Primary glomangioma of the external auditory canal with extension to the middle ear and mastoid.

Glomangioma (true glomus tumour) is a benign perivascular neoplasm that rarely arises in the head or neck. A man in his 70s presented with long-standing, unilateral, serous otorrhoea, progressive hearing loss and intermittent tinnitus. Otoscopy revealed a soft-tissue mass completely occluding the external auditory canal. Contrast-enhanced CT demonstrated an enhancing lesion filling the external auditory canal with extension into the middle ear, attic, mastoid antrum and tympanic opening of the Eustachian tube without bony erosion. The patient underwent canal-wall-down mastoidectomy with gross total excision. Histology showed a well-circumscribed, unencapsulated tumour composed of thin-walled branching vessels rimmed by uniform round cells, and immunohistochemistry revealed diffuse smooth muscle actin positivity, supporting the diagnosis of glomangioma. The symptoms resolved postoperatively and structured surveillance was arranged because of a close excision margin. This case highlights that not all vascular-appearing otologic masses are paragangliomas and underscores the diagnostic value of histopathology with immunostaining.