CLASSIFICATION 1)Primary Tumours: Benign Glomus tumour
Malignant Carcinoma,sarcoma 2)Secondary Tumours: a) From adjacent
areas like nasopharynx, external meatus and parotid. b)Metastatic
eg. From ca of bronchus, breast, thyroid, prostrate, GIT.
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GLOMUS TUMOUR: Most common benign neoplasm of middle ear and
originate from the glomus bodies. It is found in the jugular bulb
or on the promontory along course of tympanic branch of IXth
cranial nerve(jacobsons nerve). The tumour consists of
paraganglionic cells derived from the neural crest.
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AETIOLOGY AND PATHOLOGY Often seen in middle age.(40-50).
Females>Males. It is a benign non encapsulated but extremely
vascular,slow growing and locally invasive tumours. Microscopically
it shows sheets of epithelial cells with large nuclei and granular
cytoplasm with thin walled blood sinusoids without contractile
muscle coat.
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Two types of glomus tumours: 1)Glomus jugulare: They arise from
dome of jugular bulb, invade hypotympanum and jugular foramen,
causing neurological sign of IX th to XII th cranial nerve
involvement. They may compress or invade lumen of jugular vein.
2)Glomus Tympanicum: They arise from promontory of middle ear and
cause aural symptoms sometimes with facial paralysis.
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CLINICAL FEATURES: A)When tumour is intratympanic: Earliest
symptoms are deafness and tinnitus.Deafness is conductive type and
tinnitus is pulsatile. Otoscopy show red reflex through intact TM.
Rising sunappearance is seen. Pulsation sign(Browns sign) is
positive. B) When tumour present as polyp: profuse bleeding from
ear either spontaneously or after cleaning. Dizziness or vertigo
and facial paralysis may appear. Earache less common otorrhoea due
to secondary infection.Examionation reveals red vascular
polyp.
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Cranial nerve palsies: It is a late feature.IX th to XII
cranial nerves may be involved.dysphagia, hoarsness with unilateral
paralysis of soft palate, pharynx and vocal cord. Tumours may
present as mass over mastoid or in nasopharynx. Audible bruit over
mastoid. Some glomus tumours secrete catecholamines and produce
their symptoms. Rule of 10s:
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DIAGNOSIS: 1)CT scan head 2)MRI 3)Four vessel angiography
TREATMENT: Surgical removal Radiation Embolisation Combination of
the above techniques
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CARCINOMA OF MIDDLE EAR AND MASTOID AETIOLOGY: Age- 40 to 60,
females>males,chronic irritation may be the cause. PATHOLOGY:
Tumour may arise primarily from middle ear or be an extension of ca
of deep meatus. Squamous cell variety is most common.
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CLINICAL FEATURES: CHRONIC FOUL SMELLING DISCHARGE SPECIALLY
BLOOD STAINED. PAIN USUALLY SEVER AND COMES AT NIGHT FACIAL PALSY
FRIABLE HAEMORRHAGIC GRANULATIONS OR POLYP APPEARANCE OF OR
INCREASE IN DEAFNESS OR VERTIGO.
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DIAGNOSIS DEFINITIVE DIAGNOSIS IS MADE ONLY ON BIOPSY EXTENT OF
DISEASE IS JUDGED BY CLINICAL AND RADIOLOGICAL EXMINATION. CT SCAN
& ANGIOGRAPHY ARE USEFUL IN THE ASSESSMENT OF DISEASE.
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TREATMENT: Combination of surgery and radiotherapy gives better
results.