Endoscopic Resection of Temporal Bone Paragangliomas: A Case Series

Monday, October 13, 2025

10:18 AM - 10:24 AM EDT

Location: 244

Disclosure(s):

Zachary G. Schwam, MD:

faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.

Enrique R. Perez, MD:

faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.

Introduction: Jugulotympanic paragangliomas are uncommon, vascular temporal bone tumors that are often difficult to resect due to involvement of the ossicular chain, facial nerve, jugular bulb, or internal carotid artery. Herein we present the largest single-institution case series for transcanal, endoscopic resection of these lesions.

Methods: This is a retrospective case series of all patients undergoing endoscopic resection of jugulotympanic paragangliomas in the Mount Sinai Health System from January 2017-December 2024. We examined demographic characteristics, estimated blood loss, operative time, preferred techniques of hemostasis, tumor extent, degree of resection, and audiometric outcomes. We calculated summary statistics as well as t-tests for categorical variables and ANOVA for continuous variables.

Results: Of 58 jugulotympanic paragangliomas resected during the time period of interest, 30 underwent transcanal, endoscopic resection. The vast majority of tumors were tympanic paragangliomas (87%) and Glasscock-Jackson classification 1 (87%). There were four patients with small jugular paragangliomas with predominantly middle ear involvement. The average tumor size (greatest dimension) was 6.1mm (range 2-11 mm). No patients required preoperative embolization, all cases were done in the outpatient setting, and no cases required conversion to a two-handed technique using the microscope. Mean estimated blood loss was 20mL (range 1-100 mL), and gross total resection was achieved in 87%. Half of cases required concomitant tympanoplasty and only one case required ossicular chain reconstruction. Mean operative time was 85 mins (range 30-148 mins). The KTP laser was used in 43.3% of cases (successfully in 69.2% of attempts and unsuccessfully in 31.9% of attempts), a microbipolar in 10%, epinephrine soaked pledgets in 90%, and floseal in 6.7%. Pulsatile tinnitus resolved in 87%. The mean air-bone gap (ABG) was stable from pre- (8.8 dB) to post-op (8.0 dB) (p=.98).

Conclusions: Transcanal, endoscopic resection of jugulotympanic paragangliomas is feasible and safe in appropriately selected patients.

Presenting Author(s)

Zachary G. Schwam, MD

Assistant Professor
Icahn School of Medicine at Mount Sinai
New York, NY, United States

Disclosure(s):
faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.

Co-Author(s)

JA

Jason Adams, MD

NYC Health + Hospitals/Elmhurst, United States

Disclosure information not submitted.
CF

Carly Fiest, BA

Icahn School of Medicine At Mount Sinai, United States

Disclosure information not submitted.
Enrique R. Perez, MD

Assistant Professor
Icahn School of Medicine at Mount Sinai
New York, NY, United States

Disclosure(s):
faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.
Maura Cosetti, MD

Associate Professor, Director, Ear Institute of New York Eye and Ear Infirmary of Mount Sinai
New York Eye and Ear Infirmary of Mount Sinai
New York, New York, United States

Disclosure information not submitted.

Senior Author(s)

George B. Wanna, MD

Professor
Icahn School of Medicine at Mount Sinai
New York, NY, United States

Disclosure information not submitted.