Endoscopic Management of Glomus Tympanicum: Largest Australian Case Series

Quick, Mark1; Patel, Nirmal2; Kong, Jonathan2; Saxby, Alex2; Kadhim, Latif1
1 Fiona Stanley Hospital, Murdoch, Western Australia, Australia
2 Sydney Endoscopic Ear Surgery Research Group, University of Sydney

Introduction: Endoscopic management of glomus tympanicum a benign middle ear vascular tumour enables improved exposure and access. The purpose of this study was to evaluate this endoscopic approach across multi-institutional tertiary hospitals by four Australian otolaryngologists.

Method: Eight adult patients with middle ear glomus tympanicum were treated endoscopically with two requiring assisted endoscope with the microscope. Four patients underwent CO2 laser resection and four with bipolar diathermy.

Outcome measures: The primary outcome was complete resection of the benign middle ear tumour, glomus tympanicum. Secondary outcomes included analysis of surgical time, surgical complications, post-operative audiometric analysis and symptomatic resolution of pulsatile tinnitus.

Results: Endoscopic glomus tympanicum resection was performed on eight patients over a two year period. Seven of the eight patients were female. Majority of glomus tympanicum tumours were class I and II as according to the Glasscoc-Jackson glomus classification with one Class III. Each procedure was managed with endoscopic access and treatment with two cases requiring addition microscope assistance via transcanal access. There were no significant immediate post-operative or short term follow up complications. Clinical follow up of each patient showed normal facial nerve function, resolution of pulsatile tinnitus and stability of hearing with post-operative audiometric analysis.

Conclusions: Despite small cohort numbers, this retrospective analysis is the largest Australian case series of endoscopic resection for glomus tympanicum tumours. Endoscopic management represents a safe, effective and reliable procedure with good access and without an external incision or mastoidectomy approach.