Glomus jugulare tumors are rather common in the middle ear and temporal bone. They are usually easy to diagnose and surgically remove. However, there are a comparatively large number of these growths which not only cause extensive local destruction, but can spread distally and even have endocrine manifestations. This group is difficult to diagnose and manage despite recent advances in diagnostic procedures and the advent of skull base surgery. There is a void in the literature of a large series of cases being followed for a long period of time. This paper presents a comprehensive detailed statistical ten-year follow-up of 231 glomus jugulare tumors. The results suggest that our present diagnostic procedures often are inadequate in finding small tumors, and our treatment and follow-up are lacking because these tumors tend to recur often at a late date and in a different form. A comprehensive method of approach of diagnosis and treatment is described to manage all cases of glomus jugulare.