Glomus Tympanicum in an Asymptomatic 82-Year-Old Woman.

IMPORTANCE

Glomus tympanicum is a rare, highly vascular paraganglioma of the middle ear that may cause pulsatile tinnitus and hearing loss. Management decisions, particularly in older adults, must balance symptom control with the risks of intervention.

OBJECTIVE

To describe the long-term clinical course of an incidentally discovered glomus tympanicum managed with watchful waiting and close surveillance.

DESIGN

Case report with 5 years of longitudinal follow-up.

SETTING

Outpatient otolaryngology and neuro-otology referral practice.

PARTICIPANTS

An 82-year-old woman evaluated for dizziness unrelated to the final diagnosis and without otologic symptoms at presentation.

EXPOSURE: Observation with serial clinical assessments and imaging studies, without surgical or radiotherapeutic intervention.

MAIN OUTCOMES AND MEASURES: Tumor stability on serial imaging, symptom development, and need for intervention.

RESULTS

Otoscopic examination revealed a bright red mass occupying approximately one-third of the right tympanic membrane. MRI demonstrated a 3-4 mm lesion along the right cochlear prominence, consistent with a Glasscock-Jackson type I glomus tympanicum. Audiometry showed mild to moderate right-sided sensorineural hearing loss. Over 5 years of follow-up, the patient remained asymptomatic, with no significant tumor growth on serial imaging and no evidence of metastatic disease.

CONCLUSIONS AND RELEVANCE: In this older asymptomatic patient, watchful waiting with careful surveillance was associated with long-term tumor stability and avoidance of invasive treatment. Conservative management may be an appropriate option for select patients with small, slow-growing glomus tympanicum tumors.