Glomus Tumours

Head and neck Glomus tumours or Paragangliomas, are slow growing tumours found in the middle ear or an area below the middle ear, known as the jugular bulb. They can also originate on the carotid arteries in the neck, in the orbit or in certain nerves in the neck (Vagal or Glossopharyngeal).

These tumours are usually benign and locally very destructive, although around 3% of them can undergo malignant (cancerous) transformation.

Paragangliomas are highly vascular tumours and about 5% of these tumours are secreting vasoactive chemicals that cause a rise in blood pressure and a tachycardia (rise in pulse rate).
The most common symptoms or signs are pulsatile tinnitus (heart beat in the ear), hearing loss, vertigo (balance disorder), pain in the ear or headache, bleeding from the ear. Usually a red, pulsating tumour is seen in the ear. As the tumour grows in size surrounding structures are affected, like the Facial nerve (facial palsy) or the Vagal nerve (hoarseness and swallowing difficulty), the Hypoglossal nerve (tongue nerve) with speech difficulty. It also tends to grow along the carotid artery into the skull base and into the brain.

If the tumour is primarily in the neck, a slowly enlarging solid neck mass is found, usually at the angle of the jaw. The tumours arising on the carotid arteries are called carotid body tumours.

During the clinical evaluation, the head and neck and all the cranial nerves are evaluated. A CT scan and MRI scan with evaluation of the blood vessels (MRA) are done to evaluate and stage the tumour. A hearing test is also done if the ear is affected. Blood tests to exclude a secretory tumour and to evaluate the patient’s bodily functions are done.

Depending on the patient and the tumour there are different management options. One is to observe the tumour with follow up scans. Surgery is usually the preferred treatment option, except when the surgery is too risky (patient not healthy enough or too old or the risks outweigh the benefits).

In these cases radiotherapy can be offered, which only slows or sometimes stops the growth of the tumour. Unfortunately there are also complication risks involved with radiotherapy. So each patient is evaluated and the best treatment option chosen.