title: Long term surgical and hearing outcomes in the management of tympanomastoid paragangliomas.
abstract: OBJECTIVE
  To analyze the long term outcomes after surgery in tympanomastoid paragangliomas.
  
  
  METHODS
  Retrospective study.
  
  
  METHODS
  The charts of 145 patients with tympanomastoid paragangliomas managed between 1988 and 2013 were reviewed. The clinical features, audiological data, pre- and postoperative notes were noted. The tumors were staged according to the modified Fish and Mattox classification. The surgical approaches for all patients were formulated according to the surgical algorithm developed at our center.
  
  
  RESULTS
  34 (23.5%), 46 (31.7%), 22 (15.2%), 18 (12.4%) and 25 (17.2%) patients were diagnosed to have TMP class A1, A2, B1, B2 and B3 tumors respectively. Gross tumor resection was achieved in 141 (97.2%) patients. The facial nerve was uncovered in four patients and infiltrated in three. The cochlea was found eroded in seven cases. The mean follow-up was 48.4 months. Recurrence was seen in one patient (0.7%). In the cases where the facial nerve was preserved (n=143), the nerve function was graded as HB grade 1 in 138 patients (97%). Postoperatively, the mean AC showed an improvement in all categories except in class B2 and B3, which corresponds to the classes that include patients who underwent subtotal petrosectomy.
  
  
  CONCLUSIONS
  We report the long term surgical outcomes in tympanomastoid paragangliomas in the largest series published till date. It is possible to completely eradicate all types of tympanomastoid paragangliomas with minimum sequelae by choosing the correct surgical approach to achieve adequate exposure for individual tumor classes as described in our classification and algorithm.
  
  
  METHODS
  IIb.
authors.affiliation: Department of Otology and Skull Base Surgery, Gruppo Otologico, Piacenza, Rome, Italy; Department of Otolaryngology-Head and Neck Surgery, Military Hospital, Hisar, India.
authors.forename: U
authors.initials: U
authors.lastname: Patnaik
authors.affiliation: Department of Otology and Skull Base Surgery, Gruppo Otologico, Piacenza, Rome, Italy. Electronic address: sampathcp@yahoo.co.in.
authors.forename: S C
authors.initials: SC
authors.lastname: Prasad
authors.affiliation: Department of Otology and Skull Base Surgery, Gruppo Otologico, Piacenza, Rome, Italy.
authors.forename: M
authors.initials: M
authors.lastname: Medina
authors.affiliation: Department of Otology and Skull Base Surgery, Gruppo Otologico, Piacenza, Rome, Italy; Department of Otolaryngology-Head and Neck Surgery, Riyadh Military Hospital, Riyadh, Saudi Arabia.
authors.forename: M
authors.initials: M
authors.lastname: Al-Qahtani
authors.affiliation: Department of Otology and Skull Base Surgery, Gruppo Otologico, Piacenza, Rome, Italy.
authors.forename: F
authors.initials: F
authors.lastname: D'Orazio
authors.affiliation: Department of Otology and Skull Base Surgery, Gruppo Otologico, Piacenza, Rome, Italy.
authors.forename: M
authors.initials: M
authors.lastname: Falcioni
authors.affiliation: Department of Otology and Skull Base Surgery, Gruppo Otologico, Piacenza, Rome, Italy.
authors.forename: E
authors.initials: E
authors.lastname: Piccirillo
authors.affiliation: Department of Otology and Skull Base Surgery, Gruppo Otologico, Piacenza, Rome, Italy.
authors.forename: A
authors.initials: A
authors.lastname: Russo
authors.affiliation: Department of Otology and Skull Base Surgery, Gruppo Otologico, Piacenza, Rome, Italy; Department of Otolaryngology, University of Chieti, Chieti, Italy.
authors.forename: M
authors.initials: M
authors.lastname: Sanna
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004428:Ear Neoplasms / Q000150:complications / Q000473:pathology / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D043604:Glomus Tympanicum Tumor / Q000150:complications / Q000473:pathology / Q000601:surgery*; D006311:Hearing Disorders / Q000175:diagnosis / Q000209:etiology / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D020127:Recovery of Function; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult