Primary middle ear tumors are rare
Glomus tumors arise either in the middle ear (glomus tympanicum) or in the jugular bulb with upward erosion into the hypotympanum (glomus jugulare)
They present clinically with pulsatile tinnitus and hearing loss
A vascular mass may be visible behind an intact tympanic membrane
Large glomus jugulare tumors are often associated with multiple cranial neuropathies, especially involving nerves VII, IX, X, XI, and XII

Treatment

usually requires surgery, radiotherapy, or both
Pulsatile tinnitus thus warrants magnetic resonance angiography (MRA) and MRV to rule out a vascular mass