The Hearing Loss That Pulsates

Background: Glomus jugulare tumor arises within the jugular foramen with close proximity to lower cranial nerves and major vessels. The aim of treatment is complete resection of tumor with preservation of cranial nerves. However, surgery carries high morbidities and challenging especially in large tumors.
Case presentation: A 47-year old lady experienced a hearing loss followed by pulsatile tinnitus for 2 years. Upon a thorough examination and investigations, she was later diagnosed with glomus jugulare. Transmastoid approach excision of tumour was performed with residual tumour left at surgery to prevent potential morbidities. She underwent adjuvant stereotactic radiotherapy post operatively.
Conclusion: Due to insidious onset, high index of suspicion for glomus tumor is needed to initiate early treatment and reduce morbidity. Thus, tinnitus should not be taken lightly. Combined modalities of partial resection of tumor with post-operative radiotherapy are the most suited and effective treatment in large tumors with preserved cranial nerves function. Routine post-operative MRI is beneficial to monitor residual and recurrence.