Glomus tumors of the temporal region: surgical therapy

A series of 23 patients with glomus tumors of the temporal region, treated surgically at the ENT Department, University of Zurich, Switzerland from 1970 to 1977, is presented. A system of classification as to tumor size is described with tympanic, tympanomastoid, infralabyrinthine and intracranial tumors categorized as types A, B, C, and D respectively. A majority of tumors, 12 of 19 were infralabyrinthine (type C), and a surgical approach featuring permanent anterior displacement of the facial nerve, an cavity obliteration, has been employed with the aim of total tumor extirpation. There were five males in this series, with a mean age 22 years younger than for the females and all having infralabyrinthine (type C) tumors. The most frequent clinical presentation included pulsatile tinnitus, hearing loss, and observable tumor mass in the ear. Fifteen of 23 patients had significant hearing loss, of varying types on the tumor side, with one presenting as sudden hearing loss, and another as progressive unilateral sensorineural loss over several years, in the absence, initially, of tinnitus. Ten of 23 patients with type B, C, and D tumors had cranial nerve involvement, seven and tenth being the most frequent. Because of slow growth and tendency to multicentric origin, final conclusions cannot be made regarding treatment in such a recent series of cases. However, the impression gained suggests that radiotherapy is less effective than complete surgical excision, and that partial excision is to be avoided.