Glomus Tumors: When does Controversy become Convention?

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Introduction
Glomus tumors are rare benign neoplasms in the head and neck. Glomus tympanicum and glomus jugulare lesions are associated with the temporal bone. The usual presenting symptom is pulsatile tinnitus followed by hearing loss. There is no controversy with the management of glomus tympanicums as they are mainly treated with surgical removal. Controversy occurs in the management of glomus jugulare tumors because of the lower cranial morbidity associated with the surgical removal.
Materials and Methods
Glomus tympanicum and jugulare cases will be discussed. Work up and therapeutic management will be reviewed. In glomus jugulare cases, conventional surgery verses gamma knife stereotactic radiation will be discussed. Outcomes and complications will be reviewed.
Results
Glomus tympanicums respond well to surgical excision. Glomus jugulare surgery is commonly associated with dysphonia and dysphagia. Patients commonly require a short term feeding tube because of the risk of aspiration. While stereotactic radiation does prevent further growth of the lesion, it does not correct the pulsatile tinnitus or conductive hearing loss as well as surgical excision.
Conclusion
There appears to be significantly higher morbidity with surgery verses stereotactic radiation. Patients should be counseled appropriately, especially about the cranial nerve deficits. Also, they should express realistic expectations of the results particularly the resolution of the tinnitus and hearing loss.