Hearing conservation in surgery for glomus jugulare tumors

The most common ground on which surgery for glomus jugulare (GJ) tumors is criticized is the perceived risk of functional incapacity that attends possible cranial nerve (CN) loss. It is aggregate lower CN loss that is most often highlighted as particularly disabling to the quality of postsurgical survival. The documented success of both conservation surgery and operative rehabilitation of phonopharyngeal surgical deficits has, however, neutralized much of this criticism. The issue of hearing conservation (HC) in neurotologic skull base surgery, on the other hand, has not been well documented toward this end. The presence of a GJ neoplasm need not reflexly nor technically forfeit preexisting hearing. HC is, admittedly, a subordinate priority to total tumor removal, successful distal control of the internal carotid artery, and even facial nerve integrity. Yet, in appropriately selected patients, existing operative technology permits hearing preservation, a noteworthy addition to the high-grade functional outcome we have come to reasonably expect of conservation surgery. Hearing salvage further serves to define the concept of neurotologic skull base surgery. Hearing preservation in 122 GJ tumor patients is reviewed. Intuitively, as for acoustic tumor, HC appears tumor size related. Selection criteria for conservation surgery and its operative technique are detailed. Outcome is appropriately scored. The radiation therapy literature on this subject will be assiduously scrutinized for comparison.