Tinnitus is the ringing of the ears that is perceived only by the affected individual while not audible to any other person. Classically defined as ringing, it can also be any other sound such as whooshing, humming, buzzing, clicking, roaring, and more. The volume of the tinnitus can fluctuate and can be continuous, intermittent, or pulsatile. It is a symptom of an underlying disorder and not a disease by itself. Affecting as many as 10-15% of the global population, there are as many as 50 million Americans that are affected. It not only affects adults although it typically affects those 50 years and above, but it also affects children and adolescents. Other risk factors besides increasing age includes:
- Military personnel and / or veterans
- Individuals who have jobs that expose them to loud noises (such as construction workers or those who work on freight trains)
- Musicians or people who listen to music at a high volume
- Individuals who engage in motorsport
- Gender (male gender has a higher risk)
- Those who have cardiovascular issues
While there is no definitive cure for tinnitus as it may be caused by various reasons, it has certain treatment and management options that can help relieve and reduce the symptoms of tinnitus. Some of the symptoms include:
- Poor concentration
- Memory issues
- Poor work or school performance
There are many individuals who suffer from tinnitus who have adapted to their symptoms and are able to function normally. However, there are also a small portion that find their tinnitus to be severe and debilitating. For some, there is a definitive cure and one of these cases is when the underlying cause of the tinnitus is a glomus tumor.
What Is A Glomus Tumor?
A glomus tumor is also known as a paraganglioma. it is usually benign and slow growing. It is a rare condition where the annual incidence is 1 case per 1.3 million people. It is a condition that is much more common in women compared to men, and commoner in the left side as well. This tumor usually occurs in those between the ages of 40-70 years old but have also ben seen in those as young as 6 months old and as old as 88 years old. Although most cases are sporadic, some cases are hereditary with autosomal dominant inheritance.
Due to its location, it is a highly vascular tumor (has a lot of blood supply). Although it is not dangerous, it can still produce unwanted side effects due to their:
- Size – the increasing size due to growth can cause unwanted side effects especially in a small restricted space such as the ear. The growth has the potential to block the transmission of sound causing hearing loss.
- Vascularity – the ear is a very vascular area where there is high blood flow. The high blood flow can cause a pulsating sound, a form of tinnitus.
- Invasion – in such a restricted space (in the ear), invasion of adjacent structures can occur quickly. If structures in the temporal bone are invaded, the facial nerve can be compromised leading to facial paralysis, sensorineural hearing loss, or vertigo. Metastases occur approximately in 4% of cases.
- Hormones – secretion of hormones may occur although rare. The hormones secreted are usually adrenaline than can lead to episodes of sweating, tachycardia (fast heart beat), headache, and headache.
Some of the more prominent locations for paragangliomas are in the carotid body, vagal, jugular, and tympanic glomus. Symptoms of the growth usually depend on the location of the tumor. Among these, not all present with tinnitus. Some of the paragangliomas that present with tinnitus include:
These are usually located in the neck. The symptoms depend on the location of the tumor but most vagal paragangliomas arise from the glomus nodosum. Those affected usually have an asymptomatic neck mass that is found behind the angle of the mandible. Another prominent symptom is the pulsatile tinnitus or ringing in the hear that is heard as it corresponds with each heartbeat. In some patients, this can be heard by another person when the stethoscope is placed over the ear. Some patients also present with hoarseness of the voice, difficulty swallowing, shoulder drop, aspiration, and more.
These are small sized tumors that originate from the middle ear and only becomes symptomatic once patients start complaining of pulsatile tinnitus. In half of presenting patients, there is some degree of hearing loss as well. Some tympanic paragangliomas are visible as a vascular middle ear mass. A diagnosis can only be made once a careful examination of the tympanic membrane is performed and the tumor is identified through the translucent eardrum. Computed tomography (CT) or magnetic resonance imaging (MRI) scans are the diagnostic standard as it is almost impossible to view the entire tumor without imaging help. The pulsatile tinnitus can be stopped temporarily by introducing positive pressure into the ear canal.
In jugular paragangliomas, occlusion of blood vessels can occur when the tumor increases in size. Pulsatile tinnitus is one of the commonest symptom in jugular paraganglioma which can be heard by placing a stethoscope over the ear. As the tumor progresses, there is also hearing loss and occasionally dizziness. Invasion of the tumor can lead to facial paralysis, paralysis of th tongue, and eventually compression of the brain or brainstem.
Conclusion and Statistics of Treatment for Glomus Tumors
In a study by Cosetti et al., 2008, their research team recruited 12 patients with glomus tumors. Seven of the participants had surgical excision of the paraganglioma while the other five were unfit for surgery and were treated with observation and primary radiation therapy. The study found that pulsatile tinnitus was resolved in all patients. This makes surgery the treatment of choice. Another study that uses primary radiation treatment after partial resection of the tumor found long-term success in the control of the tumor growth, improvement in tinnitus, overall neurological status, and even cranial nerve function. Some cases do not require treatment and should only be observed.