Paraganglioma (glomus tumour)

What it is

Paragangliomas are benign, highly vascular neoplasms. Two are named in the ear: tympanic paragangliomas, the glomus tympanicum, and jugular bulb paragangliomas, the glomus jugulare.

In the differential of tinnitus the glomus tumor sits on the para-auditory side among the pulse synchronous causes, together with carotid bruits, a hyperdynamic state, aneurysm and venous hum. In the differential of neck masses, carotid body tumor or paraganglioma is one of the benign neoplastic entries.

How it presents

Both of the ear paragangliomas cause a loud pulsing tinnitus with hearing loss, and as the tumor enlarges it causes hearing loss. The mass itself is visible as reddish or blue.

• Glomus tympanicum is a vascular, reddish bluish mass behind the tympanic membrane, with blanching of the membrane on pneumatic otoscopy, which is Brown's sign.
• Glomus jugulare appears as the tip of the iceberg, with the majority of the tumor hidden below the eardrum.