Glomus Jugulare Tumors Clinical Presentation

Updated: Dec 07, 2022
  • Author: Ryszard M Pluta, MD, PhD; Chief Editor: Brian H Kopell, MD  more...
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The clinical course of temporal bone glomus tumors reflects their slow growth and paucity of symptoms. Often, a significant delay in diagnosis occurs, and tumors may be large when first identified.

The most common symptoms are conductive hearing loss (69%) and pulsatile tinnitus (55%). [3]  Other aural signs and symptoms are ear fullness, otorrhea, hemorrhage, bruit, and the presence of a middle ear mass. Significant ear pain is uncommon. Involvement of the inner ear produces vertigo and sensorineural hearing loss.

Cranial nerve involvement produces hoarseness and dysphagia. The presence of jugular foramen syndrome (paresis of cranial nerves IX-XI) is pathognomonic for this tumor, but it usually follows 1 year after the initial symptoms of hearing loss and pulsatile tinnitus. Less commonly, glomus tumors produce facial nerve palsy, hypoglossal nerve palsy, or Horner syndrome.

Headachehydrocephalus, and elevated intracranial pressure may be produced by intracranial extension of the tumor. Ataxia and brainstem symptoms may also develop. Involvement of the dural sinuses may mimic sinus thrombosis.

In about 2-4% of cases, the first or leading symptoms are hypertension and tachycardia (pheochromocytoma-like symptoms) produced by catecholamines, norepinephrine, or dopamine excreted by the tumor. [3]  Also, somatostatin, vasoactive intestinal polypeptide (VIP), calcitonin, and neuron-specific enolase may be produced by the tumor. Other related symptoms include headache, perspiration, pallor, and nausea. [3]