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02.02.2014

Pulsatile tinnitus glomus tumor, all about depression symptoms - Test Out

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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. 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.
Glomus tumors are similar to chemodectomas, blood vessel tumors occurring in bodies similar to the glomus body. 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 tumor appears to have invaded the jugular vein, then control of the blood vessels of the neck may be necessary with a separate incision in the neck before the tumor can be completely removed.
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. Successful removal of the tumor may also require delicate dissection of the tumor from the carotid artery. Using this team approach, the removal of glomus tumors has become a more successful procedure in terms of sparing vital cranial nerves.
Glomus tumors are not highly radiosensitive (sensitive to the radiation therapy’s x-rays). 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. However, a more useful test for glomus tumors is today’s MRA (Magentic Resonance Angiography). These tumors can occur along the carotid artery, the major arterial blood supply to the brain. In these cases, the tumor can be vaporized away from the bones of hearing without separating them in many cases. This is the exception in glomus tumors which arise from the middle ear and mastoid, but the usual situation in glomus jugular tumors. Depending on the size of the tumor, this part of the surgery is done in conjunction with a neurosurgeon at the operation. In long-standing tumors, or in very aggressive glomus tumors, the facial nerve may be invaded by the tumor itself.
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. However, in older patients, or those who should not undergo surgery, radiation therapy may help to arrest the growth of a glomus tumor.
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. 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. However, their local invasiveness means that glomus tumors can be highly destructive and difficult to remove. This condition can make it extremely difficult to separate the tumor from the facial nerve without damaging the facial nerve.
In the younger patient, complete surgical removal of the tumor after embolization is the preferred method of treatment. The size and extent of the glomus tumor of the middle ear can be well assessed by microscopic examination. It is important to be certain that there are no other associated glomus tumors or chemodectomas at the time of primary glomus tumor diagnosis. In these cases, the canal wall separating the middle ear from the mastoid is generally removed when deeply invaded by tumor.
Once the nerve is freed, the head and neck surgeon must identify the vessels in the neck leading to the tumor.
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.
This procedure is usually performed 24 hours before surgery, greatly reducing the blood supply to the tumor. As the laser energy is applied to the glomus tumor which is red, this energy is quickly absorbed into the outer pigment of the blood circulating through the 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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