Treatment of Glomus Tumors at Mount Sinai
The Division of Otology-Neurotology at the Mount Sinai Health System is a global leader in the treatment of glomus tumors, often performing minimally invasive endoscopic approaches for what many consider to be very challenging growths. The division uses a multiprong approach and a multidisciplinary team to achieve the best patient outcomes, and has been instrumental in writing international guidelines, research articles, and textbook chapters for the treatment of such tumors.
About Glomus Tumors
Glomus tumors (also known as paragangliomas) are slow growing, often benign vascular tumors typically located deep in the ear and skull base. While glomus tumors may be found in multiple sites in the head and neck, our Division specializes in treating “glomus tympanicum” and “glomus jugulare” tumors. “Glomus tympanicum” tumors originate from behind the ear drum on the cochlea, or inner ear. “Glomus jugulare” tumors originate on the top of the internal jugular vein of the neck known as the jugular bulb and may affect various structures of the skull base.
While usually benign and slow growing, because of their location in the ear and skull base, they may cause hearing loss, pulsatile tinnitus, or difficulty with speech and swallowing. With new, minimally invasive techniques and involvement of an expert multidisciplinary team, outcomes are excellent.
Symptoms and Diagnosis of a Glomus Tumor
Symptoms of a glomus tumor often include hearing loss and pulsatile tinnitus (a heartbeat sound in the ear). In more advanced cases involving the nerves and vessels of the skull base, patients may have a hoarse voice and difficulty swallowing. In rare cases, these tumors produce catecholamines, or chemicals that cause an accelerated heart rate, flushing, and high blood pressure.
Diagnosis of a glomus tympanicum or glomus jugulare is often straightforward using a standard physical exam, CT scan, and/or MRI. A special PET scan known as a “DOTATATE PET” is often useful in cases in which the diagnosis is unclear or the need to look for paragangliomas elsewhere in the body is necessary.
While most glomus tumors are not inherited, some patients, particularly those with mutations in the SDHD gene, are at risk of developing paragangliomas/glomus tumors elsewhere in the body. Patients with SDHB gene mutations were thought to have increased risk of having a cancerous glomus tumor, but this tends to be quite rare in glomus tympanicum and glomus jugulare tumors.
Treatment for Glomus Tumors
Treatment of glomus tumors is individualized for each patient based on several factors, including:
- Size and location of the tumor
- Patient age and other medical issues
- Patient preference
Mount Sinai neurotologists work with other expert members of our Skull Base Surgery Center including colleagues in head and neck surgery, neurosurgery, and radiation oncology to develop an individualized treatment plan for our patients. The most important thing to know is that this is a shared decision between the patient and treatment team.
Treatment Options for Glomus Tumors
- Minimally invasive surgery: if the tumor is small and confined to the middle ear, we can often employ a minimally invasive endoscopic technique. Mount Sinai is a global leader in endoscopic ear surgery, and people come from all over the country (and world!) to learn how we do it. Tumors that are confined to the ear and mastoid can be accessed through a small incision behind the ear. Patients go home the same day after surgery often with just a cotton ball in their ear. Once healed, hearing and pulsatile tinnitus are usually drastically improved. Read more about this technique.
- Larger tumors (specifically “glomus jugulare”) require a larger procedure and a few days in the hospital. Because the tumors are very vascular and can bleed quite a bit, in the few days before surgery, patients get embolized by our neurointerventional team using specific compounds and materials to clog the blood vessels feeding the tumor. We then perform the operation a few days later.
- If the tumor is quite large and has spread to the brain or low in the neck, we often involve our colleagues from head and neck surgical oncology and neurosurgery.
- In all cases, we aim to leave the important nerves that control facial movement, speech, swallow, shoulder movement, and tongue motion intact.
- Observation: slow growing tumors with no immediate reason for treatment can be cared for with surveillance to monitor any signs of growth or new symptoms.
- Radiation Therapy: This approach can be very effective in freezing the tumor’s growth, and it may be the sole form of treatment or in combination with surgery.