How I Do It: A Stepwise Surgical Technique for Fisch Class B Glomus Tympanicum

We describe a stepwise retroauricular microsurgical workflow for bulky tympanic paragangliomas, combining circumferential canaloplasty with temporary removal and replacement of the tympanomeatal flap and malleus to optimize exposure and bleeding control. This strategy facilitates early identification of critical structures, stepwise devascularization, and safe tumor excision in bulky lesions extending to the hypotympanum or protympanum. The technique emphasizes operative sequencing and surgical ergonomics in challenging cases.