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# Tumours of the ear: external ear, middle ear and paraganglioma

- Topic

Ear tumours are rare; look for a non-healing lesion, bleeding with chronic discharge, pulsatile tinnitus or a red mass behind the eardrum.

Updated Nov 12, 2026

**See it in 3D:** [Auricle](https://durgical.com/en/anatomy/auricle/) · [Temporal bones](https://durgical.com/en/anatomy/temporal-bone/) · [Facial nerve (VII)](https://durgical.com/en/anatomy/facial-nerve/)

## Key points

- Paraganglioma (glomus tumour) is the classic benign tumour of the middle ear: pulsatile tinnitus, conductive hearing loss and a red or bluish mass behind an intact eardrum.
- Brown sign: the retrotympanic glomus mass blanches when positive pressure is applied with a pneumatic otoscope.
- Glomus jugulare can involve the jugular foramen nerves (IX, X, XI) and the hypoglossal nerve; never biopsy a vascular middle-ear mass in clinic.
- Head and neck paragangliomas rarely secrete catecholamines (about 5 %), but plasma or urine metanephrines are checked before surgery; familial cases (SDH genes) are often multiple.
- Ear canal or temporal bone squamous cell carcinoma: chronic otorrhoea with bleeding, severe pain and granulation; biopsy any canal lesion that does not heal.
- Pinna: squamous cell and basal cell carcinoma on sun-exposed helix and preauricular skin; treated by excision with clear margins.

## What it is

Tumours can arise in the pinna, the ear canal, the middle ear and mastoid, or the internal auditory canal. The pinna is sun-exposed skin, so basal cell and squamous cell carcinoma are the common cancers there. Squamous cell carcinoma of the ear canal and temporal bone is rare and is often mistaken for chronic otitis: pain out of proportion, bleeding, granulation and facial palsy are the clues. In the middle ear the classic tumour is the paraganglioma (glomus tumour): glomus tympanicum on the promontory and glomus jugulare arising at the jugular bulb, both highly vascular. In children, rhabdomyosarcoma and Langerhans cell histiocytosis can mimic chronic otitis. Vestibular schwannoma, the commonest tumour of the internal auditory canal, has its own page.

## Key facts

- Glomus tympanicum arises from paraganglia along the tympanic nerve on the promontory; glomus jugulare from the jugular bulb; carotid body and vagal tumours are the neck paragangliomas.
- Imaging for paraganglioma: CT shows bone erosion (the jugular foramen in glomus jugulare); MRI shows a «salt and pepper» pattern from flow voids; angiography maps feeding vessels and allows preoperative embolisation.
- Paraganglioma treatment: surgery, radiotherapy or radiosurgery, or watchful waiting for slow tumours in older patients.
- Temporal bone squamous cell carcinoma is staged with the Pittsburgh system; in a meta-analysis five-year overall survival was about 60 %, and over 80 % for early (T1 to T2) disease.
- Treatment of temporal bone carcinoma is surgical (lateral or more extensive temporal bone resection) with radiotherapy for advanced disease.
- Rhabdomyosarcoma is the commonest soft tissue sarcoma in children; in the ear it presents as a polyp with bloody discharge that does not respond to otitis treatment.

## Structure

- Pinna: basal cell carcinoma, cutaneous squamous cell carcinoma, melanoma; benign lesions such as keloid.
- Ear canal: benign exostoses and osteoma, ceruminous gland tumours; squamous cell carcinoma of the canal and temporal bone.
- Middle ear and mastoid: paraganglioma (glomus tympanicum, glomus jugulare), middle-ear adenoma, facial nerve schwannoma, meningioma, metastases.
- Children: rhabdomyosarcoma (embryonal type), Langerhans cell histiocytosis with lytic temporal bone lesions.
- Internal auditory canal and cerebellopontine angle: vestibular schwannoma (bilateral in neurofibromatosis type 2), meningioma.
- Not tumours but look-alikes: congenital cholesteatoma (white mass behind an intact eardrum), aural polyp from chronic otitis.

## Ear tumours: where, the clue and the first study

| Tumour | Site | Key clue | First study |
| --- | --- | --- | --- |
| Basal or squamous cell carcinoma | Pinna, preauricular skin | Non-healing ulcer or crusted nodule on the helix | Excisional or incisional biopsy |
| Squamous cell carcinoma of the canal | Ear canal, temporal bone | Bleeding, pain out of proportion, granulation, facial palsy | Biopsy, CT and MRI |
| Glomus tympanicum | Promontory of the middle ear | Pulsatile tinnitus, red mass behind the drum, Brown sign | Temporal bone CT and MRI (no clinic biopsy) |
| Glomus jugulare | Jugular bulb, jugular foramen | Pulsatile tinnitus plus palsy of IX to XII | CT, MRI, angiography; metanephrines |
| Rhabdomyosarcoma | Middle ear (children) | Aural polyp with bloody discharge | Biopsy, MRI, oncology staging |
| Langerhans cell histiocytosis | Temporal bone (children) | Otorrhoea, postauricular swelling, lytic bone lesion | CT and biopsy |
| Vestibular schwannoma | Internal auditory canal | One-sided sensorineural loss and tinnitus | Gadolinium MRI |

## In clinical practice

- Chronic otitis that bleeds, hurts more and more or causes facial palsy, especially in an older adult: biopsy to rule out carcinoma.
- Pulsatile tinnitus with a red mass behind the eardrum: image before touching it.
- A child with an aural polyp or bloody discharge that does not settle with treatment.
- One-sided sensorineural hearing loss or tinnitus: MRI for a vestibular schwannoma.

## Next step / Initial management

- First workup: otoscopy (with the microscope if available), audiometry, cranial nerve exam (V, VII, IX to XII) and neck palpation.
- Imaging: temporal bone CT for bone erosion and MRI with gadolinium for soft tissue and nerves; for paraganglioma add angiography and plasma or urine metanephrines; a biopsy of skin or canal lesions is taken by the specialist.
- Suspected malignancy of the pinna or canal, or a cranial nerve palsy: urgent referral (within two weeks, cancer pathway) to ENT or head and neck surgery.
- Pulsatile tinnitus with a retrotympanic mass, or asymmetric sensorineural loss: priority referral to ENT; treatment is decided by a skull base team.

## Test yourself

Think of the answer, then tap the question to see it.

## A 50-year-old woman has right pulsatile tinnitus and a red mass behind an intact eardrum that blanches with positive pneumatic pressure. Diagnosis and the step to avoid?

Glomus tympanicum (paraganglioma) with a positive Brown sign: image with CT and MRI and do not biopsy in clinic because of bleeding.

## A man with a jugular foramen mass has hoarseness, dysphagia and weakness of the trapezius. Which nerves are affected?

Glossopharyngeal, vagus and accessory (IX, X, XI): a jugular foramen syndrome from a glomus jugulare; the hypoglossal nerve may also be involved.

## A 70-year-old with long-standing otorrhoea now has bleeding, severe pain and granulation in the canal. What must be excluded?

Squamous cell carcinoma of the ear canal or temporal bone: biopsy, CT and MRI, and urgent ENT referral.

## Why are metanephrines checked before removing a head and neck paraganglioma?

A few (about 5 %) secrete catecholamines, and some patients have additional pheochromocytomas, which risk a hypertensive crisis during surgery.

[Add to my cards (4)](https://durgical.app/estudiar/?add=/en/ent/tumours-of-the-ear-external-ear-middle-ear-and-paraganglioma/)

## Connections

## See it in 3D 3

The structures of Durgical's 3D anatomy where it is found.

- [Auricle](https://durgical.com/en/anatomy/auricle/)
- [Temporal bones](https://durgical.com/en/anatomy/temporal-bone/)
- [Facial nerve (VII)](https://durgical.com/en/anatomy/facial-nerve/)

## Related 6

- [Head and neck cancer: red flags and urgent referral](https://durgical.com/en/ent/head-and-neck-cancer-red-flags-and-urgent-referral/)
- [Approach to tinnitus](https://durgical.com/en/ent/approach-to-tinnitus/)
- [Approach to hearing loss](https://durgical.com/en/ent/approach-to-hearing-loss/)
- [Approach to ear discharge](https://durgical.com/en/ent/approach-to-ear-discharge/)
- [Imaging in ENT: which study for which question](https://durgical.com/en/ent/imaging-in-ent-which-study-for-which-question/)
- [External ear problems: wax, otomycosis, furuncle, perichondritis, exostoses and keratosis obturans](https://durgical.com/en/ent/external-ear-problems-wax-otomycosis-furuncle-perichondritis-exostoses-and-kerat/)

## Related conditions 8

- [Head and neck paraganglioma (carotid body tumour, glomus jugulare, glomus tympanicum)](https://durgical.com/en/conditions/head-and-neck-paraganglioma/)
- [Vestibular schwannoma (acoustic neuroma)](https://durgical.com/en/conditions/vestibular-schwannoma/)
- [Hereditary paraganglioma and pheochromocytoma (SDH)](https://durgical.com/en/conditions/hereditary-paraganglioma-and-pheochromocytoma/)
- [Basal cell carcinoma](https://durgical.com/en/conditions/basal-cell-carcinoma/)
- [Cutaneous squamous cell carcinoma](https://durgical.com/en/conditions/cutaneous-squamous-cell-carcinoma/)
- [Langerhans cell histiocytosis](https://durgical.com/en/conditions/langerhans-cell-histiocytosis/)
- [Cholesteatoma](https://durgical.com/en/conditions/cholesteatoma/)
- [Neurofibromatosis (types 1 and 2)](https://durgical.com/en/conditions/neurofibromatosis/)

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Educational content; it does not replace a medical assessment and is not a clinical instruction. For a real case, follow current guidelines and specialist advice.

Sources: [Glomus Jugulare](https://www.ncbi.nlm.nih.gov/books/NBK560489/) (StatPearls Publishing (NCBI Bookshelf), 2026); [Paraganglioma](https://www.ncbi.nlm.nih.gov/books/NBK549834/) (StatPearls Publishing (NCBI Bookshelf), 2024); [Vestibular Schwannoma](https://www.ncbi.nlm.nih.gov/books/NBK562312/) (StatPearls Publishing (NCBI Bookshelf), 2023); [Basal Cell Carcinoma](https://www.ncbi.nlm.nih.gov/books/NBK482439/) (StatPearls Publishing (NCBI Bookshelf), 2025); [Cutaneous Squamous Cell Carcinoma](https://www.ncbi.nlm.nih.gov/books/NBK441939/) (StatPearls Publishing (NCBI Bookshelf), 2024); [Rhabdomyosarcoma](https://www.ncbi.nlm.nih.gov/books/NBK507721/) (StatPearls Publishing (NCBI Bookshelf), 2026); [Survival outcomes of temporal bone squamous cell carcinoma: a systematic review and meta-analysis (Otolaryngol Head Neck Surg)](https://pubmed.ncbi.nlm.nih.gov/38341629/) (Otolaryngology–Head and Neck Surgery (PubMed), 2024).

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Representative model, for educational purposes only.

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License: CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). Cite as: DurgiPedia (durgical.com), https://durgical.com/en/ent/tumours-of-the-ear-external-ear-middle-ear-and-paraganglioma/