Glomus tumors of the head and neck are benign but locally invasive tumors that arise from glomus cells.
In the head and neck, glomus tissue is found in the middle ear, jugular bulb, and carotid artery. Of these sites, tumors are most common in the jugular bulb, which is a region of the jugular vein positioned immediately below the middle ear. These tumors may grow into the middle ear and brain. Tumors originating in glomus cells of the middle ear are called glomus tympanicum tumors. These are the most common tumors of the middle ear. Glomus tumors may also arise in deep neck space along the course of the vagus nerve; these are called glomus vagale tumors.
Glomus tumors are highly vascular, and are usually solitary. Because they are usually benign and slow-growing, mortality rates are low (less than 15 percent). However, their growth can cause significant damage to surrounding tissue.
Common symptoms of glomus tumors are hearing loss and facial palsies.
The preferred treatment at UPMC for treating glomus tumors in the skull base is the Endoscopic Endonasal Approach (EEA). This innovative technique involves using the nose and nasal cavities to reach tumors that were once considered inoperable or hard to reach. Using EEA offers the benefits of no incisions to heal, no disfigurement to the patient, and a shorter recovery time. If complementary treatments such as radiation therapy are needed, those therapies can begin soon after surgery.
Your physician will perform a physical exam and ask you about your symptoms. Symptoms depend on the location of the tumor and include:
- Glomus tympanicum: In the ear, the flow of blood may be perceived as a pulsating sound or ringing. There may be bleeding from the ear. The growing mass may interfere with sound transmission and result in hearing loss.
- Glomus jugulare: The symptoms of these tumors are similar to those of glomus tympanicum and may include ringing in the ear, hearing loss, ear pain, and bleeding from the ear. Compression of nearby cranial nerves may result in facial weakness, difficulty swallowing, hoarseness and shoulder drooping. In rare cases these tumors may produce the hormone norepinephrine, which may cause headaches, anxiety, high blood pressure and increased heart rate.
- Glomus vagale: These tumors create a mass in the parapharyngeal area and may produce facial palsies.
- Carotid body tumors: These tumors create a painless mass in the neck and tend to cause no symptoms. Larger tumors may compress the trachea and esophagus, resulting in hoarseness and difficulty swallowing.
Glomus tumors of the head and neck are diagnosed primarily through MRI and CT scans. The specific locations of these tumors are usually sufficient for a diagnosis. Because of their vascular nature, an angiogram may also be used to confirm the diagnosis.
In the middle ear, most glomus tumors are found during a physical exam and appear as a reddish-blue mass behind the eardrum.
Surgery
Glomus tumors of the skull base, particularly those with growth in the direction of the nasopharynx, may be approached directly by using the Endoscopic Endonasal Approach (EEA). This approach allows surgeons to see and access the area well without making incisions in the face or skull. EEA offers the benefits of no incisions to heal, no disfigurement to the patient, and a shorter recovery time.
At UPMC, we take a 360° Approach to treatment when evaluating each patient—looking at their conditions from every direction—to find the path that is least disruptive to the patient's brain, critical nerves, and ability to return to normal functioning. Our neurosurgical team may recommend a combination of surgical and non-surgical approaches to maximize the benefits of surgery while minimizing risks.
Radiation Therapy
Radiation therapy may be used for patients who are elderly or in poor health, or along with surgery when complete surgical excision is not practical. Patients who receive surgery with the Endoscopic Endonasal Approach may be able to begin radiation therapy soon after surgery.
Radiation therapy has not been shown to eradicate glomus tumors, so the goal in these cases is simply to stop tumor growth.
