Petrous apex pneumatisation in children: a radiological study

2020 ◽  
Vol 134 (9) ◽  
pp. 798-803
Author(s):  
T Hardcastle ◽  
I McKay-Davies ◽  
M Neeff
Keyword(s):  
Computed Tomography ◽  
Surgical Management ◽  
Middle Ear ◽  
Petrous Apex ◽  
Otic Capsule ◽  
Positive Relationships ◽  
Radiological Study ◽  
Middle Ear Disease ◽  
Cell Volumes

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.

scholarly journals Rapidly progressive labyrinthitis ossificans in an immunocompromised pediatric patient

2021 ◽  
Vol 2 (3) ◽  
Author(s):  
Sean Holmes ◽  
◽  
Katherine Babin ◽  
Avery Bryan ◽  
Gauri Mankekar ◽  
...  
Keyword(s):  
Otitis Media ◽  
Pediatric Patient ◽  
Middle Ear ◽  
Chronic Suppurative Otitis Media ◽  
Multi Drug Resistance ◽  
Otic Capsule ◽  
Drug Resistant ◽  
Suppurative Otitis Media ◽  
Labyrinthitis Ossificans ◽  
Middle Ear Disease

In this report, we present a case of rapid otic capsule obliteration within an exceedingly short timeframe in the setting of Chronic Suppurative Otitis Media (CSOM) in an immunocompromised pediatric patient with Down Syndrome. Following maximal therapy for a right sided cholesteatoma, the patient developed a multi-drug resistant infection that cause CSOM, which within 6 weeks progressed to complete obliteration of the right cochlea and otic capsule. The possibility of congenital temporal bone microscopic dehiscence allowing infection propagation cannot be excluded. Nonetheless, this case highlights the importance of appreciating how quickly chronic middle ear disease can progress to involve the labyrinth and cause intracranial complications, even with adequate concurrent medical therapy in the form of antibiotics and surgical therapy. A greater awareness as physicians should be made on management of refractory chronic middle ear disease to better treat their potential complications, which is made apparent in this case report. Keywords: Otic capsule; Chronic suppurative otitis media; Otic capsule; Tympanomastoidectomy; Multi-drug resistance. Abbreviations: CSOM: Chronic Suppurative Otitis Media; MDR: Multi-Drug Resistant; CT: Computed Tomography; MRI: Magnetic Resonance Imaging; ID: Infectious Disease.

Efficacy of pre-operative computed tomography evaluation of the tympanic cavity for hearing improvement after stapes surgery for tympanosclerosis with stapes fixation

2015 ◽  
Vol 129 (S2) ◽  
pp. S27-S32 ◽  
Author(s):  
S Kikkawa ◽  
K Kubo ◽  
H Kawano ◽  
S Komune
Keyword(s):  
Computed Tomography ◽  
Middle Ear ◽  
Stapes Surgery ◽  
Single Stage ◽  
Hearing Results ◽  
Staged Surgery ◽  
Stapes Fixation ◽  
Middle Ear Disease ◽  
Operative Findings ◽  
Tympanic Membrane Retraction

AbstractObjective:Our aim was to determine if stapes surgery is useful for treating inflammatory ear diseases.Materials and methods:Thirteen patients underwent single-stage or staged surgery for stapes fixation due to tympanosclerosis alone or with cholesteatoma. Operative criteria were: no tympanic membrane retraction, perforation or adhesion; middle-ear cavity with aeration >1 year; a fixed stapes. Computed tomography was used to analyse the relation between operative success and pre-operative pneumatisation.Results:Success rate at six months was 75 per cent. Hearing results were stable with little deterioration and no complications. Patients with poor pneumatisation had good results (with improved air–bone gap) only after staged surgery. Well-aerated ears heard better even with single-stage surgery.Conclusions:Pre-operative computed tomography and intra-operative findings are necessary to determine the pneumatisation status of tympanic mastoid cavities. If criteria approved, poorly pneumatised patients underwent staged surgery. Stapedectomy achieved good hearing results for inflammatory middle-ear disease with stapes fixation.

Differential Clinical and Radiographic Features of Cholesterol Granulomas and Cholesteatomas of the Petrous Apex

1988 ◽  
Vol 97 (6) ◽  
pp. 599-604 ◽  
Author(s):  
Peter G. Smith ◽  
John P. Leonetti ◽  
G. Robert Kletzker
Keyword(s):  
Middle Ear ◽  
Perioperative Management ◽  
Case Reports ◽  
Cranial Nerves ◽  
Clinical Manifestations ◽  
Petrous Apex ◽  
Otic Capsule ◽  
Radiographic Features

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.

Cholesterol Granuloma of the Petrous Apex and Sphenoidal Sinus: A Case Report

Neurosurgery ◽  
1985 ◽  
Vol 17 (1) ◽  
pp. 67-69 ◽  
Author(s):  
William C. Gray ◽  
Michael Salcman ◽  
Krishna C. V. G. Rao ◽  
Mohammad A. Hafiz
Keyword(s):  
Case Report ◽  
Temporal Bone ◽  
Surgical Management ◽  
Middle Ear ◽  
Petrous Apex ◽  
Cholesterol Granuloma ◽  
Sphenoidal Sinus

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.

scholarly journals Challenges in managing complex chronic middle ear disease: MERF experience

2021 ◽  
Vol 7 (10) ◽  
pp. 1653
Author(s):  
Kiran Natarajan ◽  
Aruna Devaraju S. ◽  
Anubhav Shrivastava ◽  
Swathi Ramasamy ◽  
Raghunandhan Sampathkumar ◽  
...  
Keyword(s):  
Otitis Media ◽  
Surgical Management ◽  
Middle Ear ◽  
Advanced Disease ◽  
Round Window ◽  
Chronic Otitis Media ◽  
Long Distance ◽  
Tertiary Referral Centre ◽  
Treatment Centre ◽  
Middle Ear Disease

<p><strong>Background: </strong>Chronic otitis media is one of the commonest conditions managed in otolaryngology practice. In developing countries such as India, advanced disease presentation is often seen mostly owing to lack of awareness of the disease and its potential complications, long distance between the patient’s home and the treatment centre, causing delay in treatment. Surgical management is the mainstay of treatment of chronic otitis media.</p><p><strong>Methods: </strong>The aim of this study was to retrospectively analyze the patients with complex chronic middle ear disease, who underwent tympanomastoid surgery. Forty-seven<strong> </strong>patients (4.9%) out of a total of 968 patients with chronic otitis media presented with complex advanced disease and challenging intra-operative situations at our tertiary referral centre between January 2016 to December 2020. The extent of disease, associated complications, challenges in surgical management, and the eventual outcomes were studied in detail.</p><p><strong>Results: </strong>Among<strong> </strong>these forty-seven<strong> </strong>patients, there were 24 males and 23 females. Of the 47 patients, 8 were children (17%). Extensive cholesteatoma causing facial palsy, labyrinthine fistula, dural involvement, internal auditory meatus involvement, extensive granulations extending into the inner ear through the oval or round window, extensive tympanosclerosis was noted in these patients. All patients underwent surgical management, and achieved satisfactory outcomes.</p><p><strong>Conclusions: </strong>Advanced chronic otitis media has the potential to pose various challenges during tympanomastoid surgery. Appropriate planning for surgery aiming at complete disease clearance, meticulous after-care and long-term surveillance result in favorable outcomes.</p>

Facial palsy secondary to cholesteatoma: analysis of outcome following surgery

2006 ◽  
Vol 121 (2) ◽  
pp. 114-117 ◽  
Author(s):  
M A Siddiq ◽  
L M Hanu-Cernat ◽  
R M Irving
Keyword(s):  
Middle Ear ◽  
Facial Palsy ◽  
Petrous Apex ◽  
Anatomical Location ◽  
Residual Function ◽  
Bone Surgery ◽  
Temporal Bone Surgery ◽  
Middle Ear Disease ◽  
Middle Ear Cleft ◽  
Facial Function

Facial palsy is a rare presenting feature of cholesteatoma. Prompt treatment usually results in a good outcome, but if treatment is delayed the prognosis can be difficult to predict. We retrospectively reviewed 326 consecutive patients who had undergone temporal bone surgery for cholesteatoma. Eleven patients had presented with facial palsy, of whom eight had petrous apex involvement and three had disease confined to the middle-ear cleft. All patients with middle-ear disease were operated upon within two months of presentation, and all showed some recovery in facial function. The diagnosis had been delayed in all eight cases of apical disease, with four cases having had a long-standing total weakness. One case treated after seven months' partial weakness achieved a full recovery. In three cases of long-standing partial weakness, pre-operative facial function was preserved by maintaining the facial nerve in its normal anatomical location.Facial palsy associated with cholesteatoma should be treated as early as possible. Recovery can occur even if treatment is delayed for up to seven months. After this time, recovery is increasingly unlikely, but any residual function can be maintained and further deterioration prevented.

COMPARATIVE PERFORMANCE OF RADIOGRAPHY AND COMPUTED TOMOGRAPHY IN THE DIAGNOSIS OF MIDDLE EAR DISEASE IN 31 DOGS

2006 ◽  
Vol 47 (1) ◽  
pp. 45-52 ◽  
Author(s):  
JACOB J. ROHLEDER ◽  
JERYL C. JONES ◽  
ROBERT B. DUNCAN ◽  
MARTHA M. LARSON ◽  
DON L. WALDRON ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Middle Ear ◽  
Comparative Performance ◽  
Middle Ear Disease
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