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11.09.2014

Tinnitus and ear bleeding, criteria for major depressive disorder dsm 5 - .

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Benign tumors of glomus bodies can occur within the middle ear or at other sites: the temporal bone and neck, or within the jugular vein (the large vein in the upper neck which drains the head toward the heart). Glomus tumors are highly vascular (blood sensitive) and are primarily composed of blood channels flowing through the tumor itself. Imaging studies, including a CT scanning, MRI scanning and MR angiography, should be obtained to determine the limits and extent of any glomus tumors.
A CT demonstrates whether the bone in the lower portion of the middle ear connects to the jugular bulb. Once the ear surgeon has determined the classification of glomus tumor, a careful evaluation of the x-ray results must be made in order to make certain there are no tumors associated with other blood vessels.
Many glomus tympanicum tumors can now be approached through the ear canal by elevating the eardrum and then destroying the tumor completely with an Argon or CO2 laser versus more radical surgeries performed in the past. Relatively large tumors of the middle ear can be approached by using the Argon or CO2 laser without opening the ear from behind.
When a glomus tumor extends into the mastoid, it becomes necessary to make an incision behind the ear and open the mastoid bone. If the glomus tumor continues to expand, it may invade the brain through the bone separating the middle ear and mastoid. If the tumor has invaded the bone and entered the brain, intracranial surgical excision of the tumor may be necessary. Results of removal of glomus tumors of the middle ear and mastoid are extremely good in most cases, less so when the tumor has invaded the inner ear, facial nerve or brain. Although glomus tumors are benign tumors, they grow in extremely delicate areas: near nerves which control swallowing, the vocal cords, and the nerve that controls the facial muscles. On our team, the ear surgeon performs the initial portions of the surgery isolating the facial nerve within the mastoid.
DISCLAIMER: The Ear Surgery Information Center offers and maintains this web site to provide information of a general nature about the conditions requiring the services of an ear surgeon. All other information contained within this web site is © 2015 Ear Surgery Information Center. Most patients with glomus tumors of the middle ear can hear a pulsing sound in the ear on the side which has the tumor. As the glomus tumor of the middle ear expands, it can grow into the mastoid itself or through the wall that divides the middle ear from the mastoid and deeply infiltrate the bone.


However, in small glomus tumors of the middle ear, hearing can be quite normal and there may be no symptoms at all.
It is necessary to differentiate between a glomus tumor limited to the middle ear, and a glomus tumor arising from the jugular vein. If the glomus tumor appears to be filling the lower half of the middle ear, it can be either a glomus tumor of the middle ear (limited to the middle ear), or a glomus jugulare which has eroded the bony covering of the jugular vein as it comes in touch with the lower portion of the middle ear space. If there is a distinct bony covering of the jugular bulb and separation of the tumor from the carotid artery, the ear surgeon can inform the patient that the surgery will be limited primarily to the middle ear and not involve the blood vessels of the neck. This is the exception in glomus tumors which arise from the middle ear and mastoid, but the usual situation in glomus jugular tumors. The ear surgeon, the head and neck surgeon, and a neuroradiologist are all needed to remove glomus jugulare tumors. The nerve is decompressed and taken out of its canal so that it can be preserved during the removal of the tumor.
This portion of the procedure is extremely delicate and requires the close cooperation of the head and neck surgeon, ear surgeon and, in some cases, vascular and neurosurgeons. In addition, blood loss has been brought to a minimum and most patients do not require transfusion. Most glomus tumors are readily noted by a primary care physician’s routine examination of the ear.
The tumor may also wrap around and infiltrate areas around the facial nerve, as it enlarges. The tumor itself is often identified on routine exam as being a red spot behind the eardrum. If, however, there is erosion of the floor of the middle ear and jugular blub, CT scaning will provide the information. At one time, most angiograms were performed by injecting a dye into an artery, often inserting a catheter through the femoral artery in the thigh and running the catheter up to the area of concern.
However, the larger, so-called glomus jugulare tumors, arising from the jugular vein, may be extremely vascular and are situated deep in the bone of the ear and neck. In recent years, with the perfection of new techniques used by the radiologist, feeding vessels to the tumor can be selectively found and blocked during angiography.
Also the preservation of vital structures around the tumor is enhanced, including cranial nerves going to the throat, vocal cords and face.


They can also occur along other important portions of the blood supply in the neck and throat.
However, their local invasiveness means that glomus tumors can be highly destructive and difficult to remove. Any information in the publications, messages, postings or articles on the web site should not be considered a substitute for consultation with a board-certified otolaryngologist (ear, nose and throat specialist) to address individual medical needs.
These baro receptors sense and help to regulate the oxygen pressure in the middle ear and mastoid. The size and extent of the glomus tumor of the middle ear can be well assessed by microscopic examination. In these cases, the canal wall separating the middle ear from the mastoid is generally removed when deeply invaded by tumor.
The head and neck surgeon, ear surgeon and neurosurgeon, if necessary, perform a combined procedure which isolates the blood vessels in the neck.
Once the nerve is freed, the head and neck surgeon must identify the vessels in the neck leading to the tumor. Individuals' particular facts and circumstances will determine the treatment which is most appropriate. The eardrum may pulsate, if the glomus tumor is touching the under surface of the intact eardrum. The MR Angiogram is extremely useful in defining the source, size and feeding vessels entering the glomus tumor. Thus, the removal of the tumor from the middle ear, mastoid and neck can now be done in a single unit.
In most cases, it is necessary to tie off or pack the jugular vein in the neck and the mastoid portion of the ear to prevent excessive bleeding at tumor removal.



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