deficits, extended hospitalization, or blood transfusions. All patients were followed closely with radiological imaging. The majority of patients demonstrated no disease or stable disease, while two patients demonstrated tumor growth 6 years after diagnosis.


CONCLUSIONS
A prolonged natural history and the morbidity associated with surgical intervention have led to controversies in the treatment of glomus tumors in an elderly population. Our experience supports recent limited reports advocating conservative surgical excision and vigilant long-term monitoring in this population.
Cosetti
Maura
M
Department of Otolaryngology, New York Eye and Ear Infirmary. New York, NY 10003, USA.
Linstrom
Christopher
C
Alexiades
George
G
Tessema
Belachew
B
Parisier
Simon
S
D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D001859:Bone Neoplasms / Q000453:epidemiology / Q000473:pathology* / Q000601:surgery*; D018572:Disease-Free Survival; D004428:Ear Neoplasms / Q000453:epidemiology / Q000473:pathology / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D005918:Glomus Tumor / Q000453:epidemiology / Q000473:pathology* / Q000601:surgery*; D006314:Hearing Loss, Conductive / Q000175:diagnosis / Q000453:epidemiology; D006801:Humans; D008279:Magnetic Resonance Imaging; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D009364:Neoplasm Recurrence, Local; D009367:Neoplasm Staging; D013517:Otorhinolaryngologic Surgical Procedures / Q000379:methods*; D010235:Paraganglioma / Q000453:epidemiology / Q000473:pathology* / Q000601:surgery*; D012720:Severity of Illness Index; D013701:Temporal Bone / Q000473:pathology* / Q000601:surgery*; D013997:Time Factors