A 35-year-old woman complains of left-sided pulsatile tinnitus synchronous with her pulse and mild conductive hearing loss. Otoscopy shows a reddish mass behind the intact tympanic membrane that blanches when positive pneumatic pressure is applied. What is the most likely diagnosis?

• A High jugular bulb dehiscence
• B Aberrant internal carotid artery
• C Cholesterol granuloma
• D Glomus tympanicum tumour ✓

Explanation

A vascular retrotympanic mass with pulse-synchronous tinnitus and conductive loss is the classic presentation of a glomus tympanicum tumour arising from Jacobson nerve on the cochlear promontory. Blanching of the mass with pneumatic pressure is Brown sign. An aberrant carotid artery sits lower and more posteriorly in the middle ear, a high jugular bulb appears blue rather than red, and a cholesterol granuloma is not vascular and does not blanch.

Reference: Cummings Otolaryngology: Head and Neck Surgery, 7th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.