Jugulotympanic Glomus: A Case Report on a Rare Presentation of a Vascular Middle Ear Tumor

Jugulotympanic paragangliomas (JTPs) are neuroendocrine tumors, frequently benign, that originate from paraganglia cells. Due to their small initial size and slow growth, they tend to be asymptomatic for long periods, leading to delayed presentation. Our case report describes a JTP complicated by mastoiditis and a Bezold abscess. We report the case of a 70-year-old female with a history of hypertension and an ischemic stroke 20 years prior, who was diagnosed with an unresectable JTP via MRI. At the time of presentation, she reported progressive ear pain, fever, and a tender mass behind the ear that had developed over the preceding two weeks. On examination, findings were consistent with mastoiditis, and otoscopy of the right ear showed malodorous otorrhea partially obscuring the external canal, a perforated tympanic membrane, and a red-violaceous, pulsatile mass behind it, for which, along with the already diagnosed JTP, she was admitted to the hospital. The patient experienced recurrent infections not typically associated with this tumor type. Well-known complications are otalgia, hoarseness of voice, and nerve palsy involving the facial nerve (cranial nerve VII) -- deficits associated with the mass effect near nerves found adjacent to the neck and ear. It is rare to discover mastoiditis or a Bezold abscess in this population, with only a few cases being reported worldwide. Considering the paraganglioma remained at its initial size, this did not correlate with the complications; instead, the obstruction of the ear canal, negative pressure, and tubal dysfunction created favorable conditions for bacterial growth, predisposing to infections. Strict follow-up is essential for each patient to enable early diagnosis at a treatable stage, thereby reducing adverse outcomes. Given the limited published data on this rare occurrence, we aim to contribute to the existing case reports and highlight the need for further research on uncommon paragangliomas to optimize management strategies and anticipate potential complications.