Case Report
The case report protocol number 1584204-1, titled Unusual presentation
of a large glomus tympanicum with a coexisting cholesteatoma was
approved by Franciscan Research Administration institutional review
board. A 59-year-old male with a past medical history of asthma,
hypertension, and ocular migraine presented with a long standing right
unilateral hearing loss that become more apparent about 8 years ago.
Hearing loss was non-fluctuating and was profound to the point he could
not use a telephone. His right ear has had otorrhea ongoing for years
that typically is foul smelling and is only temporarily resolved with
both oral and ototopical antibiotics. Over the past year, he required
antimicrobial therapy every 2-3 months. Patient denies vertigo,
headaches, otalgia, previous ear surgeries. He reports tinnitus that is
high frequency nonpulsatile in nature. Examination initially
demonstrated purulence in the ear canal along with some squamous debris.
After debridement of the ear canal and administration of oral with
ototopical antimicrobial therapy, further examination demonstrated a
polypoid mass completely filling about half of the ear canal
representing a glomus tumor. There was no visualization of a tympanic
membrane or ossicular chain (Figure 1).
An audiogram was ordered showing right sided profound hearing loss with
speech reception threshold at 95 decibels (dB). A Computed tomography
(CT) temporal bones without contrast and Magnetic resonance imaging
(MRI) Brain and Internal Auditory Canal (IAC) with and without contrast
was ordered for further evaluation.
CT temporal bones without contrast showed partial opacification of the
right external auditory canal with complete opacification of the right
middle ear cavity and hypoplastic right mastoid air cell. Tegmen tympani
was grossly intact. Erosive changes of the scutum as well as erosive
changes of the right middle ear ossicles including the malleus, incus
and stapes was noted. Questionable erosion involving the canal wall of
the tympanic segment of the right seventh cranial nerve. The right inner
ear structures including the cochlea, vestibule and semicircular canal
appeared to be grossly intact (Figure 2 and Figure 3). MRI did not
demonstrate intracranial extension, however, confirmed suspicion for a
glomus tumor.
After reviewing the results, patient agreed to proceed forward with
surgery. A right canal wall down tympanomastoidectomy with facial nerve
preservation was performed. The glomus tympanicum was completely excised
from the ear canal, middle ear, and mastoid. Partial dehiscence was
noted along the middle ear segment of the fallopian canal. The ossicular
chain was mostly eroded and the tympanic membrane was completely eroded.
Erosion of the scutum was confirmed. The chorda tympani was not found.
Adjacent to the glomus tumor was a cholesteatoma in the attic extending
into the mastoid antrum which was completely excised (Figure 4 and
Figure 5). The cholesteatoma was visualized only after performing the
mastoidectomy. The ossicular chain was not reconstructed due to the
level of sensorineural hearing loss. Tragal cartilage was used to
obliterate the atticoantral space and a portion was used in
reconstructing the tympanic membrane. Post-operatively the open cavity
healed well. There were no complications.