Middle ear and mastoid glomus tumors (glomus tympanicum): an algorithm for the surgical management.
OBJECTIVE
Glomus tumors are slow-growing benign lesions and represent the most common primary neoplasms of the middle ear. The objective of the present study is to report our surgical strategy in the management of glomus tympanicum tumors.


METHODS
Between December 1988 and July 2008, 68 patients with histologically confirmed glomus tympanicum tumor underwent surgical treatment. The follow-up of the series ranged from 6 to 194 months (mean, 33.4 months).


RESULTS
Distribution of tumors according to Fisch and Mattox classification was as follows: type A, 44 cases (64.7%); type B, 24 cases (35.3%). All of the 44 Class A tumors were safely removed via either a stapedectomy-type transcanal approach or a retroauricolar-transcanal approach. Five patients with Class B tumors were operated on through a transmastoid approach. Nineteen patients with larger Class B tumors underwent a subtotal petrosectomy with blind sac closure of the external auditory canal and middle ear obliteration. Gross total tumor removal was achieved in all 68 cases. In one case (1.4%) there was recurrence after 9 years, for which the patient was re-operated. No residual/recurrence has been detected on computed tomography in the rest of the patients.


CONCLUSIONS
Surgical excision of glomus tympanicum tumors is a safe procedure, allowing total tumor removal with minimal morbidity, a low recurrence rate, and a low complication rate.
Sanna
Mario
M
Gruppo Otologico, Piacenza-Rome, Italy.
Fois
Paolo
P
Pasanisi
Enrico
E
Russo
Alessandra
A
Bacciu
Andrea
A
D000328:Adult; D000368:Aged; D000465:Algorithms; D001299:Audiometry; D004428:Ear Neoplasms / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery*; D004432:Ear, Middle; D005260:Female; D005500:Follow-Up Studies; D043604:Glomus Tympanicum Tumor / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery*; D034381:Hearing Loss / Q000175:diagnosis / Q000209:etiology; D006801:Humans; D008297:Male; D008416:Mastoid; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000601:surgery; D013506:Otologic Surgical Procedures; D011184:Postoperative Period; D012086:Reoperation; D012189:Retrospective Studies; D012888:Skull Neoplasms / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery*; D013514:Surgical Procedures, Operative / Q000009:adverse effects; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D018058:Tympanic Membrane Perforation / Q000209:etiology; D055815:Young Adult