A Case of Simultaneous Glomus Tympanicum, Glomus Jugulare, and Bilateral Carotid Paraganglioma.

Paragangliomas are rare neuroendocrine tumors that can arise anywhere from the skull base to the pelvis, but most frequently occur in the head and neck, with the carotid body being the most common site. Subtypes are named according to site of origin, such as glomus tympanicum (behind tympanic membrane) and glomus jugulare (at or near jugular foramen). These tumors may cause cranial nerve deficits depending on location. The following case describes a 51-year-old male who first presented with long-standing right-sided facial paralysis who later developed progressive neurologic symptoms. Imaging revealed multiple head and neck tumors. A multidisciplinary tumor board diagnosed right glomus tympanicum, bilateral glomus jugulare, and bilateral carotid body paragangliomas based on "salt-and-pepper" imaging findings on MRI. Although surgical resection was considered, radiation therapy was ultimately recommended for all of his paragangliomas. The patient underwent radiation therapy with good response and annual surveillance is planned. Given the genetic predisposition for paragangliomas, genetic counseling is essential. Treatment remains individualized, though advances in therapy can improve standardization.