A Case of Jugulotympanicum Paraganglioma: A Treatment Dilemma

Temporal bone paragangliomas arise from the paraganglion cells that are located in the middle ear and the lateral skull base. We present a 46-year-old man with undisturbed right intermittent pulsatile tinnitus, ear fullness, and progressively reduced hearing for 1 year. Clinically, the right tympanic membrane is bulging, and there is a pulsatile reddish mass in the middle ear. Computed tomography reveals soft tissue at the right mastoid air cell that extends inferiorly to the jugular foramen and laterally to the ear canal. The mass has an epicenter at the right jugular fossa and is obliterating the internal auditory meatus in magnetic resonance imaging. The diagnosis of advanced right nonsecreting jugulotympanicum paraganglioma Glasscock-Jackson type IV was established from imaging and a normal 24-h urine metanephrine level result. After extensive multidisciplinary deliberations, radiation treatment was determined to be the patient’s best course of treatment.