2026 Poster Presentations
P162: OTALGIA: AN EARLY ISOLATED SYMPTOM OF GLOMUS TYMPANICUM. A CASE REPORT AND TARGETED REVIEW.
John P Leonetti, Dr1; William Thedinger, Dr1; Raymond Meyer2; 1Loyola University Medical Center; 2Loyola Stritch School of Medicine
Introduction: Glomus tympanicum (GT) tumors are benign vascular neoplasms that arise from paraganglionic tissue in the middle ear. They represent the most frequent primary tumor of the middle ear and typically present with pulsatile tinnitus or hearing loss. Delay in recognition can allow extension beyond the middle ear with potential morbidity. Otalgia is rarely emphasized as an initial symptom, which may contribute to diagnostic delay.
Objective: To evaluate the frequency of otalgia as a presenting symptom in GT tumors and to highlight its clinical relevance through a representative case.
Case Presentation: A 73-year-old woman presented with persistent right-sided otalgia for 10 months. She denied pulsatile tinnitus or hearing loss. Otoscopy revealed a faint reddish hue behind the tympanic membrane. Computed tomography demonstrated a 3 × 3 mm soft tissue lesion arising on the cochlear promontory with extension into the middle ear. Audiometry showed mild bilateral sensorineural hearing loss. The patient underwent right attico-mastoidectomy via endaural approach with intraoperative facial nerve monitoring. At six-month follow-up, otalgia had fully resolved.
Methods: A targeted review was conducted to identify studies reporting presenting symptoms of GT tumors. Eligible studies included case reports, case series, and retrospective reviews that provided symptom data. Studies were excluded if tumor type was unclear or if presenting symptom data were incomplete. No formal quality assessment was performed given the descriptive scope. Data were extracted to calculate the frequency of otalgia at presentation.
Results: Fourteen studies met inclusion criteria, encompassing 777 patients with GT tumors. Across these, 56 patients (7.2%) were reported to present with otalgia. In most reports, otalgia occurred alongside other symptoms (e.g., tinnitus, otorrhea), and only two clearly documented cases described otalgia as the sole presenting feature (0.26%). Several studies grouped symptoms without specifying whether otalgia was isolated, and in two reports the description of otalgia as a presenting feature was ambiguous.
Conclusion: Otalgia may represent an underrecognized presenting symptom of glomus tympanicum tumors, even in the absence of more classic signs such as tinnitus or hearing loss. Greater awareness of this subtle clinical feature could facilitate earlier detection and management. This case underscores the importance of considering GT tumors in the differential diagnosis of unexplained unilateral otalgia, particularly when subtle otoscopic or imaging findings suggest a vascular lesion.