Which of the following is earliest and consistent sympt< of glomus tumor:

Ans. (b) TinnitusRef: Dhingra 5th Ed. /. 120-121* GLOMUS TUMOUR is the most common benign neoplasm of middle ear and is so-named because of its origin from the glomus bodies.* The tumor is often seen in the middle age (40-50 years)* Females are affected five times more than males.* There are two types of glomus tumor:# Glomus jugulare arise from the dome of jugular bulb. Invade the hypotympanum and jugular foramen. They may compress jugular vein or invade its lumen# Glomus tympanicum arise from the promontory of the middle ear and cause aural symptoms and sometimes with facial paralysis.Clinical Features* Earliest symptoms are tinnitus and hearing loss.# Tinnitus is pulsatile and of swishing character.# Hearing loss is conductive and slowly progressive.* Otoscopy shows a red reflex through intact tympanic membrane.* "Rising sun" appearance is seen when tumor arises from the floor of middle ear.* In addition to hearing loss and tinnitus, there is history of profuse bleeding from the ear either spontaneously or on attempts to clean it* Dizzines or vertigo and facial paralysis may appear* Ear ache is less common* Otorrhea may occur due to secondary infection and the condition may simulate chronic suppurative otitis media with polyp.* IXth to Xllth cranial nerves may be paralyzed* There is dysphagia and hoarseness with unilateral paralysis of the soft palate, pharynx and vocal cord with weakness of the trapezius and sternomastoid muscles.* Rule of 10's Remember that 10% of the tumors are familial, 10% multicentric and up to 10% functional, i.e. they secrete catecholamines.