初回術後 9 年目に再手術を行った鼓室型グロームス腫瘍例

Glomus tumors (paragangliomas) are benign neuroendocrine tumors derived from the paraganglia. Temporal bone paragangliomas are classified as glomus tympanicum or glomus jugulare according to their location. Total surgical removal is the treatment of first choice for glomus tympanicum. A 60-year-old man presented to us with the symptom of ear fullness. Contrast-enhanced CT showed a non-enhancing soft-tissue lesion in the middle ear. We performed exploratory tympanotomy to examine the histology, and intraoperative surgical pathology indicated that the soft tissue was an inflammatory granuloma. We did not perform total removal of the lesion, as the granulation tissue surrounded the stapes, and we wished to preserve the bone conduction hearing. Postoperative histopathological diagnosis revealed that the tumor was a paraganglioma. Since paraganglioma is a slow-growing benign tumor, we decided to observe the residual lesion. During nine years of observation, the lesion gradually increased in size and the patient’s hearing level worsened. Therefore, we performed reoperation for total removal of the lesion. At present, two years since the surgery, the patient’s hearing has been stable and no recurrence of the lesion has been observed. The standard treatment for glomus tympanicum is total removal. However, if close observation is possible, partial removal is acceptable as an alternative strategy to preserve the bone conduction hearing.