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Endoscopic Management of Middle Ear Paragangliomas: A Case Series
Daniel E Killeen1, Cameron C Wick, Jacob B Hunter
1*Department of Otolaryngology-Head and Neck Surgery, University of Texas Southwestern Medical Center, Dallas, Texas†Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee‡Department of Otolaryngology, Universidade Estadual do Ceará, Ceará, Brazil.
Objective:
To investigate the efficacy and safety of endoscopic middle ear paraganglioma (glomus tympanicum) resection.
Study Design:
Case series with chart review.
Setting:
Multi-institutional tertiary university medical centers.
Patients:
Adult patients with middle ear paragangliomas treated via a transcanal endoscopic approach from 1/2012 to 11/2015.
Intervention:
All tumors were initially approached via a transcanal endoscopic technique. An operating microscope was used only if the tumor could not be adequately visualized or resected with endoscopic techniques alone.
Main Outcome Measures:
The main outcome was completeness of tumor resection via the endoscopic technique. Secondary measures were resolution of pulsatile tinnitus, audiometric outcomes, surgical duration, and surgical complications.
Results:
Endoscopic resection was attempted on 14 middle ear paragangliomas. Thirteen patients (93%) were women with a mean age of 61.6 years. The mean tumor size was 6.2 mm (SD, 3.3). Eleven cases (79%) had complete resection via an exclusive endoscopic approach. The mean surgical duration was 108.1 minutes (SD, 55.6). One case required use of an operating microscope via a transcanal route and two cases required postauricular incisions with mastoidectomy. There were no significant postoperative complications. Two patients (14%) had tympanic membrane perforations repaired intraoperatively without residual perforation on follow-up. All patients had normal postoperative facial nerve function. Pulsatile tinnitus resolved after surgery in all 13 patients who presented with this symptom preoperatively. The mean pure-tone average improved by 5.9 dB (SD, 4.6) after surgery.
Conclusions:
Endoscopic management of middle ear paraganglioma is safe, feasible, and effective.
