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1
Ko, Min Chul, Ji Yun Jeong, Sung Kyoo Hwang, and Myung Hoon Yoo. "A Case of Temporal Bone Cholesterol Granuloma Extending to Posterior Cranial Fossa without Middle Ear Involvement." Korean Journal of Otorhinolaryngology-Head and Neck Surgery 63, no. 7 (July 21, 2020): 324–29. http://dx.doi.org/10.3342/kjorl-hns.2019.00703.
Full textAbstract:
Cholesterol granulomas of the temporal bone can occur in the petrous apex, middle ear, and mastoid cavity. Although cholesterol granulomas in the petrous apex often extend to the middle cranial fossa, cholesterol granulomas in the middle ear and mastoids rarely invade the cranial cavity with bony erosion. We report a case of a large cholesterol granuloma involving the posterior cranial fossa with pneumatic mastoid and not affecting the middle ear. The patient had no otologic or neurologic symptoms, and the mass was found incidentally on a brain MRI included in a regular medical checkup. The mass was removed via a combined transmastoid and suboccipital approach without complications, and characteristic pathology findings demonstrated a cholesterol granuloma.
2
Rashad, Usama, Maurice Hawthorne, Udhaya Kumar, and Andrée Welsh. "Unusual cases of congenital cholesteatoma of the ear." Journal of Laryngology & Otology 113, no. 1 (January 1999): 52–54. http://dx.doi.org/10.1017/s0022215100143130.
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AbstractCongenital cholesteatoma may originate at various sites in the temporal bone. For example, in the petrous apex, the cerebellopontine angle, the middle ear cavity, the mastoid process or the external auditory canal. The least common site being the mastoid process. We present two cases of congenital cholesteatoma of the mastoid process, each presenting with different symptoms and at different ages. Both patients underwent surgical treatment, which confirmed the diagnosis and radiological findings.
3
Muller, M., I. Zammit-Maempel, J. Hill, and B. Wilkins. "An unusual middle-ear mass." Journal of Laryngology & Otology 124, no. 1 (July 9, 2009): 108–10. http://dx.doi.org/10.1017/s0022215109990442.
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AbstractObjective:We describe a case of endolymphatic sac tumour confined to the middle ear, which radiologically mimicked a glomus tympanicum, in a 58-year-old woman with tinnitus.Case report:A 58-year-old woman presented with a one-year history of right-sided tinnitus. The clinical, radiological and surgical features were felt to be in keeping with a glomus tympanicum. However, the histopathological picture was that of a low grade papillary carcinoma of the endolymphatic sac, i.e. an endolymphatic sac tumour.Conclusion:Endolymphatic sac tumours are classically locally aggressive and centred around the petrous temporal bone. Further growth results in complete replacement of the mastoid and petrous pyramid by tumour. To the best of our knowledge, there have been no previous reports of an endolymphatic sac tumour located solely within the hypo- and epitympanum of the middle ear.
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Halawani, Roa Talal, and Talaat Yossef. "Mastoid cholesterol granuloma: a case presentation." International Journal of Otorhinolaryngology and Head and Neck Surgery 2, no. 4 (September 26, 2016): 271. http://dx.doi.org/10.18203/issn.2454-5929.ijohns20163479.
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<p class="abstract"><span lang="EN-IN">Cholesterol granuloma (CG) may involve the petrous apex and rarely may involve the middle ear and the mastoid bone. On magnetic resonance imaging, the mass revealed a high signal on both T1 and T2- weighted images. This is a case report of mastoid cholesterol granuloma in association of cholesteotoma causing persistent ear discharge in a 12 years old boy.</span></p>
5
Coker, Newton J., Herman A. Jenkins, and Ugo Fisch. "Obliteration of the Middle Ear and Mastoid Cleft in Subtotal Petrosectomy: Indications, Technique, and Results." Annals of Otology, Rhinology & Laryngology 95, no. 1 (January 1986): 5–11. http://dx.doi.org/10.1177/000348948609500102.
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Lateral surgical approaches to the base of the skull through the temporal bone often result in a large cavity with exposed dura and vascular structures and no possibility of reconstruction of the middle ear conductive hearing mechanism. Subtotal petrosectomy with tympanomastoid obliteration provides a relatively safe and secure closure of the surgical defect in the temporal bone and eliminates the problems associated with an open mastoid cavity. Eradication of all accessible air cell tracts and mucosa in the petrous pyramid, obliteration of the eustachian tubal orifice, closure of the external auditory canal, and fat obliteration of the middle ear and mastoid clefts are essential in the procedure. Over the last 10 years this technique has been utilized in 372 base of skull procedures with a complication rate of less than 5%. Infection occurred only in those cases with draining cavities or contaminated wounds.
6
Maxwell, Anne K., Hiroki Takeda, and Samuel P. Gubbels. "Primary Middle Ear Mucosal Melanoma: Case Report and Comprehensive Literature Review of 21 Cases of Primary Middle Ear and Eustachian Tube Melanoma." Annals of Otology, Rhinology & Laryngology 127, no. 11 (August 13, 2018): 856–63. http://dx.doi.org/10.1177/0003489418793154.
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Objective: To present a case of primary middle ear mucosal melanoma and perform a comprehensive literature review of middle ear and eustachian tube mucosal melanoma. Patient: A 61-year-old female presented with no prior history of melanoma and 3 months of aural fullness. A middle ear mass demonstrated primary mucosal melanoma. The mass extended from mesotympanum into hypotympanum, epitympanum, protympanum, eustachian tube, and mastoid antrum. Additionally, a nonenhancing expansile lesion of the petrous apex was noted on magnetic resonance imaging. Intervention: Subtotal temporal bone resection with transotic approach to the petrous abnormality was performed. Postoperative adjuvant radiation and immunotherapy were given. Results: Five months postoperatively, the patient developed an isolated cutaneous metastatic focus treated with wide local excision and has had no further evidence of recurrence to date. Upon comprehensive literature review, patients with primary middle ear melanomas (n = 10) present with otorrhea (50%), aural fullness (40%), and hearing loss (30%) most commonly, while hearing loss (81.8%) and aural fullness (54.5%) were the most common presenting symptoms for eustachian tube melanomas (n = 11). Patients were treated with combinations of surgery, radiation, and/or chemotherapy. Middle ear melanoma demonstrated particularly poor outcomes, with 70% mortality, 20% local recurrence, and 50% distant metastasis, whereas eustachian tube origin demonstrated 9.1%, 18.2%, and 36.4%, respectively. Conclusions: Middle ear and eustachian tube mucosal melanomas are exceedingly rare, with middle ear melanomas demonstrating a worse prognosis. Multimodality therapy is commonly used; however, outcomes are poor, with high mortality among affected patients.
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Al-Muhaimeed, Hamad S., Hazem Y. Abdelwahed, Essam A. Elgamal, Ghassan M. Alokby, Ameen M. Binnasser, and Masoada M. Ashraf. "Extradural Dermoid Cyst of Mastoid Bone: A Case Report." Case Reports in Otolaryngology 2012 (2012): 1–5. http://dx.doi.org/10.1155/2012/548340.
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Dermoid cysts of the head and neck are rare congenital benign tumors. According to the literature they represent about seven percent of all dermoids and less than one percent of all intracranial neoplasms. Extradural dermoid cysts are very rare. We report a case of intracranial extradural dermoid cyst of mastoid bone. We believe that this is the second documented extradural dermoid cyst, the first case reported in the literature (Ammirati et al., 2007) was in close relation to the petrous apex but ours is in close relation to mastoid antrum. Hearing loss was the only clinical presentation in this case, while neurological symptoms were the main presenting symptoms in the first reported case. We present our management of this rare case with respect to the clinical, radiological, histopathological, and surgical aspects and conclude that dermoid tumors, though rare, need to be included in differential diagnosis of middle ear lesions.
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Aslan, S., H. Yavuz, A. C. Cagici, and O. Kizilkilic. "Embolisation of an extensive arteriovenous malformation of the temporal region as an alternate treatment: case report." Journal of Laryngology & Otology 122, no. 7 (July 2008): 737–40. http://dx.doi.org/10.1017/s0022215108001977.
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AbstractObjectives:To report the case of a spontaneous arteriovenous malformation involving the auricula, external auditory meatus, middle ear and part of the petrous apex, and also to provide updated information about its management.Case report:A 33-year-old woman presented complaining of accelerated growth of a retro-auricular swelling during her latest pregnancy, together with pain, pulsatile tinnitus and ear discharge. An arteriovenous malformation occupying the right auricula, external auditory canal, mastoid proccess of the temporal bone and the lateral half of the petrous segment was diagnosed, using temporal computerised tomography and magnetic resonance imaging. The lesion was embolised with polyvinyl alcohol particles at angiography. Excision of the arteriovenous malformation nidus was performed. Three years post-operatively, magnetic resonance imaging showed no residual lesion or recurrence at the temporal bone and petrous apex, although a few scanty, serpiginous, vascular remnants had persisted.Conclusions:In the head and neck, arteriovenous malformations usually occur intracranially; they are rare outside the cranium. To our knowledge, there have been no previously published cases of such an extensive arteriovenous malformation involving the temporal region. Apropos of our case, the definition, clinical findings, diagnostic approaches and therapeutic management of arteriovenous malformations are discussed.
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Terao, Kyoichi, Sebahattin Cureoglu, Schachern Patricia, Michael M. Paparella, Norimasa Morita, Nomiya Rie, and Kiyotaka Murata. "R447 – Temporal Bone Histopathology in Acute Lymphocytic Leukemia." Otolaryngology–Head and Neck Surgery 139, no. 2_suppl (August 2008): P194. http://dx.doi.org/10.1016/j.otohns.2008.05.603.
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Problem There are reports of hearing loss, tinnitus, and/or vertigo in patients with leukemia. However, there is no human temporal bone study of a large number of cases specific to acute lymphocytic leukemia. We studied the correlation between clinical otologic complaints and temporal bone histopathology in patients with this disease. Methods Clinical otologic complaints and histologic findings were evaluated in 13 patients (25 temporal bones) with acute lymphocytic leukemia. Results Nine patients had a history of clinical otologic complaints including: hearing loss in 5 patients; otalgia in 3; otorrhea in 3; and dizziness in 2. Hemorrhage was seen most commonly in the middle ear in 10 patients, but was also evident in the cochlea in 5 and the vestibular labyrinth in 2. Leukemic infiltration was observed in the petrous apex in 12 patients, in the middle ear in 6, the cochlea in 5, the vestibular labyrinth in 2 and the internal auditory canal in 3. Inflammatory cell infiltration was also seen in the cochlear labyrinth in 4 patient, the vestibular labyrinth in 5 and the modiolus in 1. Otitis media with hyperplasia of subepithelial fibrous tissue was seen in 10 patients. Three patients had granulation tissue extending into the middle ear or mastoid. Conclusion Ear involvement is a common finding in patients with acute lymphocytic leukemia. Significance With prolonged survival due to new chemotherapeutics, the diagnosis and treatment of non-hematopoietic system complications such as ear problems due to acute lymphocytic leukemia have become more important. Support International Hearing Foundation, Hubbard Foundation, Starkey Foundation.
10
van der Valk, Jens, Frank Treurniet, Jan Pieter Koopman, and Hille Koppen. "Severe Daily Headache as an Uncommon Manifestation of Widespread Skull Base Osteomyelitis." Case Reports in Neurology 11, no. 2 (May 21, 2019): 178–82. http://dx.doi.org/10.1159/000500240.
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Temporal bone osteomyelitis has been recognized for decades as a complication of otitis externa, specifically in elderly patients with diabetes. A much less prevalent form is skull base osteomyelitis. We report a 70-year-old man with diabetes who presented to our outpatient clinic with severe chronic daily complaints of headache. The headache was located frontoparietally and kept him awake at night. Imaging (nonenhanced computed tomography [CT], magnetic resonance imaging, and positron emission tomography/CT) showed a hypermetabolic mass on the right side of the skull base, in the middle ear, and in the mastoid process, with invasion and partial destruction of the surrounding elements of the petrous bone, the occipital bone, and the sphenoid bone on the right, with extension by way of the clivus into the apex of the left petrous bone. Diagnostic puncture revealed Streptococcus pneumoniae.The final diagnosis was severe daily headache due to central skull base osteomyelitis. Our case emphasizes the need for proper clinical and radiological investigation keeping the diagnosis of skull base osteomyelitis in mind with patients with diabetes or otherwise immunocompromised status who present with chronic daily headache and otalgia.
11
Calzolari, F., E. Sarti, A. Sensi, G. Garani, L. Clauser, and A. Martini. "Malformazioni dell'orecchio nelle anomalie congenite cranio-facciali." Rivista di Neuroradiologia 16, no. 3 (June 2003): 411–20. http://dx.doi.org/10.1177/197140090301600313.
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The aim of this study is to describe external, middle and inner ear malformations in children with congenital craniofacial abnormalities. Seventeen patients with craniofacial and external ear anomalies, aged between 12 days and 15 years (mean 3.4 years), were studied. The majority of children had conductive hearing loss. High-resolution CT of the petrous bone was performed in all cases; in 9 cases three-dimensional reconstructions were done. For each child CT findings of external, middle, inner ear, facial nerve and skull base were analysed. Ear malformations have been correlated with anomalies of the auricle. The most serious auricular anomalies were more frequently associated with external auditory canal atresia, dysplasia of the tympanic cavity and malleo-incudal joint and aberration of the mastoid segment of the facial nerve. These anomalies are probably related through a common embryological origin. Inner ear malformations were diagnosed more rarely, but we emphasize that these malformations are more frequent in “syndromic” forms with craniofacial abnormalities rather than in isolated anomalies of the auricle; it is very important because inner ear abnormalities are considered a contraindication to functional surgery in patients with atresia. Diagnostic imaging is useful for an early and complete characterization of the craniofacial and ear malformations; a precise analysis of the ear abnormalities is necessary to give an indication for the eventual audiological treatment. High-resolution CT is the method of choice for the analysis of the external and middle ear; CT and MR should be integrated for the study of the inner ear and facial nerve. CT and MR are helpful to determine the extent of craniofacial abnormalities; MR should be done when encephalic malformations are suspected. Finally, three-dimensional CT is useful for the maxillofacial surgeon to plan surgical treatment.
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Santiago, Marc Reinald G., and Natividad A. Almazan. "Gradenigo Syndrome." Philippine Journal of Otolaryngology-Head and Neck Surgery 23, no. 2 (December 27, 2008): 46–48. http://dx.doi.org/10.32412/pjohns.v23i2.747.
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Chronic suppurative otitis media (CSOM) has a potential for intratemporal complications. Gradenigo syndrome, lateral sinus thrombosis and cavernous sinus thrombosis must be considered when patients present with ear discharge, headache, fever and lateral rectus palsy. Computed Tomography and Magnetic Resonance Imaging are essential in confirming the diagnosis but do not substitute for a good clinical eye in establishing the diagnosis and initiating proper treatment.
CASE
A 17 year old male with an 11-year history of otorrhea on the right ear was admitted because of on-and-off diffuse headache, drowsiness, occasional sensorial changes, high grade fever and vomiting. Later in the ward, he complained of double vision; anisocoria and lateral rectus palsy were confirmed by active generation test. Associated symptoms included right-sided frontal, orbital and mastoid pain with neck stiffness. Otoscopy showed yellowish foul smelling discharge with a pink, smooth mass partially obstructing the external auditory canal.
Leukocytosis was seen with a count of 32.9 x 103/L. Pure tone audiometry revealed moderate conductive hearing loss on the right ear. CT scan with contrast (Figure 1) showed lytic erosion of the underpneumatized right mastoid bone and sigmoid sinus plates with slightly asymmetric right internal auditory canal (IAC). Penicillin G 5 million “IU” every 6 hours and Chloramphenicol 1.5 grams IV every 8 hours were given for 3 weeks, but he continued to deteriorate and two units of PRBC were transfused. Because of his worsening condition, Penicillin G was shifted to Ceftriaxone 2 grams IV BID while Chloramphenicol IV was continued at the same dose. The patient’s headache and fever steadily lessened after 4 weeks but orbital pain and diplopia persisted. On the 50th hospital day, patient underwent Modified Radical Mastoidectomy, right. Intraoperatively, granulation tissue was noted occupying the enlarged mastoid cavity and antrum. A 0.5 cm break at the sigmoid sinus was also occupied by granulation tissue. IV antibiotics was continued 2 weeks postoperatively and after 64 days of hospitalization he was discharged on oral Ciprofloxacin 500mg BID for 1 month with steroid/antibiotic otic drops.
Regular follow-up documented gradual lessening of diplopia, headache and orbital pain. Complete resolution of diplopia with normal ophthalmologic findings and a dry mastoidectomy cavity were noted on the fourth month of follow-up.
DISCUSSION
In the Philippines, the prevalence of Chronic Suppurative Otitis Media (CSOM) is estimated at 2.5 – 29.5%.1 Complications of chronic otitis media can cause grave morbidity and even mortality2 even though the intratemporal and/or intracranial complications of infectious ear disease have become rarer with the advent of broad spectrum antibiotics.3 The spread of infection can occur by osteothrombosis, bone erosion and when present along preformed pathways.2
The triad of Gradenigo syndrome includes otorrhea, retroorbital pain and abducens nerve palsy. Chole and Donald found that the most common presenting symptom in 22 patients from 1976-1995 was otalgia (72%) followed by deep pain, headache and otorrhea (59%). Cranial nerve VI paralysis was only present in 18.2% of the cases.4 Homer and others reported 3 cases with middle ear infection and 6th nerve palsy without petrositis. 5
MRI and CT are required to identify the deep seated petrous apex as the site of the inflammatory process.6 While CT scans may demonstrate opacification of the air cells of the petrous apex with cortical bone erosion, MRI is very useful for assessing inflammatory soft tissue lesions around the petrous apex.5 Both CT and MRI are essential to establish opacification of air cells in the petrous apex under suspicion, as opposed to assymetric pneumatization.2 However, acute petrositis cannot always be equated with Gradenigo syndrome.7 A study by Back and others documented 8 cases of radiologically confirmed apical petrositis that did not manifest the classical syndrome of deep facial pain, otitis media and ipsilateral abducens nerve palsy.8
Petrous apicitis is essentially mastoiditis that occurs in the petrous apex.2 Because the trigeminal (CN V) or gasserian ganglion lies in Meckel’s cave on the antero-superior aspect of the petrous tip, damage or irritation to the ganglion may explain the deep facial pain in some patients with apicitis. The petroclinoid ligament extends from the tip of the petrous apex to the clinoid. Below this ligament, the gasserian ganglion (CN V) and abducens nerve (CN VI) travel in the small Dorello's canal. Inflammation extending into the canal produces the triad of symptoms recognized by Gradenigo9: lateral rectus (CN VI) palsy, retroorbital pain (CN V), and otorrhea.
Lateral Sinus Thrombophlebitis (LST) or thrombosis of the lateral sinus usually forms as an extension of a perisinus abscess following mastoid bone erosion from cholesteatona, granulation tissue or coalescence which eventually leads to pressure necrosis and mural thrombus formation.2 Classic symptoms of LST include a "picket fence" fever pattern, chills and progressive anemia. Symptoms of septic emboli, headache and papilledema may indicate extension to involve the cavernous sinus4 or sudden intracranial hypertension resulting from decreased venous drainage from the skull.2
The diagnostic procedure of choice is MRI with MR angiography. The thrombus can be identified by its signal intensity on MRI and the flow void in the affected sinus is clearly documented on MR angiography.10 Non-contrast CT findings include dense cord sign, dense dural sinuses, diffuse cerebral edema, non hemorrhagic infarct or multifocal haemorrhages.11 Papilledema and anisocoria may be symptoms of progression of lateral sinus thrombophlebitis or development of cavernous sinus thrombosis.4 Fresh thrombi from the lateral sinus can propagate and extend to the cavernous sinus via the superior and inferior petrosal sinus.
Cavernous Sinus Thrombosis is usually a late complication of an infection of the central face or paranasal sinuses. Other causes include bacteremia, trauma, and infections of the maxillary teeth or ear, as seen in our patient. CST is generally a fulminant process with high rates of morbidity and mortality. Headache is the most common presenting symptom that usually precedes fever, periorbital edema (which may or may not occur) and cranial nerve dysfunction.
This intimate relationship of veins, arteries, nerves, meninges, petrous apex and paranasal sinuses account for the characteristic etiology and presentation of CST. The internal carotid artery with its surrounding sympathetic plexus passes through the cavernous sinus. The third, fourth, and sixth cranial nerves are attached to the lateral wall of the sinus while the ophthalmic and maxillary divisions of the fifth cranial nerve are embedded in the wall.8
Other signs and symptoms include chemosis resulting from occlusion of the ophthalmic veins, lateral gaze palsy (isolated cranial nerve VI), ptosis, mydriasis and eye muscle weakness from cranial nerve III dysfunction. These are followed by manifestations of increased retrobulbar pressure (such as exophthalmos) and increased intraocular pressure (such as sluggish pupil and decreased visual acuity). Systemic signs indicative of sepsis are late findings.
The complications of Gradenigo syndrome, lateral sinus thrombophlebitis and cavernous sinus thrombosis from chronic suppurative otitis media need immediate diagnosis and aggressive medical treatment with broad spectrum antibiotics against gram positive cocci (Staphylococci and Streptococci), gram negative bacilli (Pseudomonas aeruginosa) and to a lesser extent, Anaerobes. These antibiotics should also cross the blood-brain barrier.
Mastoidectomy is required once the patient is neurologically stable.2 In cases of lateral sinus thrombosis, surgical removal of emboli can be done. However, Cummings, Syms and colleagues2 report 6 patients operated on without opening and evacuating the lateral sinus clot who all survived, albeit with a longer 49 day average hospital stay. Once a highly controversial issue, ligation of the internal jugular vein is seldom needed. In the majority of recent cases, anticoagulation has not been found to be necessary.2
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Khan, Md Ahsanuzzaman, AKM Asaduzzaman, Md Tauhidul Islam, Bashir Ahmed, Mohammad Kamal Hossain, Mohammad Misbah Al Kabir Sumon, and Sarder Mohammad Golam Rabbani. "Clinical Presentation of Cholesteatoma- A Study of 50 Cases." Journal of Armed Forces Medical College, Bangladesh 13, no. 1 (April 21, 2017): 66–70. http://dx.doi.org/10.3329/jafmc.v13i1.41032.
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Introduction: Cholesteatoma is an abnormal accumulation of keratin-producing squamous epithelium in the middle ear, epitympanum, mastoid or petrous apex. It is a threedimensional epidermoid structure exhibiting independent growth, replacing middle ear mucosa, resorbing and replacing underlying bone. Although it is not a neoplastic lesion, it can be insidious and potentially dangerous to the patient.
Objective: To find out the socio-demographic pattern, clinical presentation and complication of cholesteatoma.
Materials and Methods: This prospective study of 50 cases was done in the Department of Otolaryngology and Head-Neck surgery, CMH, Dhaka adopting simple random sampling technique from July 2008 to Dec 2009. Data were collected by personal interview and clinical examination in a pre-designed data sheet and were analyzed by SPSS 20.
Results: In this study, the highest number of patients (44%) was in the age group 11-20 years with a mean age of 17.2 years. Male were more affected (70%) and the male to female ratio was 2.33:1. Commonest symptom was otorrhoea (100%), followed by hearing impairment (80%), otalgia (16%), postauricular painful swelling (12%) and postauricular discharging sinus (10%). Extracranial complications were in 26% and intracranial complications in 12% of patients in this series. Abscess (temporal lobe + extra dural) were found in 02 cases (10%) by CT scan. A maximum number of patients had moderate conductive deafness (74.47%) followed by mild conductive deafness (19.15%) and only a few with severely mixed deafness (6.38%).
Conclusion: Clinical presentation of cholesteatoma in this study was discharge and deafness. The discharge was thick purulent foul smelling, scanty, occasionally blood-stained. Grave intracranial complications in children developed because of illiteracy, poverty, lack of awareness and medical facilities mostly in the rural areas. So early diagnosis and prompt treatment was a necessity.
Journal of Armed Forces Medical College Bangladesh Vol.13(1) 2017: 66-70
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Carnate, Jose M., and Amado O. Tandoc. "Endolymphatic Sac Tumor." Philippine Journal of Otolaryngology-Head and Neck Surgery 24, no. 1 (June 15, 2009): 37–38. http://dx.doi.org/10.32412/pjohns.v24i1.717.
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We present the case of a 48 year old lady with a history of episodic hearing loss and tinnitus of several years duration. One month prior to consult, there was note of left occipital pain. No history of dizziness, vertigo or facial nerve palsy was elicited. She was neither a smoker nor an alcoholic beverage drinker. No other co-morbidities were elicited. Physical examination revealed a 4 cm diameter left posterior auricular mass which was tender. There was note of a bluish bulge on the left posterior wall of the external auditory canal. The tympanic membrane was intact. The MRI revealed a 5 cm diameter, irregular, avidly enhancing mass at the left mastoid bone with permeative bone destruction and indentation of the left cerebellar hemisphere and left superior temporal lobe but without evidence of brain invasion. A biopsy was performed followed by a pre-operative tumor embolization then a sub-total petrosectomy with mastoid obliteration. Histologic sections showed an unencapsulated mass with bony invasion composed of cystically dilated glandular structures containing colloid-like material (Fig. 1) while other areas showed simple and coarse papillae (Fig. 2). The cells were cuboidal to columnar and had a bland cytomorphology with little nuclear pleomorphism (Fig. 3). Mitoses and necrosis were absent. The general histology had a striking resemblance to either normal thyroid tissue or papillary thyroid carcinoma. A TTF-1 immunohistochemical stain however showed negative nuclear staining (Fig. 4). We signed out the case as an Endolymphatic Sac Tumor. This tumor has been known in the past by such synonyms as “Aggressive Papillary Middle Ear Tumor”, “Heffner Tumor” and “Low-grade Adenocarcinoma of the Middle Ear”. It is rare, affects both sexes in roughly equal frequencies and often presents with hearing and vestibular dysfunctions, facial nerve palsy and a mass. It presents radiologically as a multilocular lytic lesion in the petrous area of the temporal bone with bone destruction. Because of the histologic resemblance to thyroid tissue, a metastatic thyroid neoplasm is a differential diagnosis. Metastases to this area are rare, cases invariably have a known primary focus and otologic symptoms are uncommon. Immunohistochemical studies and clinical correlation are helpful in ruling out a metastasis. Treatment is primarily surgical. Prognosis is generally good but is dependent on the extent of the lesion at presentation. It is locally destructive, has the capacity to damage adjacent nerves and is recurrent if incompletely excised. Death may result from a large, destructive lesion in a vital area. To date, there are no reports of metastasis which may make the term “adenocarcinoma” not entirely appropriate. We have limited follow-up information on our present case at this time.
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Cândido, Duarte N. C., Jean Gonçalves de Oliveira, and Luis A. B. Borba. "Microsurgical Resection of Glomus Jugulare Tumors With Facial Nerve Reconstruction: 3-Dimensional Operative Video." Operative Neurosurgery 16, no. 1 (May 8, 2018): E1. http://dx.doi.org/10.1093/ons/opy100.
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Abstract Paragangliomas are tumors originating from the paraganglionic system (autonomic nervous system), mostly found at the region around the jugular bulb, for which reason they are also termed glomus jugulare tumors (GJT). Although these lesions appear to be histologically benign, clinically they present with great morbidity, especially due to invasion of nearby structures such as the lower cranial nerves. These are challenging tumors, as they need complex approaches and great knowledge of the skull base. We present the case of a 31-year-old woman, operated by the senior author, with a 1-year history of tinnitus, vertigo, and progressive hearing loss, that evolved with facial nerve palsy (House-Brackmann IV) 2 months before surgery. Magnetic resonance imaging and computed tomography scans demonstrated a typical lesion with intense flow voids at the jugular foramen region with invasion of the petrous and tympanic bone, carotid canal, and middle ear, and extending to the infratemporal fossa (type C2 of Fisch's classification for GJT). During the procedure the mastoid part of the facial nerve was identified involved by tumor and needed to be resected. We also describe the technique for nerve reconstruction, using an interposition graft from the great auricular nerve, harvested at the beginning of the surgery. We achieved total tumor resection with a remarkable postoperative course. The patient also presented with facial function after 6 months. The patient consented with publication of her images.
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Cüreoglu, Sebahattin, Üstün Osma, M. Faruk Oktay, Hasan Nazaroglu, Faruk Meric, and Ismail Topçu. "Congenital cholesteatoma of the mastoid region." Journal of Laryngology & Otology 114, no. 10 (October 2000): 779–80. http://dx.doi.org/10.1258/0022215001903906.
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Congenital cholesteatoma may arise in the petrous apex, mastoid, middle ear, or external auditory canal. The least common site being the mastoid process. We present one case of primary mastoid cholesteatoma confirmed by clinical examination, surgical findings and radiological evaluation.
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Robert, Y., F. Dubrulle, S. Carcasset, C. Hennequin, L. Gaillandre, F. M. Vanecloo, and L. Lemaitre. "Petrous Bone Extension of Middle-Ear Acquired Cholesteatoma." Acta Radiologica 37, no. 1P1 (January 1996): 166–70. http://dx.doi.org/10.1177/02841851960371p134.
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Purpose: To describe CT and MR features of extension to the petrous bone, which is a rare complication of acquired cholesteatoma (AC). Material and Methods: Postcontrast CT was performed in 4 patients, in axial (n=4) and coronal planes (n=2). The section thickness was 1.2 or 2.5 mm. MR was performed in 3 cases, using T1- and T2-weighted images (n=3) and postcontrast T1-weighted images (n=2). Results: CT demonstrated a well-outlined lesion involving the petrous bone (n=4). Density could be assessed in 3 cases, showing a hypodense unenhanced mass. Lateral (n=1), superior (n=2), and posterior (n=2) semicircular canals were affected in 3 patients. AC extended to the vestibula, cochlea, and internal acoustic meatus (IAM) in 3 patients. Two ACs extended to the level of IAM, whereas 2 extended further, to the petrous apex. In one case the sphenoid sinus was affected. On MR imaging the lesion was hypointense relative to brain on T1-weighted images and hyperintense on T2-weighted images. MR imaging helped to delineate the lesion and to distinguish it from other cystic lesions of the petrous bone. Conclusion: CT and MR offer accurate preoperative assessment of the extension of cholesteatoma, which helps to choose the surgical approach.
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Robert, Y., F. Dubrulle, S. Carcasset, C. Hennequin, L. Gaillandre, F. M. Vanecloo, and L. Lemaitre. "Petrous Bone Extension of Middle-Ear Acquired Cholesteatoma." Acta Radiologica 37, no. 2 (1996): 166–70. http://dx.doi.org/10.3109/02841859609173438.
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Robert, Y., F. Dubrulle, S. Carcasset, C. Hennequin, L. Gaillandre, F. M. Vanecloo, and L. Lemaitre. "Petrous Bone Extension of Middle-Ear Acquired Cholesteatoma." Acta Radiologica 37, no. 2 (January 1996): 166–70. http://dx.doi.org/10.1080/02841859609173438.
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Karmarkar, Sandeep. "Congenital cholesteatoma of the middle ear and petrous bone." Indian Journal of Otolaryngology and Head and Neck Surgery 47, no. 2 (April 1995): 95–100. http://dx.doi.org/10.1007/bf03047935.
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Danino, Joshua, Henry Z. Joachims, Yehudith Ben-Arieh, Tsila Hefer, and Miriam Weyl-Ben-Arush. "T cell lymphoma of the ear presenting as mastoiditis." Journal of Laryngology & Otology 111, no. 9 (September 1997): 852–54. http://dx.doi.org/10.1017/s0022215100138794.
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AbstractMastoiditis is a complication of otitis media characterized by suppuration and destruction of air cell septa in the mastoid and petrous pyramid. Diagnosis is made by clinical findings and computerized tomography (CT) of the temporal bone. We present a patient initially diagnosed by CT as having chronic mastoiditis who was subsequently shown to have an unusual large-cell malignant lymphoma of T cell type.
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Shi, Zhenshan, Qian Zhuang, and Dairong Cao. "Intramastoid solitary neurofibroma mimicking middle ear carcinoma." Acta Radiologica Open 4, no. 12 (December 1, 2015): 205846011560866. http://dx.doi.org/10.1177/2058460115608660.
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We report an extremely rare case of intramastoid neurofibroma. A mass with destruction of the mastoid bone of a 51-year-old woman was examined with computed tomography. Subsequent magnetic resonance imaging demonstrated an ill-defined soft tissue mass with the opacification of mastoid air cells that had a mass effect in the same area. The patient underwent left subtotal temporal bone resection, and histological and immunohistochemical findings confirmed the lesion to be a neurofibroma. Given that similar imaging features of neurofibroma have been reported previously elsewhere in the head/neck and extremities, we suggest that it may be possible to include this tumor in the preoperative differential diagnosis.
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Grewal, D. S., Puneet Bhargava, Bachi Mistry, and Ninad Gaikwad. "Tuberculoma of the mastoid." Journal of Laryngology & Otology 109, no. 3 (March 1995): 232–35. http://dx.doi.org/10.1017/s0022215100129779.
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AbstractTuberculoma is a rare but known complication of tuberculosis. It rarely occurs in the mastoid bone. When it occurs in the middle ear cleft, it can lead to intracranial complications if there is a delay in the diagnosis and management.A rare case of tuberculosis of the middle ear cleft which presented as tuberculoma of the mastoid bone with infranuclear facial palsy is described. The tuberculoma was removed and a canal wall down tympanomastoidectomy was performed. Post-operatively the patient was kept on antituberculous therapy. The various problems encountered in the diagnosis and management of this case are discussed.
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Muren, C., and H. Wilbrand. "The Semicircular Canals of the Inner Ear and the Pneumatization of the Temporal Bone." Acta Radiologica. Diagnosis 27, no. 3 (May 1986): 325–29. http://dx.doi.org/10.1177/028418518602700313.
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In an investigation of 94 plastic casts of temporal bone specimens a wide range of variations both in the general outline of the pyramid and in the anatomy of its specific structures was found. Attempts were made to estimate the transverse and vertical dimensions of the petrous bone. Both the mastoid and the perilabyrinthine pneumatization correlated to the dimensions of some structures, but not to the size and shape of the semicircular canals. References
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Eby, Thomas L., and Joseph B. Nadol. "Postnatal Growth of the Human Temporal Bone." Annals of Otology, Rhinology & Laryngology 95, no. 4 (July 1986): 356–64. http://dx.doi.org/10.1177/000348948609500407.
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Recent interest in cochlear implantation for children has made it important to understand how postnatal growth of the ear will affect such devices. In this study, the postnatal growth of the labyrinth, middle ear, and mastoid was measured in three dimensions using radiographic and temporal bone data. Measurements were made from histologic sections of 48 temporal bones from children and compared to adult temporal bones. Radiographic measurements were made from 253 sets of skull radiographs of children and compared to adult skull series. In the three dimensions measured, there was no postnatal growth of the labyrinth and little variation in size between individuals. Measurements of the middle ear showed greater variation between individuals than measurements of the inner ear, but growth only in the distance from stapes footplate to the tympanic membrane. The mastoid showed growth in all three dimensions: length, width, and depth. The pattern of growth for mastoid length and width appears to follow a double logistic model, with differences between males and females. The growth in mastoid depth is smaller and appears to follow a single exponential curve. The implications for cochlear implantation in children are discussed.
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Benton, Nick C., Harold W. Korol, and Lawrence T. Smyth. "Plasma Cell Granuloma of the Middle Ear and Mastoid." Annals of Otology, Rhinology & Laryngology 101, no. 1 (January 1992): 92–94. http://dx.doi.org/10.1177/000348949210100120.
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We present the case of a 37-year-old man with plasma cell granuloma affecting the middle ear and mastoid. At magnetic resonance imaging scan, the lesion appeared as a homogeneously enhancing mass of soft tissue replacing the majority of the mastoid bone and causing vascular compression. After surgical resection, microscopic examination showed predominantly plasmacytes, and histochemical studies confirmed a polyclonal origin consistent with nonneoplastic plasma cell granuloma. We believe this is the first case report of plasma cell granuloma affecting the middle ear and mastoid.
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Puranik, K. R., P. S. N. Murthy, Ramesh Gopalakrishna, and D. R. Nayak. "Unusually large mastoid antrum (‘mega antrum’)." Journal of Laryngology & Otology 106, no. 2 (February 1992): 164–65. http://dx.doi.org/10.1017/s0022215100118973.
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AbstractPatients who present with a unilateral non-tender bony swelling in the mastoid region without any clinical evidence of middle ear infection could be diagnosed as having a fibrous or bony lesion affecting the temporal bone. In such cases, if there is radiological evidence of large lucent area in the mastoid antrum without any bony dehiscence one should keep in mind in the differential diagnosis a mega antrum in addition to congenital cholesteatoma and eosinophilic granuloma. A large lytic lesion in the mastoid segment of the temporal bone with an intact tympanic membrane therefore presents a diagnostic dilemma. A case of an unusually large mastoid antrum in an young adult with no middle ear suppuration and a cosmetically unacceptable swelling behind the ear is presented.
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Hardcastle, T., I. McKay-Davies, and M. Neeff. "Petrous apex pneumatisation in children: a radiological study." Journal of Laryngology & Otology 134, no. 9 (August 24, 2020): 798–803. http://dx.doi.org/10.1017/s0022215120001681.
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AbstractObjectiveThis study aimed to investigate petrous apex pneumatisation in children, as an understanding of petrous apex pneumatisation is useful in the diagnosis and surgical management of middle-ear disease.MethodsComputed tomography head scans from 1700 patients aged 0–16 years were assessed. Petrous apex bone and air cell volumes were calculated to determine the degree of petrous apex pneumatisation. Scans were analysed for communicating tracts between the middle ear and petrous apex.ResultsPetrous apex pneumatisation was found in 21.0 per cent of patients. Positive relationships were found between age and petrous apex pneumatisation prevalence (rs = 0.990, p < 0.001), and between age and degree of petrous apex pneumatisation (rs = 0.319, p < 0.001). Petrous apex pneumatisation prevalence did not significantly differ by sex or ethnicity. Communicating tracts were identified in 84.3 per cent of patients with petrous apex pneumatisation, most commonly anterior to the otic capsule.ConclusionIn children, the prevalence and degree of petrous apex pneumatisation increases with age, but prevalence is not affected by sex or ethnicity.
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Brodkey, Jason A., Jon H. Robertson, John J. Shea, and Gale Gardner. "Cholesterol granulomas of the petrous apex: combined neurosurgical and otological management." Journal of Neurosurgery 85, no. 4 (October 1996): 625–33. http://dx.doi.org/10.3171/jns.1996.85.4.0625.
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✓ Cholesterol granulomas of the head are relatively rare. Isolated lesions of the cerebellopontine angle are even more uncommon. In this report, 17 cases of petrous apex cholesterol granulomas are presented and management is discussed. Symptoms at presentation included dizziness (14 patients), pressure (nine patients), tinnitus (eight patients), hearing loss (eight patients), otalgia (six patients), headache (six patients), nausea (three patients), drainage from ear (two patients), facial pain (two patients), seizure (two patients), lightheadedness (one patient), hemifacial spasm (one patient), and facial numbness (one patient). Six cases were managed without surgery and 11 patients underwent operative procedures. The approaches used included the infralabyrinthine (eight patients), transcanal—infracochlear (two patients), and translabyrinthine (one patient). The mean follow-up period for all cases was 29.5 months. Of those patients managed without surgery, symptoms improved in all except one, whose tinnitus was slightly worse. Of surgically treated patients, symptoms improved or remained the same except in one with worsened dizziness. There were nine patients with hearing present presurgery and seven whose hearing was preserved postsurgery. The authors present a case that was managed at another center where an attempt at surgical resection through a subtemporal middle fossa approach was unsuccessful. This lesion was successfully treated using an infralabyrinthine approach with drainage into the mastoid cavity. Cholesterol granulomas of the petrous apex can be managed without surgery when symptoms are stable or improve. Otherwise, a transmastoid extradural approach with simple drainage into the mastoid sinus or middle ear produces symptomatic improvement with low morbidity. Resection of petrous apex cholesterol granulomas is not necessary.
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Bozdemir, Kazım, Behçet Tarlak, Hasan Çakar, Ahmet Doblan, Ahmet Kutluhan, İmdat Dilek, and Nuran Adıyaman Süngü. "Langerhans Cell Histiocytosis in Bilateral Mastoid Cavity." Case Reports in Otolaryngology 2013 (2013): 1–3. http://dx.doi.org/10.1155/2013/957926.
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A 39-year-old male was admitted to our clinic with symptoms of headache, dizziness, nausea, otalgia, otorrhea, tinnitus, and hearing loss in both ears for 3 weeks. Physical examination revealed edema in the tympanic membrane and external ear canal, and pain by palpation in the mastoid area bilaterally. There was no nystagmus, and the rest of the physical examination was otherwise normal. Temporal bone high resolution computed tomography (CT) showed a lesion causing erosion in the mastoid cortex, tegmen tympani, ossicles, and in the bone covering the sigmoid sinus bilaterally. There was also erosion in the superior semicircular canal and petrous bone on the left side. Cortical mastoidectomy was performed under general anesthesia. Histopathologic examination of the tissue revealed Langerhans cell histiocytosis (LCH). In this paper a case with LCH, presenting with bilateral mastoid involvement which has been rarely reported in the literature, is discussed with the existing literature.
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Yang, Nathaniel W. "Spontaneous Middle Fossa Encephalocele." Philippine Journal of Otolaryngology-Head and Neck Surgery 31, no. 2 (November 30, 2016): 63–64. http://dx.doi.org/10.32412/pjohns.v31i2.247.
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A 48-year old man presented with a unilateral right hearing loss of four months’ duration. A right middle ear effusion was noted on physical examination. Endoscopic examination of the nasopharynx was unremarkable. Due to the duration of the symptoms, myringotomy with ventilation tube insertion was offered as a treatment option. Upon myringotomy, clear pulsatile liquid flowed out of the incision. More than 5 cc of liquid was collected which continued to flow out despite active suctioning. Due to the realization that the liquid most likely represented cerebrospinal fluid, insertion of a ventilation tube was not performed. The ear canal was packed with sterile cotton, and the patient was given a short course of acetazolamide to decrease CSF production. Upon further questioning, the patient did not have any prior head trauma. The patient then underwent both computerized tomographic (CT) imaging and magnetic resonance imaging (MRI) of the temporal bone to look specifically for evidence of a dehiscence in the middle fossa plate (tegmen) or posterior fossa plate, as well as the presence of a meningoencephalocele.
Computerized tomographic imaging of the temporal bone in the axial plane showed a soft tissue density completely occupying the air-containing spaces of the middle ear, epitypanum and mastoid air cells, without any evidence of bony erosion of the scutum, the ossicles, or the bony septations of the mastoid air cells. T2-weighted magnetic resonance imaging in the axial plane showed that the soft tissue densities in the middle ear, the epitympanum and mastoid air cells had a naturally high signal intensity characteristic of fluid. (Figure 1).
On coronal CT imaging, a dehiscence of the middle fossa plate (tegmen) was noted lateral to the superior semicircular canal. Magnetic resonance imaging in the same plane revealed a soft tissue density in the region of the dehiscence that was contiguous with, and isointense with the temporal lobe. This soft tissue density appeared to originate from the temporal lobe, and extended downwards into the upper portion of the mastoid antrum. No enhancement was noted on gadolinium-enhanced T1-weighted imaging (Figure 2). With these imaging findings, a middle fossa encephalocele was considered. Exploratory mastoidectomy confirmed the diagnosis, and the patient subsequently underwent a transmastoid repair of the tegmen and dural dehiscence using both temporalis fascia and mastoid cortical bone, after the herniated brain tissue was amputated.
A middle fossa encephalocele is a condition of the temporal bone that may arise as a complication of chronic otitis media, temporal bone fractures, or after surgery involving the temporal bone. Although rare, spontaneous middle fossa encephaloceles may also occur.1,2 One must maintain a high degree of clinical suspicion for this condition in an adult patient presenting with a unilateral middle ear effusion or watery otorrhea in the absence of an identifiable cause of otologic disease2 or nasopharyngeal pathology. It should definitely be highly considered if profuse, persistent clear otorrhea is encountered during a myringotomy for what may initially appear to be a chronic middle ear effusion. Surgical treatment of the encephalocele and repair of the skull base defect is generally recommended, as life threatening complications such as meningitis, brain abscess and temporal lobe seizures have been known to occur.2
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Turgut, S., and M. Tos. "Correlation between temporal bone pneumatization, location of lateral sinus and length of the mastoid process." Journal of Laryngology & Otology 106, no. 6 (June 1992): 485–89. http://dx.doi.org/10.1017/s0022215100119942.
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AbstractThe relationship between temporal bone pneumatization and the location of the lateral sinus and length of the mastoid process was investigated in 60 fresh frozen adult temporal bones, by plain X-rays, computed tomography and surgical dissection including otomicroscopic findings. Temporal bone pneumatization was classified as small, moderate and large. After drilling, the shortest distances between the middle fossa dura and mastoid tip representing the mastoid length and between the sigmoid sinus and posterior border of external auditory canal were measured and compared to the degree of pneumatization. The distances in the specimens with pathological eardrum and adhesions in the middle ear were compared to the ones without gross pathology. The length of mastoid process was significantly shorter in specimens with small pneumatization than those with large (Mann Whitney P<0.001).The specimens with a pathological eardrum and middle ear adhesions had a significantly shorter mastoid length than those without gross pathology. There was no significant difference between degree of pneumatization and the shortest distance between sigmoid sinus and external auditory canal (Mann Whitney P>0.05). It is demonstrated that the ‘under-developed’ mastoid process can be a consequence of hampered pneumatization.
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Cho, Hyong-Ho, Hyun-Seok Choi, Chul-Ho Jang, and Yong-Bum Cho. "S224 – Efficacy of Long Silastic Sheet in COM Surgery." Otolaryngology–Head and Neck Surgery 139, no. 2_suppl (August 2008): P150. http://dx.doi.org/10.1016/j.otohns.2008.05.399.
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Objectives To determine the effect of long silastic sheet for middle ear aeration in chronic otitis media surgery. Methods Between January 2003 and May 2007, 46 patients underwent planned staged canal wall up tympanomastoidetomy, because possibility of residual cholesteatoma and severe swelling middle ear mucosa, especially around the stapes. Long silastic sheet was inserted from mastoid cavity to middle ear via facial recess during operation procedure. To determine the effect of long silastic sheet for recovery of mastoid aeration, various factors such as computed tomography grading, Valsalva maneuver grading for Eustachian function, and hearing result were compared. Results During the average follow-up of 31 months, there was 1 recurred chronic otitis media which was revealed tuberculosis otitis media. Intact tympanic membrane was obtained in 45(97.8%) of 46 patients. In CT grading, middle ear aeration was increased significantly (p<0.05). Air-Bone gap was significantly decreased after staged operation, preoperative average ABG was 29.7dB and last average ABG was 21.0dB (p <0.05). But Eustachian function using Valsalva manerver was not significantly changed (p >0.05). Conclusions Long silastic sheet insertion from mastoid to middle ear is statistically effective for amelioration of middle ear and mastoid aeration after the first-stage operation.
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Murad, Nurfadhilah Aisyah, Zalilah Musa, Kharudin Abdullah, and Irfan Mohamad. "Luc Abscess: A Rare Complication of a Common Pediatric Ear Infection." Malaysian Journal of Paediatrics and Child Health 27, no. 1 (April 28, 2021): 20–24. http://dx.doi.org/10.51407/mjpch.v27i1.127.
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Middle ear infection occurs when fluid accumulate in middle ear as a result of inflammatory response to viral or bacterial infection. Infections may spread from the middle ear, resulting in a subperiosteal collection beneath the temporal muscle. Luc abscess is a rare complication of otitis media. The difference of this complication with other extracranial abscesses relating to otitis media is, it may not be associated with mastoid bone involvement. Therefore, it is defined as benign complication of otitis media. Here, we report a case of 10-month-old baby boy diagnosed with Luc abscess with mastoid involvement.
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GHEORGHE, Dan-Cristian, and Adina ZAMFIR-CHIRU-ANTON. "A meningocele complicating mastoidectomy – case considerations." Romanian Journal of Medical Practice 11, no. 1 (March 31, 2016): 89–92. http://dx.doi.org/10.37897/rjmp.2016.1.18.
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Objective. To discuss a less common complication of middle ear surgery. Meningoceles are dural herniations that can fill the mastoid cavities through congenital or acquired bony defects of the mastoid walls. They can complicate the postoperative course of surgery for chronic middle ear disease. Material and method. Case presentation showing one patient who developed a mastoid meningocele after extensive cholesteatoma surgery. Discussion. The causes of dural herniation into the mastoid cavities are presented. Some hypothesis regarding the factors that favor the occurrence of this complication are presented. Conclusions. Surgical closing of the bone gap in the mastoid wall was the treatment we used. We can not ascertain yet the long term results of such surgical maneuver, regarding the technique and the graft we used. Attention to the mastoid surgical detail and good postoperative intensive care could prevent such complications.
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Gray, William C., Michael Salcman, Krishna C. V. G. Rao, and Mohammad A. Hafiz. "Cholesterol Granuloma of the Petrous Apex and Sphenoidal Sinus: A Case Report." Neurosurgery 17, no. 1 (July 1, 1985): 67–69. http://dx.doi.org/10.1227/00006123-198507000-00011.
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Abstract A case of a cholesterol granuloma located in the petrous apex and eroding into the sphenoidal sinus is reported. Cholesterol granuloma is thought to occur when pneumatized cells in the temporal bone become obstructed. Although usually ocurring in the middle ear, it can occur in the petrous apex. The diagnosis and surgical management are discussed.
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Goksu, Nebil, Nalan Karademir, Rifki Haziroglu, Ismet Bayramoglu, Yusuf Kemaloglu, and Necmettin Akyeldiz. "Anatomy of the Guinea Pig Temporal Bone." Annals of Otology, Rhinology & Laryngology 101, no. 8 (August 1992): 699–704. http://dx.doi.org/10.1177/000348949210100814.
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The middle ear of guinea pigs has long been used for experimental studies, but no detailed information about its temporal bone anatomy is available. In 18 adult guinea pigs, the temporal bone, eustachian tube, and inner ear anatomy, in addition to the anatomy of the middle ear, were investigated under the dissection microscope. In addition to properties of the eardrum, ossicles, air cell system, and cochlea previously described, the appearance of Huschke's foramen and the crista stapedis in an adult guinea pig ear, the structure of the eustachian tube, the architecture of the internal auditory canal, and the communication of the mastoid cells with the tympanic bulla are described. Differences and similarities among guinea pigs, other experimental animals, and humans are discussed to show the advantages and disadvantages of the guinea pig ear for experimentation.
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Antonelli, Patrick J., G. Joseph Parell, Gary D. Becker, and Michael M. Paparella. "Temporal Bone Pathology in Scuba Diving Deaths." Otolaryngology–Head and Neck Surgery 109, no. 3 (September 1993): 514–21. http://dx.doi.org/10.1177/019459989310900321.
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Scuba diving has long been associated with otologic injuries; however, little is known about temporal bone pathology in diving-related deaths. We examined 18 temporal bones from 11 divers who died, primarily from complications of rapid ascent. Bleeding into the middle ear and mastoid air cells was nearly universal. Inner ear damage included hemorrhage around Reissner's membrane and the round window membrane and rupture of the utricle and saccule. Most of the observed inner ear damage was not surgically treatable. (OTOLARYNGOL HEAD NECK SURG 1993;109:514-21.)
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Devesa, P. Martinez, H. S. Reid, and A. F. Jefferis. "Temporocele: CT findings and management." Journal of Laryngology & Otology 113, no. 7 (July 1999): 661–62. http://dx.doi.org/10.1017/s0022215100144779.
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AbstractThe temporocele, a rare case of extra-mastoid pneumatization is discussed. It presented as a swelling over the mastoid in a 16-year-old female and the diagnosis was made by computed tomography (CT) scan. It was treated by obliteration by covering the sieve-like mastoid with bone dust and a large piece of temporalis fascia as well as ventilating the middle ear.
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Annalisa, Pace, Iannella Giannicola, Rossetti Valeria, Messineo Daniela, Visconti Irene Claudia, Polimeni Roberta, Milani Alessandro, and Magliulo Giuseppe. "Isolated Congenital Mastoid Cholesteatoma with no Involvement of Aditus Ad Antrum and Middle Ear." Clinical Medicine Insights: Case Reports 14 (January 2021): 117954762110140. http://dx.doi.org/10.1177/11795476211014032.
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Cholesteatoma is a non-neoplastic, keratinized squamous epithelial lesion that affects the temporal bone. The middle ear is the most frequent, while the isolated cholesteatoma of the mastoid is rare. The aim of this study was to describe a rare case of isolated mastoid cholesteatoma with no involvement of aditus ad antrum and middle ear including a literature review of the topic. This case report describes the case of a 58 years old female with a cholesteatoma isolated in the mastoid region, evidenced by imaging (computer tomography and magnetic resonance). A mastoidectomy was performed: mastoid process was completely involved, but antrum was not reached. Moreover, it reached the soft tissue of stylomastoid foramen as well as the posterior belly of the digastric muscle. In the literature few articles described cases of cholesteatoma isolated in the mastoid region. Research was conducted using PubMed and reference list and there were considered only reports about cholesteatoma exclusively located in the mastoid process without involvement of antrum or middle ear. Fourteen articles were included in this review, with a total number of 23 cases of cholesteatoma isolated in the mastoid region. All papers analyzed reported the cases of isolated mastoid cholesteatoma that presented a congenital origin. Its diagnosis is difficult, therefore, imaging evaluation is mandatory and surgery is the treatment of choice. Mastoid cholesteatomas without involvement of aditus ad antrum and middle ear are rare and only 23 cases are reported in literature. Our case is in line with all clinical and diagnostic features of this rare disease, but it is the only one that evidenced an exposure of the soft tissue of stylomastoid foramen as well as the posterior belly of the digastric muscle. The treatment of choice was the surgical one, avoiding damaging of important anatomo-functional structure.
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Hussein, A., H. M. Abdel Tawab, W. T. Lotfi, N. Fayad, and N. Elsisy. "Relation between temporal bone pneumatisation and middle-ear barotrauma in aircrew members." Journal of Laryngology & Otology 133, no. 10 (September 27, 2019): 918–22. http://dx.doi.org/10.1017/s0022215119002020.
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AbstractObjectiveThis study aimed to assess the potential role of pneumatisation of the mastoid and its communicating air cells in the development of middle-ear barotrauma in aircrew members.MethodsSeventy-nine aircrew members (158 ears) underwent temporal computed tomography. All were assessed before flying by clinical examination and audiology evaluation, followed by post-flight examination to detect barotrauma.ResultsAircrew members’ ears were divided into 3 groups based on barotrauma and temporal bone pneumatisation: 33 ears with barotrauma and temporal bone pneumatisation of 71 cm3 or greater (group A); 12 ears with barotrauma and temporal bone pneumatisation of 11.2 cm3 or lower (group B); and 113 ears with no barotrauma (group C). Mean pneumatisation volumes were 91.05 cm3, 5.45 cm3 and 28.01 cm3 in groups A, B and C, respectively. A direct relationship was observed between volume of temporal bone pneumatisation of 71 cm3 or greater and barotrauma grade.ConclusionPneumatisation volume of the mastoid and its communicating air cells that ranges from 11.3 cm3 to 70.4 cm3 serves as a reliable predictor of the avoidance of middle-ear barotrauma associated with flying in aircrew members who have normal resting middle-ear pressure and good Eustachian tube function.
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Smith, Peter G., John P. Leonetti, and G. Robert Kletzker. "Differential Clinical and Radiographic Features of Cholesterol Granulomas and Cholesteatomas of the Petrous Apex." Annals of Otology, Rhinology & Laryngology 97, no. 6 (November 1988): 599–604. http://dx.doi.org/10.1177/000348948809700605.
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Cholesterol granulomas and cholesteatomas are expansile, destructive lesions of the petrous apex that occur more frequently than we previously realized. Having obscure causes, they grow silently, often reaching impressive proportions, until they encroach on adjacent cranial nerves or the otic capsule. The lesions have distinguishing histopathologies, early clinical manifestations, and neuroradiographic features that, when integrated, allow for a critical preoperative differentiation. Cholesterol granulomas are treated effectively through internal marsupialization into the mastoid or middle ear cavity. Cholesteatomas, however, are managed usually by a much more aggressive and complicated exteriorization or exenteration. Selected case reports are used to emphasize salient clinical and radiographic features and perioperative management.
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Alves, Ricardo, Francisco Cabral Junior, Anna Fonseca, and Ricardo Bento. "Mastoid Obliteration with Autologous Bone in Mastoidectomy Canal Wall Down Surgery: a Literature Overview." International Archives of Otorhinolaryngology 20, no. 01 (August 24, 2015): 076–83. http://dx.doi.org/10.1055/s-0035-1563382.
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Introduction The objectives of mastoidectomy in cholesteatoma are a disease-free and dry ear, the prevention of recurrent disease, and the maintenance of hearing or the possibility to reconstruct an affected hearing mechanism. Canal wall down mastoidectomy has been traditionally used to achieve those goals with greater or lesser degrees of success. However, canal wall down is an aggressive approach, as it involves creating an open cavity and changing the anatomy and physiology of the middle ear and mastoid. A canal wall up technique eliminates the need to destroy the middle ear and mastoid, but is associated with a higher rate of residual cholesteatoma. The obliteration technics arise as an effort to avoid the disadvantages of both techniques. Objectives Evaluate the effectiveness of the mastoid obliteration with autologous bone in mastoidectomy surgery with canal wall down for chronic otitis, with or without cholesteatoma. Data Synthesis We analyzed nine studies of case series comprehending similar surgery techniques on 1017 total cases of operated ears in both adults and children, with at least 12 months follow-up. Conclusion Mastoid Obliteration with autologous bone has been utilized for many years to present date, and it seems to be safe, low-cost, with low recurrence rates - similar to traditional canal wall down procedures and with greater water resistance and quality of life improvements.
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Lee, Jong Im, Ki Kwon Kim, Yoon Keun Park, Kyung Yoon Eah, and Jung Ran Kim. "Glial Choristoma in the Middle Ear and Mastoid Bone: A Case Report." Journal of Korean Medical Science 19, no. 1 (2004): 155. http://dx.doi.org/10.3346/jkms.2004.19.1.155.
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NADOL, J. B. "Obliteration of the Mastoid and Middle Ear for Severe Temporal Bone Trauma." Archives of Otolaryngology - Head and Neck Surgery 113, no. 8 (August 1, 1987): 811. http://dx.doi.org/10.1001/archotol.1987.01860080017004.
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Yang, Nathaniel W. "Blunting of the Scutum: A Key Feature in the Radiologic Diagnosis of Acquired Cholesteatoma." Philippine Journal of Otolaryngology-Head and Neck Surgery 23, no. 1 (June 30, 2008): 37–38. http://dx.doi.org/10.32412/pjohns.v23i1.775.
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The determination of the presence of acquired cholesteatoma in the middle ear and mastoid is one of the most common indications for computerized tomographic (CT) imaging of the temporal bone. While the presence of a soft tissue density in the mesotympanum, epitympanum or antrum is a feature of cholesteatomatous disease, CT imaging cannot reliably differentiate soft tissue densities caused by cholesteatoma, middle ear effusion or fluid completely filling the middle ear and mastoid air cell system, granulation tissue, brain, or other soft tissue densities that may fill the air-containing space.1,2 Bone erosion is the radiologic sine qua non of a cholesteatoma. In the absence of bone erosion, a cholesteatoma may be present but cannot be diagnosed on CT imaging studies. One of the earliest abnormalities of a cholesteatoma that can be appreciated on a CT scan is erosion of the scutum, which is the medial aspect of the roof of the external auditory canal, and where the tympanic membrane attaches superiorly. Scutum erosion is most easily seen on coronal CT images.2
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Jahrsdoerfer, Robert A., Joel W. Yeakley, Eugenio A. Aguilar, and Randolph R. Cole. "Treacher Collins Syndrome: An Otologic Challenge." Annals of Otology, Rhinology & Laryngology 98, no. 10 (October 1989): 807–12. http://dx.doi.org/10.1177/000348948909801011.
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Patients with Treacher Collins syndrome have severe middle ear malformations that render operation difficult. We have evaluated 43 patients with Treacher Collins syndrome, on whom only 11 were operated. Computed tomography, the single most important study done preoperatively, routinely showed an underdeveloped temporal bone with islands of bone marrow and absent mastoid pneumatization. The middle ear space was often underdeveloped. Ossicular dysjunction was often noted in which the fused malleus/incus remnant was found 3 to 4 mm distant to the stapes. A common finding was severe dysplasia of the stapes-facial nerve complex that often made the middle ear malformation uncorrectable. Hearing results were much less predictable than in patients with isolated atresia/stenosis of the ear.
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Pollanen, M. S., J. H. N. Deck, B. Blenkinsop, and E. M. Farkas. "Fracture of Temporal Bone With Exsanguination: Pathology and Mechanism." Canadian Journal of Neurological Sciences / Journal Canadien des Sciences Neurologiques 19, no. 2 (May 1992): 196–200. http://dx.doi.org/10.1017/s0317167100042256.
Full textAbstract:
ABSTRACT:Eight cases of basal skull fracture with transverse fracture of the petrous temporal bone with medial extension to the internal carotid artery and lateral extension of the structures of the middle ear are described. Injuries in all cases were due to major blunt impact to the head usually occurring in a motor vehicle accident. General autopsy revealed major blood loss without any obvious external or internal site of hemorrhage suggesting that exsanguination was a complication of the head injury. The internal carotid arteries at the most medial extension of the fractures were lacerated or transected in all cases. In selected cases, the cervical internal carotid arteries were perfused and perfusate escaped rapidly from the ear(s) with the majority of fluid bypassing the cerebral venous system. Magnetic resonance image reconstruction of sequential sections of the fractured base of the skull confirmed the laceration of the internal carotid arteries and disruption of the middle ear. Based on this evidence, we propose that some displaced fractures of the base of the skull produce carotid-middle ear continuities which act as arterial shunts, resulting in rapid fatal exsanguination through the ear.
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Kumar, Surender, Uma Garg, Naveen Sharma, Neha Salaria, and Deepak Verma. "Squamous cell carcinoma of tympano-mastoid region: a series of six cases." International Journal of Otorhinolaryngology and Head and Neck Surgery 4, no. 3 (April 26, 2018): 874. http://dx.doi.org/10.18203/issn.2454-5929.ijohns20181891.
Full textAbstract:
<p class="abstract">The malignancies of tympanomastoid region are very rare entity. These tumours are more common in elderly persons in 6th and 7th decade. Males are more commonly affected than females. Chronically discharging ears are considered as risk factor which may be due to metaplasia in the middle ear mucosa following prolonged chronic infection. The most common symptoms are long standing blood tinged ear discharge, severe nocturnal pain, rapidly growing polypoidal or granulomatous mass in EAC or middle ear, peripheral facial palsy and painless ulceration over pinna or EAC. CT scan for bony erosion and MRI for soft tissue involvement and neural invasion are investigations of choice. Tissue biopsy is must for histopathological examination and confirmation of diagnosis. Surgery and chemo-radiotherapy are the mainstay of treatment. Surgery includes wide local excision, lateral temporal bone resection, subtotal temporal bone resection and total temporal bone resection.</p><p class="abstract"> </p>
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Charlton, Alexander, Noor Janjua, and Darius Rejali. "Cotton bud in external ear canal causing necrotising otitis externa and subdural abscess." BMJ Case Reports 12, no. 3 (March 2019): e227971. http://dx.doi.org/10.1136/bcr-2018-227971.
Full textAbstract:
Necrotising otitis externa (NOE) is an infection originating in the soft tissues of the external auditory canal (EAC) spreading to the surrounding bone and rarely causing intracranial complications. It is usually caused by Pseudomonas aeruginosa and has historically occurred in elderly patients with diabetes or immunodeficiency. EAC foreign body is a risk factor for otitis externa but has not been described in NOE. A healthy 31-year-old man presented with new-onset seizures and worsening left-sided otalgia and otorrhoea. Brain imaging revealed left temporal subdural abscesses superior to the petrous bone. A retained cotton bud was identified in the left EAC, along with osseocartilaginous junction and mastoid granulation tissue. The foreign body was removed; a cortical mastoidectomy performed and intravenous antibiotic administered. At 10 weeks, the patient remained well, with no neurological deficit and no residual ear symptoms, and CT demonstrated complete resolution of the intracranial abscesses.