title: Endoscopic Management of Middle Ear Paragangliomas: A Case Series.
abstract: To investigate the efficacy and safety of endoscopic middle ear paraganglioma (glomus tympanicum) resection.
  
  
  
  Case series with chart review.
  
  
  
  Multi-institutional tertiary university medical centers.
  
  
  
  Adult patients with middle ear paragangliomas treated via a transcanal endoscopic approach from 1/2012 to 11/2015.
  
  
  
  All tumors were initially approached via a transcanal endoscopic technique. An operating microscope was used only if the tumor could not be adequately visualized or resected with endoscopic techniques alone.
  
  
  
  The main outcome was completeness of tumor resection via the endoscopic technique. Secondary measures were resolution of pulsatile tinnitus, audiometric outcomes, surgical duration, and surgical complications.
  
  
  
  Endoscopic resection was attempted on 14 middle ear paragangliomas. Thirteen patients (93%) were women with a mean age of 61.6 years. The mean tumor size was 6.2 mm (SD, 3.3). Eleven cases (79%) had complete resection via an exclusive endoscopic approach. The mean surgical duration was 108.1 minutes (SD, 55.6). One case required use of an operating microscope via a transcanal route and two cases required postauricular incisions with mastoidectomy. There were no significant postoperative complications. Two patients (14%) had tympanic membrane perforations repaired intraoperatively without residual perforation on follow-up. All patients had normal postoperative facial nerve function. Pulsatile tinnitus resolved after surgery in all 13 patients who presented with this symptom preoperatively. The mean pure-tone average improved by 5.9 dB (SD, 4.6) after surgery.
  
  
  
  Endoscopic management of middle ear paraganglioma is safe, feasible, and effective.
authors.affiliation: *Department of Otolaryngology-Head and Neck Surgery, University of Texas Southwestern Medical Center, Dallas, Texas†Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee‡Department of Otolaryngology, Universidade Estadual do Ceará, Ceará, Brazil.
authors.forename: Daniel E
authors.initials: DE
authors.lastname: Killeen
authors.forename: Cameron C
authors.initials: CC
authors.lastname: Wick
authors.forename: Jacob B
authors.initials: JB
authors.lastname: Hunter
authors.forename: Alejandro
authors.initials: A
authors.lastname: Rivas
authors.forename: George B
authors.initials: GB
authors.lastname: Wanna
authors.forename: João Flávio
authors.initials: JF
authors.lastname: Nogueira
authors.forename: Joe Walter
authors.initials: JW
authors.lastname: Kutz
authors.forename: Brandon
authors.initials: B
authors.lastname: Isaacson
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001299:Audiometry; D004428:Ear Neoplasms / Q000473:pathology / Q000601:surgery*; D004432:Ear, Middle / Q000601:surgery; D005260:Female; D043604:Glomus Tympanicum Tumor / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D057605:Natural Orifice Endoscopic Surgery / Q000379:methods*; D012189:Retrospective Studies; D016896:Treatment Outcome; D055815:Young Adult