Search Results (2)

Objective: Comparing the clinical outcomes of glomus tympanicum (GT) resections by transcanal endoscopic ear surgery (TEES), microscopic- and endoscopic-assisted microscopic approaches. Methods: Adult patients conducting exclusive operations for GT within the tympanomastoid cavity were recruited in this retrospective cohort study at five international tertiary referral centers. GT resections were conducted by TEES, microscopic- and endoscopic-assisted microscopic approaches based on modified Fisch–Mattox classifications. Clinical characteristics and surgical outcomes were recorded and analyzed. Results: A total of 46 patients were included. A longer operative time was seen in more advanced GTs (A1: 106.73 ± 9.33 min, A2: 133.21 ± 13.47 min, B1: 176.88 ± 18.69 min, p = 0.005), while no significant differences were observed in the mean operative times among various surgical approaches. Preoperatively, 89.1% of patients experienced pulsatile tinnitus, and 56.5% exhibited conductive hearing loss. Postoperatively, only one patient continued to experience tinnitus (p < 0.001), and two patients had persistent hearing loss (p < 0.001). Higher disease grades correlated with poorer preoperative air-conduction thresholds (p = 0.015), while the differences in air-conduction thresholds before and after surgery did not demonstrate statistical significance across different tumor stages (p = 0.894) and surgical approaches (p = 0.257). The median follow-up period was 4 years, and only one recurrent case was found (2.2%, 1/46), which was treated by TEES and involved a B1 glomus tumor. Conclusions: Similar and excellent surgical outcomes were found among the TEES and microscope- and endoscopic-assisted microscopic approaches in early-stage GTs. Full article

Objective: To analyze the long-term facial function as well as overall postoperative condition in surgically treated tympanomastoid PGL patients. Study Design: Retrospective study. Method: The medical records of patients with surgically managed class A and B tympanomastoid PGLs between 1983 and 2023 were thoroughly evaluated. Result: Our center has treated a total of 213 cases of tympanomastoid PGL surgically. The mean age of patients was 54, and the male-to-female ratio was 1:6. The most common symptoms at presentation were hearing loss (80%), pulsatile tinnitus (77%), and vertigo (15%). According to the modified Fisch classification, 45% of the cases were classified as class A (A1 and A2), while 55% were classified as class B (B1, B2, and B3). All class A and most class B1 and B2 tumors were removed either with transcanal or retroauricular-transcanal approaches. However, more advanced class B3 lesions were removed with subtotal petrosectomy (SP) along with middle ear obliteration. Facial nerve outcome was excellent in all class A and B cases, while chances of postoperative paresis slightly increased with the size and extent of the tumor (p < 0.05). The hearing outcome is excellent for class A1, A2, B1, and B2 tumors, whereas more advanced class B3 cases have a loss of air conduction (AC) and increased bone conduction (BC) threshold (p < 0.05). Complete surgical removal was achieved in 97% of our cases. The most common late complication was permanent TM perforation (7%), and the recurrence rate was 3%. Conclusions: Tympanomastoid PGL represents the most common neoplasm of the middle ear space. The most frequent presenting symptoms include pulsatile tinnitus and hearing loss, whereas the presence of retrotympanic mass was evident in all cases at the time of initial otoscopic evaluation. Proper documentation of facial function and audiometric evaluation are crucial elements of preoperative workup. The most preferred preoperative radiologic examination is high-resolution computer tomography (HRCT), whereas magnetic resonance imaging (MRI) with or without gadolinium enhancement is reserved for cases with a dilemma of carotid artery or jugular bulb involvement. The main goal of tympanomastoid PGL treatment is complete disease removal with preservation of hearing and facial functions. Surgical treatment remains the preferred treatment modality with the benefits of complete disease removal, lower rate of recurrence and complication, and acceptable postoperative hearing level. Here, we present our 40 years of experience, which, to the very best of our knowledge, is the largest series of tympanomastoid PGL in the English literature. Full article