HEARING CONSERVATION IN SURGERY FOR GLOMUS-JUGULARE TUMORS

The most common ground on which surgery for glomus juglare (GJ) tumors is criticized is the perceived risk of functional incapacity that att ends possible cranial nerve (CN) loss. It is aggregate lower CN loss t hat is most often highlighted as particularly disabling to the quality of postsurgical survival. The documented success of both conservation surgery and operative rehabilitation of phonopharyngeal surgical defi cits has, however, neutralized much of this criticism. The issue of he aring conservation (HC) in neurotologic skull base surgery, on the oth er hand has not been well documented toward this end. The presence of a GJ neoplasm need not reflexly nor technically forfeit preexisting he aring. HC is, admittedly, a subordinate priority to total tumor remova l, successful distal control of the internal carotid artery, and even facial nerve integrity. Yet, in appropriately selected patients, exist ing operative technology permits hearing preservation, a noteworthy ad dition to the high-grade functional outcome we have come to reasonably expect of conservation surgery. Hearing salvage further serves to def ine the concept of neurotologic skull base surgery. Hearing preservati on in 122 GJ tumor patients is reviewed. Intuitively, as for acoustic tumor, HC appears tumor size related. Selection criteria for conservat ion surgery and its operative technique are detailed. Outcome is appro priately scored. The radiation therapy literature on this subject will be assiduously scrutinized for comparison.