A temporal bone paraganglioms (glomus jugulare or glomus tympanicum) are mostly benign growths of the middle ear and adjacent structures. Some glomus jugulare tumors can reach substantial sizes with tumor extending well into the brain and neck.
With any glomus tumor, a thorough clinical evaluation should precede any treatment decision. These evaluation typically will include CT and MRI scans as well as an octreotide study. The first two demonstrating the extension of the tumor and the latter is performed to exclude multi-focal involvement. Also, a 24 hour urine sample should be obtained to rule-out abnormal hormone excretion, which is rarely associated with these growths.
Once the properties of the tumor have been determined (staged), a thorough discussion with the affected individual is necessary. Overall, the treatment options include surgical removal, radiation, or watchful waiting with frequency MRIs. Smaller tumors are typically surgically removed. However, surgery for larger tumors can often pose a risk, since glomus tumors are made up of blood vessels and the blood loss during removal can be substantial. More importantly, many larger growths are intimately involved with multiple cranial nerves controlling swallowing and vocal cord function thus protecting the airway and controlling voice. Recently, a management paradigm featuring a planned subtotal resection with subsequent stereotactic radiation has been suggested. This algorithm allows functional preservation while offering excellent tumor control.
In summary, temporal bone paragangliomas are mostly benign growths. Affected individuals often have multiple management options including surgical removal, (sterotactic radiation), a combination of the two, as well as watchful waiting.