Inside-Outside Mastoidectomy for Middle Ear Paragangliomas: Surgical Technique and Outcomes.

Middle ear paragangliomas (glomus tympanicum) are rare vascular tumors that pose significant surgical challenges due to their location and vascularity. The inside-outside mastoidectomy combines transcanal and retroauricular approaches to optimize resection and preserve hearing.  Methods: We conducted a retrospective observational study of eight female patients with stage A1-B3 glomus tympanicum treated at Carlos Andrade Marín Specialty Hospital between 2018 and 2024. Clinical presentation, imaging, intraoperative findings, complications, and audiological outcomes were analyzed.  Results: All patients presented with conductive hearing loss and pulsatile tinnitus. Complete tumor resection was achieved in 100% of cases with mean intraoperative bleeding of 200 ± 82 milliliters and mean follow-up of 38 ± 18 months. Complications included three tympanic membrane perforations (37.5%) and one transient facial palsy (12.5%). Hearing improvement was documented in 37.5% of patients. No tumor recurrences were observed during follow-up.  Conclusion: Inside-outside mastoidectomy is a safe and effective approach for the management of middle ear paragangliomas, offering excellent tumor control and favorable hearing outcomes. Further studies with larger cohorts are warranted to validate these findings.