Glomus Jugulare Presenting with Isolated Facial Nerve Palsy

Glomus jugulare is a rare slow growing tumor occurring within the jugular foramen that rarely presents with isolated symptoms. Although histologically benign, these tumors are locally destructive because of their proximity to the petrous bone, the lower cranial nerves, and the major vascular structures (Miller et al. (2009) and Silverstone (1973)). We wish to report a glomus jugulare tumor eroding the petrous bone and producing an ipsilateral peripheral facial weakness. The mechanism of this erosion is discussed. 1. Case Report A 73-year-old Caucasian woman, with a history of Parkinson’s disease and breast carcinoma, presented with a 2-month history of a rapidly progressive right total facial palsy, hyperacusis, and changes in taste. She had no sensory symptoms. She had a 7-year history of Parkinson’s disease treated with carbidopa 25/100？mg 4 times a day and ropinirole 3？mg tid. She was functional with a Hoehn-Yahr staging of 2, and she was 90% independent. She had a history of breast cancer treated with breast resection and radiation therapy 12 years prior to the presentation. There had been no cancer relapse. She had a brain MRI without gadolinium 3 years prior to the presentation showing mild volume loss of the brain. On physical examination, she had normal pupils and eye movements. She had weakness of the occipitofrontalis, corrugator supercilii nasalis, risorius, buccinators, zygomaticus major, mentalis, and platysma muscles of the right side of the face. Corneal reflex was decreased on the right. The Weber test lateralized to the left. The Rinne test revealed that air conduction was better than bone conduction bilaterally. There was a low frequency conductive hearing loss of the right ear tested with a 128？HZ tuning fork. Palate and tongue were in the midline. Because of her Parkinsonism, her gait was slow with narrow strides and short steps and the arm swing was reduced. Cerebellar tests were slow but well performed. Muscle stretch reflexes were present and equal. There were no pathologic reflexes. There was an assumption that she had had a right Bell’s palsy and was treated as such. Unenhanced MRI of the brain was reported as normal. As time passed, the facial palsy and hearing deficit did not resolve. There were times where her face was more symmetric than others but her ability to close the right eye had improved. Three months after presentation, her facial palsy worsened again and she complained of hearing loss in the right ear. Otologic examination showed bulging right tympanic membrane consistent with right otitis media, but examination by