Perilymphatic Fistula: A Histopathologic Study

1986 ◽  
Vol 95 (5) ◽  
pp. 466-471 ◽  
Author(s):  
Robert I. Kohut ◽  
Raul Hinojosa ◽  
Joseph A. Budetti
Keyword(s):  
Middle Ear ◽  
Clinical History ◽  
Histologic Diagnosis ◽  
Perilymphatic Fistula ◽  
Clinical Criteria ◽  
Histopathologic Study ◽  
Temporal Bones ◽  
The University ◽  
Physical Findings ◽  
Chicago Medical

Over the last two decades, clinical criteria for perilymphatic fistulae have been defined to the extent that differentiation can be made between such fistulae and other balance-affecting disorders such as Meniere's syndrome. On the assumption that the specimens in the temporal bone bank of the University of Chicago Medical School that had been obtained from patients having vertigo, hearing loss, or both, before those clinical criteria were so defined might have been classified incorrectly, we proposed a retrospective histopathologic study, with prediction of two independent variables: 1) a clinical history and physical findings consistent with the diagnosis of perilymphatic fistula and 2) communication between the vestibule and the middle ear adjacent to or via the fissula ante fenestram. Eleven pairs of temporal bones with the histologic diagnosis of idiopathic labyrinthine hydrops were evaluated before the clinical histories relevant to those specimens were reviewed. In one specimen, a communication between the vestibule and the middle ear space was identified. In none of the other specimens was there a similar communication. As this study continued, significance was given to the histologic details of the communication between the middle ear and posterior canal ampulla. The temporal bones without these communications did not have clinical histories consistent with the diagnosis of perilymphatic fistula.

Ataxia and Hearing Loss Secondary to Perilymphatic Fistula

PEDIATRICS ◽  
1978 ◽  
Vol 61 (2) ◽  
pp. 238-241
Author(s):  
Gerald B. Healy ◽  
Jules M. Friedman ◽  
Joseph DiTroia
Keyword(s):  
Hearing Loss ◽  
Soft Tissue ◽  
Head Trauma ◽  
Middle Ear ◽  
Vestibular System ◽  
Perilymphatic Fistula ◽  
Labyrinthine Fistula ◽  
First Case ◽  
The Absolute ◽  
Physical Findings

Ataxia is rarely attributed to lesions of the peripheral vestibular system. In 1973, the first case of ataxia and hearing loss secondary to a labyrinthine fistula was reported. Until now, this syndrome has not been reported in patients under the age of 10 years. A case is presented of a 5-year-old boy with symptoms of ataxia and hearing loss as well as vertigo and tinnitus after head trauma. Three physical findings appear to be most characterisitic of patients with perilymphatic fistulas: a positive fistula response, positive positional testing with the involved ear down, and evidence of vestibular ataxia when testing station and gait. The absolute diagnosis of perilymphatic fistula can only be established by exploration of the middle ear space. If a fistula is found, it may be sealed with soft tissue and, if this fails, actual stapedectomy may be required.

scholarly journals Pediatric neurosurgery telemedicine clinics: a model to provide care to geographically underserved areas of the United States and its territories

2016 ◽  
Vol 18 (6) ◽  
pp. 753-757 ◽  
Author(s):  
Hector E. James
Keyword(s):  
Pediatric Patients ◽  
Pediatric Neurosurgery ◽  
Clinical History ◽  
The United States ◽  
Nursing Personnel ◽  
Cultural Barriers ◽  
University Of Florida ◽  
Clinic Patient ◽  
The University ◽  
Physical Findings

OBJECTIVE The author describes the creation, structuring, and development of a pediatric neurosurgery telemedicine clinic (TMC) to provide telehealth across geographical, time, social, and cultural barriers. METHODS In July 2009 the University of Florida (UF) Division of Pediatric Neurosurgery received a request from the Southeast Georgia Health District (Area 9–2) to provide a TMC to meet regional needs. The Children's Medical Services (CMS) of the State of Georgia installed telemedicine equipment and site-to-site connectivity. Audiovisual connectivity was performed in the UF Pediatric Neurosurgery office, maintaining privacy and HIPAA (Health Insurance Portability and Accountability Act) requirements. Administrative steps were taken with documentation of onsite training of the secretarial and nursing personnel of the CMS clinic. Patient preregistration and documentation were performed as required by the UF College of Medicine–Jacksonville. Monthly clinics are held with the CMS nursing personnel presenting the pertinent clinical history and findings to the pediatric neurosurgeon in the presence of the patient/parents. Physical findings and diagnostic studies are discussed, and management decisions are made. RESULTS The first TMC was held in August 2011. A total of 40 TMC sessions have been held through January 2016, with a total of 43 patients seen: 13 patients once; 13 patients twice; 8 patients for 3 visits; 2 for 4 visits; 2 for 6 visits; 2 for 5 visits; 2 for 7 visits; and 1 patient has been seen 8 times. CONCLUSIONS Pediatric patients in areas of the continental US and its territories with limited access to pediatric neurosurgery services could benefit from this model, if other pediatric neurosurgery centers provide telehealth services.

Otopathologic Abnormalities in CHARGE Syndrome

2021 ◽  
pp. 019459982110089
Author(s):  
Rafael da Costa Monsanto ◽  
Renata Malimpensa Knoll ◽  
Norma de Oliveira Penido ◽  
Grace Song ◽  
Felipe Santos ◽  
...  
Keyword(s):  
Facial Nerve ◽  
Middle Ear ◽  
Spiral Ganglion ◽  
Internal Auditory Canal ◽  
Semicircular Canals ◽  
Charge Syndrome ◽  
University Of Minnesota ◽  
Bony Canal ◽  
Ganglion Neurons ◽  
Temporal Bones

Objective To perform an otopathologic analysis of temporal bones (TBs) with CHARGE syndrome. Study Design Otopathologic study of human TB specimens. Setting Otopathology laboratories. Methods From the otopathology laboratories at the University of Minnesota and Massachusetts Eye and Ear Infirmary, we selected TBs from donors with CHARGE syndrome. These TBs were serially sectioned at a thickness of 20 µm, and every 10th section was stained with hematoxylin and eosin. We performed otopathologic analyses of the external ear, middle ear (middle ear cleft, mucosal lining, ossicles, mastoid, and facial nerve), and inner ear (cochlea, vestibule, internal auditory canal, and cochlear and vestibular nerves). The gathered data were statistically analyzed. Results Our study included 12 TBs from 6 donors. We found a high prevalence of abnormalities affecting the ears. The most frequent findings were stapes malformation (100%), aberrant course of the facial nerve (100%) with narrow facial recess (50%), sclerotic and hypodeveloped mastoids (50%), cochlear (100%) and vestibular (83.3%) hypoplasia with aplasia of the semicircular canals, hypoplasia and aplasia of the cochlear (66.6%) and vestibular (91.6%) nerves, and narrowing of the bony canal of the cochlear nerve (66.6%). The number of spiral ganglion and Scarpa’s ganglion neurons were decreased in all specimens (versus normative data). Conclusions In our study, CHARGE syndrome was associated with multiple TB abnormalities that may severely affect audiovestibular function and rehabilitation.

scholarly journals Supratubal recess and sinus tympani: CT analysis of middle ear hidden areas

2019 ◽  
Vol 50 (1) ◽  
Author(s):  
Mohammad Waheed El-Anwar ◽  
Diaa Bakry Eldib ◽  
Ashraf Elmalt ◽  
Alaa Omar Khazbak
Keyword(s):  
Middle Ear ◽  
Preoperative Imaging ◽  
High Resolution Computed Tomography ◽  
Sinus Tympani ◽  
Ct Analysis ◽  
Length Width ◽  
Middle Ear Anatomy ◽  
Grade 3 ◽  
Temporal Bones ◽  
Ct Classification

Abstract Background High-resolution computed tomography (HRCT) magnifies the role of preoperative imaging for detailed middle ear anatomy particularly its hidden area. The purpose of the current study was to assess the sinus tympani (ST) and supratubal recess (STR) by HRCT, to create CT classification of the STR depth, and to study the relationship between ST types and the new STR grades. Results In HRCT of non-pathological temporal bones of 100 subjects (200 ears), measurements of the STR and ST were calculated, registered, and analyzed. The depth of the STR was classified into grade 1 with depth less than 3 mm, grade 2 with depth ranged between 3 and 5 mm, and grade 3 with depth more than 5 mm. The mean STR length, width, and height were 4.17 ± 0.86, 3.55 ± 0.65, and 3.64 ± 0.7 mm, respectively, while the ST mean length and width of were 2.52 ± 0.5 and 1.82 ± 0.78 mm, respectively, without significant differences between either sexes or sided. The ST types were found to be type A in 56 ears (28%), type B in 142 ears (71%), and type C in 2 ears (1%). The STR grading was grade 1 in 12 ears (6%), grade 2 in 160 ears (80%), and grade 3 in 28 ears (14%) without significant relationship between ST types and STR grading (P = 0.3). Conclusion The current study provided reliable and applicable methods of CT assessment of STR and ST that can help to predict the degree of surgical visibility of the ST and STR during ear surgery.

Persistence of the Stapedial Artery: A Histopathologic Study

1985 ◽  
Vol 93 (3) ◽  
pp. 298-312 ◽  
Author(s):  
Mitchell Marion ◽  
Raúl Hinojosa ◽  
Anwar A. Khan
Keyword(s):  
Facial Nerve ◽  
Clinical Significance ◽  
Rare Event ◽  
Middle Meningeal Artery ◽  
The Third ◽  
Histopathologic Study ◽  
Stapedial Artery ◽  
Developmental Theories ◽  
Temporal Bones ◽  
Meningeal Artery

Persistence of the stapedial artery is a rare event. Fewer than 30 cases have been reported since the discovery of this artery in 1836. We carried out a histopathologic study on three temporal bones from two patients who had this anomaly, and were able to trace the full course of the artery. In two specimens a large stapedial artery persisted and substituted for the middle meningeal artery. In the third, a small, persistent stapedial artery ended in the arterial plexus surrounding the facial nerve. Persistence is discussed in terms of embryogenesis, developmental theories, histologic findings, and clinical significance. The material suggests that the stapedial artery can persist to varying degrees

Malignant Melanoma Presenting as an Intrathymic Tumor

2000 ◽  
Vol 124 (1) ◽  
pp. 130-134
Author(s):  
P. M. Alli ◽  
B. J. Crain ◽  
R. Heitmiller ◽  
P. Argani
Keyword(s):  
Malignant Melanoma ◽  
Previous History ◽  
Clinical History ◽  
Computed Tomographic ◽  
Eosinophilic Cytoplasm ◽  
S 100 ◽  
History Of ◽  
Solitary Metastases ◽  
Physical Findings ◽  
Pleomorphic Cells

Abstract The identification of malignant melanoma in a visceral organ of nonepidermal origin is not an uncommon occurrence. Frequently, these cases are solitary metastases that present years after a thin epidermal melanoma has been diagnosed (and sometimes forgotten). However, primary visceral melanomas have been reported that have not been preceded by an epidermal lesion. We describe herein a unique case of melanoma presenting as a primary intrathymic tumor. The patient had no previous history of epidermal melanoma, and extensive workup did not reveal evidence for an alternative primary site. The tumor exhibited histologic features characteristic of melanoma, including an abundance of large pleomorphic cells with eosinophilic cytoplasm, prominent nucleoli, and occasional intranuclear inclusions. Tumor cells stained for HMB-45 and S-100 protein and ultrastructural analysis revealed stage II and stage III melanosomes. The patient remained free of disease until intrathoracic recurrence was detected on a computed tomographic scan 14 months later. The lack of clinical history and physical findings of melanoma at presentation, the intrathymic location of the tumor, and the pattern of recurrence suggest that this case likely represents a primary thymic melanoma, a previously unreported entity.

Tympanometry Revealing Middle Ear Pathology

1976 ◽  
Vol 85 (2_suppl) ◽  
pp. 209-215 ◽  
Author(s):  
Ulf Renvall ◽  
Jörgen Holmquist
Keyword(s):  
Middle Ear ◽  
Pure Tone ◽  
Screening Method ◽  
Initial Study ◽  
Predisposing Factor ◽  
Pilot Studies ◽  
Impedance Audiometry ◽  
Middle Ear Pressure ◽  
Stapedius Reflex ◽  
Temporal Bones

In order to evaluate the usefulness of impedance audiometry as a screening method for school children, two different pilot studies were performed. The results indicated that impedance audiometry (tympanometry and stapedius reflex test) was more efficient than otoscopy and pure tone screening in the detection of ears with secretory otitis media (SOM). In order to gain some more experience, an extended study of 800 7-year-olds was performed. The results from this investigation showed 6.5% pathological values with pure tone screening, 13.5% pathological values with tympanometry and 32% elevated or nonelicitable stapedius reflexes. Analysis of our observations indicates that the stapedius reflex may be too sensitive a test to be used as a screening method. Tympanometry, however, is recommended as a complement to pure tone screening in screening of children. A 6–12 months follow-up was also performed on 357 ears in which an initial study had shown a middle ear pressure of ≤ −100 mm H2O. At the repeated test 20% had pathological pure tone screening, 40% had a middle ear pressure of ≤ −100 mm H2O, 57% had elevated or nonelicitable stapedius reflexes, and 14% had middle ear effusion. The high frequency of persisting abnormal middle ear pressure and effusion in these 357 ears suggests that a middle ear pressure of ≤ −100 mm H2O can be a predisposing factor for SOM. In an experimental study on human temporal bones it was demonstrated that the tympanogram preserves its original appearance when the water level is low in the middle ear, while a higher level gives rise to a pathological tympanogram. It is also demonstrated that there is a discrepancy between the tympanometrically, indirectly recorded middle ear pressure and the middle ear pressure as measured manometrically, directly from the middle ear.

scholarly journals The Histopathological Spectrum and Clinico-Pathological Concordance in 85 Cases of Skin Biopsy: A Single Center Experience

2021 ◽  
Vol 19 (1) ◽  
pp. 20-24
Author(s):  
Harendra Kumar Jha ◽  
Achyut Pokharel
Keyword(s):  
Skin Biopsy ◽  
Skin Disease ◽  
Clinical History ◽  
Pathological Diagnosis ◽  
Single Center Experience ◽  
Clinical Diagnoses ◽  
Histological Data ◽  
Male Patients ◽  
The Mean ◽  
Physical Findings

Introduction Skin disease is common in developing countries but the spectrum varies widely. Skin biopsy is an important tool in confirming or establishing diagnoses in cases with diagnostic dilemmas. And, there may be a discrepancy between clinical and pathological diagnoses.  Objective To determine the spectrum of histological diagnoses in skin disease and to know the consistency between clinical and pathological diagnoses. Materials and methods A retrospective review of histological and clinical diagnoses was done at a multi-specialty hospital. A total of 85 cases were included in the study. Clinical and histological data along with demographic details, the site of the biopsy was noted. Concordance between clinical and pathological diagnosis was determined as concordant, partially concordant and discordant. Results There were 60% female and 40% male patients out of 85 biopsies. The most common age group was 31-40 years and the mean age was 41.24 years. The most common histological spectrum was infectious group in 29.4%, followed by papulosquamous disorders in 22.4% and eczema in 12.9% cases. The concordance between clinical and pathological diagnosis was 60%, while partial concordance was seen in 16.5% and discordance was seen in 23.5% cases. Conclusion Skin biopsy is an important tool in confirming clinical diagnoses. There is a wide variation of histological diagnoses and concordance with clinical diagnoses may be increased with proper clinical history, physical findings and differential diagnosis.  

scholarly journals COVID-19 Admission Screening, and Assessment of Infectiousness at an Academic Medical Center, Iowa 2020

2021 ◽  
pp. 1-19
Author(s):  
Mohammed Alsuhaibani ◽  
Takaaki Kobayashi ◽  
Alexandra Trannel ◽  
Stephanie Holley ◽  
Oluchi J. Abosi ◽  
...  
Keyword(s):  
Medical Center ◽  
Academic Medical Center ◽  
Clinical History ◽  
Rt Pcr ◽  
University Of Iowa ◽  
Past Infection ◽  
Admission Screening ◽  
Academic Medical ◽  
The University ◽  
Positive Results

Abstract Objective: Patients admitted to the hospital may unknowingly carry SARS-CoV-2 and hospitals have implemented SARS-CoV-2 admission screening. However, because SARS-CoV-2 RT-PCR may remain positive for months after infection, positive results may represent active or past infection. We determined the prevalence and infectiousness of patients who were admitted for reasons unrelated to COVID-19 but tested positive on admission screening. Methods: We conducted an observational study at the University of Iowa Hospitals & Clinics from July 7 to October 25, 2020. All patients admitted without suspicion of COVID-19 infection were included and medical records of those with a positive admission screening test were reviewed. Infectiousness was determined using patient history, PCR cycle threshold (Ct) value, and serology. Results: A total of 5,913 patients were screened and admitted for reasons unrelated to COVID-19. Of these, 101 had positive admission RT-PCR results. Thirty-six patient were excluded because they had respiratory signs/symptoms on admission on chart review. Sixty-five patients (1.1%) did not have respiratory symptoms. A total of 55 patients had Ct values available and were included in this analysis. The median age was 56 years, and (51%) were male. Our assessment revealed that 23 patients (42%) were likely infectious. The median duration of in-hospital isolation was five days for those likely infectious and two days for those deemed non-infectious. Conclusions: COVID-19 infection was infrequent among patients admitted for reasons unrelated to COVID-19. An assessment of the likelihood of infectiousness using clinical history, RT-PCR Ct values, and serology may help discontinue isolation and conserve resources.

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