Simultaneous Contralateral Vestibular Schwannoma and Glomus Tumor of the Temporal Bone- A Case Report

Document Type : Case Report

Authors

Department of Otolaryngology – Head and Neck Surgery and Audiology, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark.

Abstract

Introduction:
Presence of vestibular schwannoma and a simultaneous glomus jugulare tumor is an extremely rare event. There is only one case report regarding the incidence of a contralateral vestibular schwannoma, along with a glomus jugulare tumor. Herein, we present the second case with a contralateral tumor.
 
Case Report:
A 69-year-old woman presented with a long history of bilateral hearing loss and a 2-year history of left-sided pulsatile tinnitus. The patient also suffered the itching of the left ear canal and mild vertigo; however, she had no recollection of middle ear infection, ear discharge, or ear pain. Magnetic resonance imaging (MRI) revealed a right-sided 8-mm extrameatal vestibular schwannoma and a left-sided almost purely extracranial glomus jugulare tumor of 18 mm. The pure-tone average values were 63 and 43 dB HL for the right and left ears, respectively. Speech audiometry showed a discrimination score of 76/88 (%). Caloric irrigation was performed and revealed a unilateral weakness of 81% towards the side of vestibular schwannoma. The patient was included in a watchful waiting regimen with annual MRI scans.
 
Conclusion:
Though vestibular schwannomas and glomus jugulare tumors are pathophysiologically different, they are similar in terms of symptomatology, growth pattern, diagnostic process, and therapeutic strategy. Based on this case report, it can be concluded that a vestibular evaluation demonstrates a unilateral vestibular weakness towards the side of the vestibular schwannoma, thereby facilitating clinical discrimination between the lesions.

Keywords

Main Subjects


1. El-Naggar AK, Chan JKC, Rubin Grandis J, Takata T, Slootweg PJ. International Agency for Research on Cancer. WHO Classification of Head and Neck Tumours. http:// publications. iarc.fr/ Book-And-Report-Series/Who-Iarc-Classification-Of-Tumours/Who-Classification-Of-Head-And-Neck-Tumours-2017. Accessed December 7, 2017.
2. Trofatter J a, MacCollin MM, Rutter JL, Murrell JR, Duyao MP, Parry DM,et al. A novel moesin-, ezrin-, radixin-like gene is a candidate for the neurofibromatosis 2 tumor suppressor. Cell. 1993;75(4):826.
3. Stangerup SE, Tos M, Thomsen J, Caye-Thomasen P. True incidence of vestibular schwannoma? Neurosurgery. 2010;67(5):1335-40.
4. Stangerup SE, Caye-Thomasen P. Epidemiology and Natural History of Vestibular Schwannomas. Otolaryngol Clin North Am. 2012;45(2):257-68.
5. Moffat DA, Hardy DG. Surgical management of large glomus jugulare tumours: infra- and trans-temporal approach. J Laryngol Otol. 1989; 103(12): 1167-80.
6. Weber R, Draf W, Bachor E. [Simultaneous occurrence of an acoustic neurinoma and a glomus tympanicum tumor in a patient. An unusual constellation and problematic surgical task]. HNO. 1992;40(10):410-3.
7. Schallawitz T, Strauss G, Bootz F. Pulsierende Raumforderung in der rechten Paukenhöhle bei Zustand nach Radikaloperation. HNO. 2001; 49(3): 226-7.
8. Falcioni M, Caruso A, Sanna M. [Coexistence of vestibular schwannoma and glomus tympanicum tumor]. Acta Otorhinolaryngol Ital  organo Uff della Soc Ital di Otorinolaringol e Chir Cerv-facc. 1998;18(6):398-401.
9. Moumoulidis I, Brewis C, Moffat DA. Simultaneous contralateral vestibular schwannoma and glomus jugulare tumor: a case report. Ear Nose Throat J. 2005;84(5):290-2.
10. American Academy of Otolaryngology-Head and Neck Surgery Foundation. Committee on Hearing and Equilibrium guidelines for the evaluation of hearing preservation in acoustic neuroma (vestibular schwannoma). Otol head neck surg. 1995;(113):179–80.