Pulsatile tinnitus as the first manifestation of a jugular paraganglioma

We present the case of a 59 year old male patient with pulsate tinnitus, referred as the first manifestation of a jugular parganglioma. The patient examined at the outpatient ENT Department of our hospital with a left lateral cervical swelling, difficulty in swallowing and pulsatile tinnitus. Tinnitus was the first reported symptom that appeared one month before. The patient had no medical history. The clinical examination showed an asymmetric swelling of the left tonsil, a left vocal cord paralysis, a retrotympanic mass otoscopically and conductive hearing loss in the left ear. The patient underwent a head-and-neck computed tomography that raised the suspicion of a paraganglioma. The magnetic resonance imaging and the magnetic angiography with the administration of a contrast agent set the diagnosis of a jugular paraganglioma. After the tumor embolization, the patient unerwent primary resection of the tumor. This is the first case of a patient with a jugular paraganglioma and pulsatile tinnitus as the first reported symptom.