Excision aural glomus tumor; transmastoid
CPT4 code
Name of the Procedure:
Excision of Aural Glomus Tumor; Transmastoid
- Common Name: Transmastoid Glomus Tumor Removal
- Medical Term: Excision of Paraganglioma via Transmastoid Approach
Summary
This surgical procedure involves the removal of a glomus tumor from the ear canal or middle ear using an approach through the mastoid bone. The goal is to excise the tumor while preserving ear function and minimizing complications.
Purpose
- Condition Addressed: Aural glomus tumors, also known as paragangliomas or chemodectomas, which are typically benign but can cause hearing loss, ear fullness, tinnitus, and other symptoms.
- Goals: Remove the tumor, alleviate symptoms, prevent further growth and potential malignancy, and preserve as much normal ear function as possible.
Indications
- Symptoms such as pulsatile tinnitus, hearing loss, or a visible mass in the ear
- Radiological evidence of a glomus tumor
- Tumor growth causing cosmetic or functional issues
- Patient suitability for surgery based on overall health
Preparation
- Pre-Procedure Instructions: The patient may need to fast for at least 8 hours before surgery. Adjustments to medications (e.g., stopping blood thinners) as advised by the doctor.
- Diagnostic Tests: Audiograms, CT scans, MRI, and sometimes angiography to map the tumor’s blood supply.
Procedure Description
- Anesthesia: General anesthesia is administered.
- Accessing the Tumor: An incision is made behind the ear; the mastoid bone is drilled to access the middle ear.
- Tumor Removal: The surgeon carefully excises the tumor, taking care to preserve critical structures such as the ossicles and facial nerve.
- Closure: The incision is closed with sutures, and a dressing is applied.
Tools and Equipment: Surgical drill, microsurgical instruments, surgical microscope, cautery device.
Duration
The procedure typically takes 2 to 4 hours, depending on tumor size and complexity.
Setting
Performed in a hospital operating room or a specialized surgical center.
Personnel
- Surgeon: An otolaryngologist or neurotologist with expertise in skull base surgeries.
- Anesthesiologist: To manage anesthesia and patient vital signs.
- Nurses and Surgical Technicians: To assist with the procedure and monitor patient condition.
Risks and Complications
- Common Risks: Infection, bleeding, hearing loss, dizziness.
- Rare Risks: Facial nerve damage, cerebrospinal fluid leak, persistent tinnitus, incomplete tumor removal, potential malignancy.
Benefits
- Relief from symptoms such as hearing loss and tinnitus
- Prevention of further tumor growth and possible complications
- Improved quality of life
Realization Timeline: Benefits are typically realized immediately but can take a few weeks to fully assess as swelling subsides and healing occurs.
Recovery
- Post-Procedure Care: Monitoring in a recovery room, possible overnight hospital stay.
- Instructions: Keep the incision dry, avoid heavy lifting and strenuous activity for several weeks, attend follow-up appointments.
- Recovery Time: Typically 2 to 6 weeks for complete healing.
Alternatives
- Radiation Therapy: May control tumor growth but doesn't remove the tumor.
- Observation: Appropriate for small, asymptomatic tumors, with regular monitoring.
- Pros/Cons: Radiation avoids surgery but carries its own risks and doesn't remove the tumor; observation avoids immediate intervention but requires ongoing monitoring.
Patient Experience
- During Procedure: Under general anesthesia, so the patient will be unconscious and feel no pain.
- After Procedure: The patient might experience discomfort, mild pain managed with medications, and temporary dizziness or hearing changes.
- Pain Management: Pain relief through prescribed medications and personalized comfort plans.
This document provides an overview of the transmastoid excision of aural glomus tumors for educational purposes. Patients should consult with their healthcare provider for personalized medical advice.