This patient presented with left pulsatile tinnitus. Note the reddish mass behind the left tympanic membrane. CT images showed the mass was limited to the middle ear.

Pulsatile Tinnitus: Glomus Tympanicum

One of the causes of pulsatile tinnitus is a very vascular benign (non-cancerous) tumour that arises from certain cells paraganglion cells) in the middle ear. Patients with this tumour usually present with unilateral conductive hearing loss and pulsatile tinnitus. Usually these tumours are quite small but very large tumours may destroy the surrounding structures and may cause vertigo, facial paralysis and sensori-neural hearing loss. Very small tumours may be asymptomatic and may be diagnosed on a routine ear examination.

Otoscopic or microscopic examination of the ear will show a “reddish mass” behind the tympanic membrane.

Imaging studies such as CT temporal bone, Magnetic Resonance Imaging and angiogram are done to determine the extent of the tumour and plan the surgical removal.