Total Endoscopic Approach in Glomus Tympanicum Surgery

Document Type : Original

Authors

1 ENT Head and Neck Research Center and Department, Iran University of Medical Science, Tehran, Iran.

2 Skull Base Research Center, Iran University of Medical Science, Tehran, Iran.

3 Department of Otolaryngology, Hamedan University of Medical Science, Hamedan, Iran.

Abstract

Introduction:
Glomus tympanicum (GT) is a benign primary tumor of the middle ear. The evolution of endoscopic ear surgery has allowed for an alternative approach to managing this vascular tumor. The purpose of this study was to evaluate an endoscopic approach in GT surgery, and also to investigate its applicability and feasibility.
 
Materials and Methods:
Prospectively, 13 class I and II patients, according to the Glasscock-Jackson glomus classification, were candidates for management via a transcanal endoscopic approach. Patients were categorized into three groups according to the location of the tumor in the middle ear. Group A consisted of patients with tumors located anteriorly while occupying the Eustachian tube. Group B were patients with tumors located on the promontory with entirely visible tumor borders. Patients in Group C had tumors that occupied the entire middle ear. Under specially designed flap elevation and hemostasis, the tumors were completely removed using an endoscopic technique.
 
Results:
Based on the classification criteria, three patients fell into Group A (30%), six into Group B (46%), and three into Group C (23%). The principal chief complaint was pulsatile tinnitus that disappeared after surgery in most cases. Hearing status was mostly mixed hearing loss. No change was detected in bone conduction after surgery, but air conduction was improved in nine cases. No major complication or recurrence was observed over 30 months of follow up.
 
Conclusion:
Improved exposure and access in the endoscopic transcanal approach to GT leads to safe, rapid, and reliable tumor removal, as well as allowing comfortable surgery for both the surgeon and most patients.

Keywords

Main Subjects

References

1. Sweeney AD, Carlson ML, Wanna GB, Bennett ML. Glomus tympanicum tumors. Otolaryngol Clin North Am, 2015;48:293–304.
2. Hutchins T, Palacios E. Glomus tympanicum tumor. Ear Nose Throat J. 2007;86:202,4.
3. Bowdino B, Farrell P, Moore G, Leibrock L. Long-Term Surgical Results for Glomus Temporale Tumors. Neurosurgery Quarterly. 2004; 14: 19–26.
4. Nogueira JF, Martins M, Aguiar CV, Pinheiro AI/ Fully endoscopic stapes surgery (stapedotomy): Technique and preliminary results. Braz. J. Otorhinolaryngol. 2011;77:721–7.
5. Daneshi A, Jahandideh H. Totally endoscopic stapes surgery without packing: novel technique bringing most comfort to the patients. Eur. Arch. Oto Rhino Laryngol. 2016;273:631–4.
6. Tarabichi M. Endoscopic transcanal middle ear surgery. Ind J. Otolaryngol. Head Neck Surg. 2010; 62: 6–24.
7. Sajjadi H, Endoscopic Middle Ear and Mastoid Surgery for Cholesteatoma. Iranian J Otorhinolaryn- gol  2013;25:63–70.
8. Tarabichi M, Ayache S, Nogueira JF, Al Qahtani M, and Pothier DD. Endoscopic management of chronic otitis media and tympanoplasty. Otolaryn- gologic Clin North Am. 2013;46:155–163.
9. Jackson G, Glasscock ME and Harris PF. Glomus Tumors Diagnosis, Classification and Management of Large Lesions. Arch Otolaryngol. 1982; 109:  401–6.
10. Dobie RA, Van Hamel, Ed Hearing Loss: Determining Eligibility for Social Security Benefits. Washington, DC: The National Academies Press. 2004, page 74, https://doi. org/ 10. 17226/ 110 99.
11. Carlson ML, Sweeney AD, Pelosi S, Wanna GB, Glasscock ME, Haynes DS. Glomus Tympanicum: A Review of 115 Cases over 4 Decades. Otolaryngol. Head. Neck Surg. 2015; 152: 136–42.
 12. Rohit MS, JainY, Carusso A, Russo A. Glomus tympanicum tumour: An alternative surgical technique. J Laryngol Otol. 2003;117: 462–6.
13. Tarabichi M. Endoscopic middle ear surgery. Ann Otol Rhinol Laryngol. 1999;108:39–46.
14. Thomassin JM, Duchon-Doris JM, Emram D, Rud C, Conciatori J, Vilcoq P. Endoscopic ear surgery. Initial evaluation. Ann Otolaryngol Chir Cervicofac. 1990;107:564–70.
15. Marchioni D, Alicandri-Ciufelli M, Rubini A, Presutti L. Endoscopic transcanal corridors to the lateral skull base: Initial experiences. Laryngoscop. 2015;125:S1–S13.
16. O’Leary MJ, Shelton C, Giddings NA, Kwartler J, Brackmann DE. Glomus tympanicum tumors:
A clinical perspective. Laryngoscop. 1991; 101: 1038–43.
17. Durvasula V, Baguley R, Moffat DA. Laser excision of glomus tympanicum tumours: Long-term results. Eur Arch Oto-Rhino-Laryngology. 2005; 262: 325–7.
18. Balkany TJ, Telischi FF, Angeli SI, Eshraghi AA. Tympanomeatal Flaps. Laryngoscop. 2003: 113: 1266–8.
19. Papaspyrou K, Mewes T, Toth M, Schmidtmann I, Amedee RG, Mann WJ. Hearing Results After Hypotympanotomy for Glomus Tympanicum Tumors. Otol Neurotol. 2011; 32: 291–6.
20. Sanna M, Fois P, Pasanisi E, Russo A, Bacciu A. Middle ear and mastoid glomus tumors (glomus tympanicum): An algorithm for the surgical management. Auris Nasus Larynx. 2010; 37:661–8.
Iranian Journal of Otorhinolaryngology
Volume 29, Issue 6 - Serial Number 95
November and December 2017
Pages 305-311

Files

Share

How to cite

Statistics