Glomus jugulare.

A 72-year-old Jehovah's Witness presented with a 1-month history of right-sided neck pain and headache. She was also aware of a slight hearing loss. She had an intermittent "roaring" tinnitus on the right that had begun 5 months earlier. The physical examination revealed the presence of a vascular mass without clearly delineated borders behind her tympanic membrane (figure). During pneumo-otoscopy, the tympanic membrane was brought into contact with the mass.

Weber's test was midline, and an audiogram revealed bilateral sensorineural hearing loss that was slightly worse on the right at 3,000, 4,000, and 6,000 Hz. There was no conductive component. The patient had no otalgia, otorrhea, or vertigo, and the lesion was not believed to be causally related to her neck pain or generalized headache.

Magnetic resonance imaging showed findings typical of a glomus jugulare tumor (paraganglioma). The mass extended along the carotid sheath and internal jugular vein to the inferior border of C2. It filled the carotid sheath and surrounded the right internal carotid artery, displacing the artery anteriorly. Magnetic resonance angiography showed that the mass was highly vascular, and magnetic resonance venography revealed no flow in the right sigmoid sinus or internal jugular vein. Multiple collateral vessels were seen throughout the neck. The mass was nearly 5 cm in its largest dimension.

Because of the patient's age and other health problems, treatment with radiation therapy was elected. Although her status as a Jehovah's Witness enhanced the potential for serious surgical complications, including death, our inability to transfuse would not have been an absolute contraindication to surgery if surgery had been deemed necessary.

From the Department of Otolaryngology-Head and Neck Surgery, Thomas Jefferson University, Philadelphia, and the Department of Otolaryngology-Head and Neck Surgery, Graduate Hospital, Philadelphia.