{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,23]],"date-time":"2026-09-23T00:32:35Z","timestamp":1790123555555,"version":"4.0.1"},"reference-count":44,"publisher":"MDPI AG","issue":"8","license":[{"start":{"date-parts":[[2024,4,11]],"date-time":"2024-04-11T00:00:00Z","timestamp":1712793600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Cancers"],"abstract":"<jats:p>Objective: To analyze the long-term facial function as well as overall postoperative condition in surgically treated tympanomastoid PGL patients. Study Design: Retrospective study. Method: The medical records of patients with surgically managed class A and B tympanomastoid PGLs between 1983 and 2023 were thoroughly evaluated. Result: Our center has treated a total of 213 cases of tympanomastoid PGL surgically. The mean age of patients was 54, and the male-to-female ratio was 1:6. The most common symptoms at presentation were hearing loss (80%), pulsatile tinnitus (77%), and vertigo (15%). According to the modified Fisch classification, 45% of the cases were classified as class A (A1 and A2), while 55% were classified as class B (B1, B2, and B3). All class A and most class B1 and B2 tumors were removed either with transcanal or retroauricular-transcanal approaches. However, more advanced class B3 lesions were removed with subtotal petrosectomy (SP) along with middle ear obliteration. Facial nerve outcome was excellent in all class A and B cases, while chances of postoperative paresis slightly increased with the size and extent of the tumor (p &lt; 0.05). The hearing outcome is excellent for class A1, A2, B1, and B2 tumors, whereas more advanced class B3 cases have a loss of air conduction (AC) and increased bone conduction (BC) threshold (p &lt; 0.05). Complete surgical removal was achieved in 97% of our cases. The most common late complication was permanent TM perforation (7%), and the recurrence rate was 3%. Conclusions: Tympanomastoid PGL represents the most common neoplasm of the middle ear space. The most frequent presenting symptoms include pulsatile tinnitus and hearing loss, whereas the presence of retrotympanic mass was evident in all cases at the time of initial otoscopic evaluation. Proper documentation of facial function and audiometric evaluation are crucial elements of preoperative workup. The most preferred preoperative radiologic examination is high-resolution computer tomography (HRCT), whereas magnetic resonance imaging (MRI) with or without gadolinium enhancement is reserved for cases with a dilemma of carotid artery or jugular bulb involvement. The main goal of tympanomastoid PGL treatment is complete disease removal with preservation of hearing and facial functions. Surgical treatment remains the preferred treatment modality with the benefits of complete disease removal, lower rate of recurrence and complication, and acceptable postoperative hearing level. Here, we present our 40 years of experience, which, to the very best of our knowledge, is the largest series of tympanomastoid PGL in the English literature.<\/jats:p>","DOI":"10.3390\/cancers16081466","type":"journal-article","created":{"date-parts":[[2024,4,11]],"date-time":"2024-04-11T07:09:28Z","timestamp":1712819368000},"page":"1466","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":9,"title":["Long-Term Surgical Outcome of Class A and B Tympanomastoid Paragangliomas"],"prefix":"10.3390","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0452-5176","authenticated-orcid":false,"given":"Melcol Hailu","family":"Yilala","sequence":"first","affiliation":[{"name":"Department of Otology and Skull Base Surgery, Gruppo Otologico, 29121 Piacenza, Italy"},{"name":"Department of Otorhinolaryngology, College of Health Sciences, Addis Ababa University, Addis Ababa P.O. Box 1176, Ethiopia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giuseppe","family":"Fancello","sequence":"additional","affiliation":[{"name":"Department of Otorhinolaryngology, Careggi University Hospital, 50134 Florence, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Virginia","family":"Fancello","sequence":"additional","affiliation":[{"name":"Department of Otology and Skull Base Surgery, Gruppo Otologico, 29121 Piacenza, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lorenzo","family":"Lauda","sequence":"additional","affiliation":[{"name":"Department of Otology and Skull Base Surgery, Gruppo Otologico, 29121 Piacenza, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mario","family":"Sanna","sequence":"additional","affiliation":[{"name":"Department of Otology and Skull Base Surgery, Gruppo Otologico, 29121 Piacenza, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2024,4,11]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"795","DOI":"10.1210\/er.2014-1026","article-title":"Current approaches and recent developments in the management of head and neck paragangliomas","volume":"35","author":"Kaliski","year":"2014","journal-title":"Endocr. Rev."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"115","DOI":"10.1007\/s12022-022-09708-2","article-title":"Overview of the 2022 WHO Classification of Neuroendocrine Neoplasms","volume":"33","author":"Rindi","year":"2022","journal-title":"Endocr. Pathol."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"661","DOI":"10.1016\/j.anl.2010.03.006","article-title":"Middle ear and mastoid glomus tumors (glomus tympanicum): An algorithm for the surgical management","volume":"37","author":"Sanna","year":"2010","journal-title":"Auris Nasus Larynx"},{"key":"ref_4","first-page":"382","article-title":"Long-term surgical and hearing outcomes in the management of tympanomastoid PGL","volume":"36","author":"Patnaik","year":"2015","journal-title":"Am. J. Otolaryngol. Head Neck Med. Surg."},{"key":"ref_5","unstructured":"Siekert, R.G. (2023, December 12). Chemodectoma, Nonchromaffin Paraganglioma, or Carotid-Body-Like Tumor. Available online: http:\/\/archneurpsyc.jamanetwork.com\/."},{"key":"ref_6","unstructured":"Rosenwasser, H., and York, N. (2023, December 12). Carotid Body Tumor of the Middle Ear and Mastoid. Peterson and Meeker9. Available online: http:\/\/archotol.jamanetwork.com\/."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"1038","DOI":"10.1288\/00005537-199110000-00002","article-title":"Glomus tympanicum tumors: A Clinical Perspective","volume":"101","author":"Shelton","year":"1991","journal-title":"Laryngoscope"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"232","DOI":"10.1097\/00129492-200103000-00020","article-title":"Long-Term Control of Surgically Treated Glomus Tympanicum Tumors","volume":"22","author":"Forest","year":"2001","journal-title":"Otol. Neurotol."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"189","DOI":"10.1055\/s-2007-1016957","article-title":"Intradural jugular paragangliomas: Complications and sequelae","volume":"18","author":"Magliulo","year":"2008","journal-title":"Skull Base"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"401","DOI":"10.1001\/archotol.1982.00790550005002","article-title":"Glomus Tumors. Diagnosis, Classification, and Management of Large Lesions","volume":"108","author":"Jackson","year":"1982","journal-title":"Arch. Otolaryngol."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"956","DOI":"10.1017\/S0022215100142173","article-title":"Clinical Records KTP Laser-Assisted Excision of Glomus Tympanicum","volume":"112","author":"Molony","year":"1998","journal-title":"J. Laryngol. Otol."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"462","DOI":"10.1258\/002221503321892307","article-title":"Glomus Tympanicum Tumour: An Alternative Surgical Technique","volume":"117","author":"Jain","year":"2003","journal-title":"J. Laryngol. Otol."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"1392","DOI":"10.1007\/s11864-023-01127-7","article-title":"An Update on Temporal Bone Paragangliomas","volume":"24","author":"Zhong","year":"2023","journal-title":"Curr. Treat. Options Oncol."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"941","DOI":"10.1016\/S0030-6665(05)70356-X","article-title":"Glomus tympanicum and glomus jugulare tumors","volume":"34","author":"Jackson","year":"2001","journal-title":"Otolaryngol. Clin. N. Am."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"827","DOI":"10.1007\/s00405-008-0829-z","article-title":"The crucial role of imaging in determining the approach to glomus tympanicum tumors","volume":"266","author":"Alaani","year":"2009","journal-title":"Eur. Arch. Oto-Rhino-Laryngol."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"875","DOI":"10.1288\/00005537-198909000-00001","article-title":"Glomus tympanicum tumors: Contemporary concepts in conservation surgery","volume":"99","author":"Jackson","year":"1989","journal-title":"Laryngoscope"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"380","DOI":"10.1002\/lio2.122","article-title":"Head and neck paragangliomas: A two-decade institutional experience and algorithm for management","volume":"2","author":"Smith","year":"2017","journal-title":"Laryngoscope Investig. Otolaryngol."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"5210","DOI":"10.1210\/jcem.86.11.8034","article-title":"Benign Paragangliomas: Clinical Presentation and Treatment Outcomes in 236 Patients","volume":"86","author":"Erickson","year":"2001","journal-title":"J. Clin. Endocrinol. Metab."},{"key":"ref_19","unstructured":"Eisenhofer, G., Huynh, T.-T., Hiroi, M., and Pacak, K. (2001). Understanding Catecholamine Metabolism as a Guide to the Biochemical Diagnosis of Pheochromocytoma, Kluwer Academic Publishers."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"627","DOI":"10.1053\/j.seminoncol.2010.10.017","article-title":"Metastatic paraganglioma","volume":"37","author":"Fliedner","year":"2010","journal-title":"Semin. Oncol."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"30","DOI":"10.1097\/00005537-199901000-00007","article-title":"Malignant Glomus Tumors","volume":"109","author":"Manolidis","year":"1999","journal-title":"Laryngoscope"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"898","DOI":"10.1111\/cen.12074","article-title":"Evaluation of SDHB, SDHD, and VHL gene susceptibility testing in the assessment of individuals with non-syndromic phaeochromocytoma, paraganglioma, and head and neck paraganglioma","volume":"78","author":"Jafri","year":"2013","journal-title":"Clin. Endocrinol."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"730","DOI":"10.1002\/cncr.10252","article-title":"National cancer database report on malignant paragangliomas of the head and neck","volume":"94","author":"Lee","year":"2002","journal-title":"Cancer"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"1915","DOI":"10.1210\/jc.2014-1498","article-title":"Pheochromocytoma and paraganglioma: An endocrine society clinical practice guideline","volume":"99","author":"Lenders","year":"2014","journal-title":"J. Clin. Endocrinol. Metab."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"331","DOI":"10.1016\/j.otc.2014.12.007","article-title":"Contemporary management of jugular paragangliomas","volume":"48","author":"Wanna","year":"2015","journal-title":"Otolaryngol. Clin. N. Am."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"278","DOI":"10.1007\/s12105-017-0803-4","article-title":"Paragangliomas of the Head and Neck: An Overview from Diagnosis to Genetics","volume":"11","author":"Williams","year":"2017","journal-title":"Head Neck Pathol."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"159","DOI":"10.1016\/j.anorl.2013.05.003","article-title":"Malignant head\/neck paragangliomas. Comparative Study","volume":"131","author":"Mediouni","year":"2014","journal-title":"Eur. Ann. Otorhinolaryngol. Head Neck Dis."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"447","DOI":"10.1177\/0145561319863373","article-title":"Is Regional Lymph Node Metastasis of Head and Neck Paraganglioma a Sign of Aggressive Clinical Behavior: A Clinical\/Pathologic Review","volume":"100","author":"Javidiparsijani","year":"2021","journal-title":"Ear Nose Throat J."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"2112","DOI":"10.1007\/s00259-019-04398-1","article-title":"European Association of Nuclear Medicine Practice Guideline\/Society of Nuclear Medicine and Molecular Imaging Procedure Standard 2019 for radionuclide imaging of phaeochromocytoma and paraganglioma","volume":"46","author":"Hicks","year":"2019","journal-title":"Eur. J. Nucl. Med. Mol. Imaging"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"84","DOI":"10.1308\/rcsann.2014.96.1.84a","article-title":"Microsurgery of Skull Base Paragangliomas","volume":"96","author":"Sanna","year":"2014","journal-title":"Ann. R. Coll. Surg. Engl."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"2611","DOI":"10.1002\/hed.26732","article-title":"Dynamic contrast-enhanced magnetic resonance imaging for differentiating head and neck paraganglioma and schwannoma","volume":"43","author":"Malla","year":"2021","journal-title":"Head Neck."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"146","DOI":"10.1177\/019459988509300202","article-title":"Facial Nerve Grading System","volume":"93","author":"House","year":"1985","journal-title":"Otolaryngol. Neck Surg."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"8402","DOI":"10.4076\/1757-1626-2-8402","article-title":"Bilateral glomus tumor treated with PET-CT based conformal radiotherapy: A case report","volume":"2","author":"Onal","year":"2009","journal-title":"Cases J."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"200","DOI":"10.1016\/S0377-1237(04)80125-4","article-title":"Glomus Tympanicum","volume":"60","author":"Singh","year":"2004","journal-title":"Med. J. Armed Forces India"},{"key":"ref_35","first-page":"45","article-title":"Glomus tympanicum","volume":"13","author":"Appannan","year":"2018","journal-title":"Malays. Fam. Physician"},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"328","DOI":"10.1097\/00129492-200105000-00010","article-title":"Hearing Rehabilitation Using the BAHA Bone-Anchored Hearing Aid: Results in 40 Patients","volume":"22","author":"Lustig","year":"2001","journal-title":"Otol. Neurotol."},{"key":"ref_37","doi-asserted-by":"crossref","unstructured":"Linder, T., Schlegel, C., Demin, N., and Van Der Westhuizen, S. (2008). Active Middle Ear Implants in Patients Undergoing Subtotal Petro-Sectomy: New Application for the Vibrant Soundbridge Device and Its Implication for Lateral Cranium Base Surgery, Otology & Neurotology, Inc.","DOI":"10.1097\/MAO.0b013e31818be812"},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"325","DOI":"10.1007\/s00405-004-0822-0","article-title":"Laser excision of glomus tympanicum tumors: Long-term results","volume":"262","author":"Durvasula","year":"2005","journal-title":"Eur. Arch. Oto-Rhino-Laryngol."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"236","DOI":"10.1017\/S0022215100122728","article-title":"NdYAG Laser Treatment of a Glomus Tympanicum Tumour","volume":"107","author":"Robinson","year":"1993","journal-title":"J. Laryngol. Otol."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"912","DOI":"10.1111\/j.1524-4725.1986.tb02130.x","article-title":"Laser Treatment of Hereditary Multiple Glomus Tumors","volume":"12","author":"Barnes","year":"1986","journal-title":"J. Dermatol. Surg. Oncol."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"185","DOI":"10.1055\/s-2008-1058145","article-title":"An Update on the Surgical Treatment of Temporal Bone Paragangl Ioma","volume":"9","author":"Moe","year":"1999","journal-title":"Skull Base Surg."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"1063","DOI":"10.1016\/j.ijrobp.2006.02.020","article-title":"Long-term results of irradiation for paraganglioma","volume":"65","author":"Krych","year":"2006","journal-title":"Int. J. Radiat. Oncol. Biol. Phys."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"147","DOI":"10.1055\/s-2008-1058638","article-title":"Long-Term Results of Surgery for Temporal Bone Paragangl Ioma","volume":"6","author":"Gjuric","year":"1996","journal-title":"Skull Base Surg."},{"key":"ref_44","first-page":"693","article-title":"Paraganglioma of the facial nerve, a rare differential diagnosis for facial nerve paralysis: Case report and review of the literature","volume":"269","author":"Zenk","year":"2011","journal-title":"Eur. Arch. Oto-Rhino-Laryngol."}],"container-title":["Cancers"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2072-6694\/16\/8\/1466\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T14:26:22Z","timestamp":1760106382000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2072-6694\/16\/8\/1466"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,4,11]]},"references-count":44,"journal-issue":{"issue":"8","published-online":{"date-parts":[[2024,4]]}},"alternative-id":["cancers16081466"],"URL":"https:\/\/doi.org\/10.3390\/cancers16081466","relation":{},"ISSN":["2072-6694"],"issn-type":[{"value":"2072-6694","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,4,11]]}}}