Clinical Outcome of Endoscopic and Endoscopic-Assisted Microscopic Removal of Glomus Tympanicum: A Multicenter Retrospective Study

TL;DR

This study compares different surgical methods for removing glomus tympanicum tumors and finds similar excellent outcomes for early-stage cases.

Contribution

The study provides a multicenter comparison of endoscopic and microscopic approaches for GT removal, showing similar clinical outcomes.

Findings

Early-stage glomus tympanicum tumors show excellent outcomes with either endoscopic or microscopic approaches.

Only 2.2% of patients experienced tumor recurrence after surgery.

Preoperative pulsatile tinnitus and hearing loss significantly improved post-surgery.

Abstract

Objective: Comparing the clinical outcomes of glomus tympanicum (GT) resections by transcanal endoscopic ear surgery (TEES), microscopic- and endoscopic-assisted microscopic approaches. Methods: Adult patients conducting exclusive operations for GT within the tympanomastoid cavity were recruited in this retrospective cohort study at five international tertiary referral centers. GT resections were conducted by TEES, microscopic- and endoscopic-assisted microscopic approaches based on modified Fisch–Mattox classifications. Clinical characteristics and surgical outcomes were recorded and analyzed. Results: A total of 46 patients were included. A longer operative time was seen in more advanced GTs (A1: 106.73 ± 9.33 min, A2: 133.21 ± 13.47 min, B1: 176.88 ± 18.69 min, p = 0.005), while no significant differences were observed in the mean operative times among various surgical approaches. Preoperatively, 89.1% of patients experienced pulsatile tinnitus, and 56.5% exhibited conductive hearing loss. Postoperatively, only one patient continued to experience tinnitus (p < 0.001), and two patients had persistent hearing loss (p < 0.001). Higher disease grades correlated with poorer preoperative air-conduction thresholds (p = 0.015), while the differences in air-conduction thresholds before and after surgery did not demonstrate statistical significance across different tumor stages (p = 0.894) and surgical approaches (p = 0.257). The median follow-up period was 4 years, and only one recurrent case was found (2.2%, 1/46), which was treated by TEES and involved a B1 glomus tumor. Conclusions: Similar and excellent surgical outcomes were found among the TEES and microscope- and endoscopic-assisted microscopic approaches in early-stage GTs.

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