scholarly journals Paediatric acquired cholesteatoma, our experience in a tertiary care: two year prospective study

2020 ◽  
Vol 6 (11) ◽  
pp. 1960
Author(s):  
Akshay Jain ◽  
Smruti Milan Tripathi ◽  
Poonji Gupta
Keyword(s):  
Soft Tissue ◽  
Facial Nerve ◽  
Temporal Bone ◽  
Middle Ear ◽  
Age Group ◽  
Soft Tissue Density ◽  
Nerve Paralysis ◽  
Tissue Density ◽  
Acquired Cholesteatoma ◽  
Canal Dehiscence

<p><strong>Background:</strong> Aim of the study was to estimate the benefits of having high-resolution computed tomography (HRCT) of temporal bone on clinically evaluated paediatric patients of acquired cholesteatoma.</p><p><strong>Methods:</strong> A total of 60 patients of paediatric age group (2-18 years) who were diagnosed with active squamosal type of chronic otitis media were selected for the study. HRCT of temporal bone was done in all the patients and findings were recorded.</p><p><strong>Results:</strong> Most patients were in the age group of 11-15 years (46.6%). Findings of pars tensa were subtotal perforation in 2 patients (3.3%), small central perforation in 8 patients (13.3%) and postero-superior marginal perforation in 12 patients (20%). Pars flaccida retraction pocket with cholesteatoma was seen in 31 patients (51.6%) and perforation with cholesteatoma in 13 patients (21.6%). Scutum erosion was seen in 31 patients (51.6%), ossicular erosion in 12 patients (20%) and facial nerve paralysis in 2 patients (3.3%). On HRCT temporal bone we found soft tissue density in middle ear in 60 patients (100%), soft tissue density in mastoid in 53patients (88.3%), osscicular erosion in 54 patients (90%), scutum erosion in 46 patients (76.6%), facial nerve canal dehiscence in 5 patients (8.3%), semicircular canal dehiscence in 2 patients (3.3%) and dural plate dehiscence in 11 patients (18.3%).</p><p><strong>Conclusions:</strong> HRCT of temporal bone is helpful in depicting a clearer picture of middle ear cavity structures involved by cholesteatoma and thus helpful in formulating a strategy for further management.</p>

scholarly journals Diagnostic efficacy of high-resolution computed tomography findings in patients of chronic suppurative otitis media atticoantral type

2020 ◽  
Vol 6 (10) ◽  
pp. 1854
Author(s):  
Nikki Gajjar ◽  
Neena Bhalodiya ◽  
Simple Bhadania
Keyword(s):  
Soft Tissue ◽  
Temporal Bone ◽  
Facial Canal ◽  
Soft Tissue Density ◽  
High Resolution Computed Tomography ◽  
Suppurative Otitis Media ◽  
Tissue Density ◽  
Facial Canal Dehiscence ◽  
Operative Findings ◽  
Canal Dehiscence

<p><strong>Background: </strong>High resolution computed tomography (HRCT) provides information about anatomy and pathology of temporal bone and middle ear cleft, thus becoming important imaging modality in diagnosis and pre-operative planning in patients of chronic suppurative otitis media (attico-antral) CSOM (AA) type. The aim of study was to study disease extension and plan surgery accordingly in patients of CSOM (AA) and to study correlation between the HRCT findings and intra-operative findings of CSOM (AA) like soft tissue density mass, ossicular chain erosion, facial canal dehiscence, semi-circular canal erosion.</p><p><strong>Methods: </strong>Study of 70 patients clinically diagnosed of having CSOM (AA) in period between August 2018 to March 2020 was done at Sola civil hospital, Ahmedabad. All patients were advised HRCT temporal bone except those who had contraindications to CT scan, analysed and operated. Pre-operative CT-scan findings and intra-operative findings were compared for statistical analysis.</p><p><strong>Results: </strong>Soft tissue density was found in 100% of cases on HRCT temporal bone. Bony erosion seen in 25% of cases. 90% showed ossicular erosion. Lateral semi-circular canal fistula was observed in 10% of cases with facial canal dehiscence in 10% of cases. Intra-operative findings showed accuracy of HRCT in detecting soft tissue density to be 100%; bony erosion was observed in 25% cases. 10% patients had lateral semi-circular canal fistula. Facial canal dehiscence was seen in 15% cases.</p><strong>Conclusion: </strong>HRCT has proved quite useful and reliable to identify the disease extension before surgery and plan surgery accordingly.<p> </p>

scholarly journals Spontaneous Middle Fossa Encephalocele

2016 ◽  
Vol 31 (2) ◽  
pp. 63-64
Author(s):  
Nathaniel W. Yang
Keyword(s):  
Soft Tissue ◽  
Temporal Bone ◽  
Middle Ear ◽  
Middle Fossa ◽  
Resonance Imaging ◽  
Middle Ear Effusion ◽  
Soft Tissue Density ◽  
Air Cells ◽  
Ear Effusion ◽  
Mastoid Air Cells

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

scholarly journals Blunting of the Scutum: A Key Feature in the Radiologic Diagnosis of Acquired Cholesteatoma

2008 ◽  
Vol 23 (1) ◽  
pp. 37-38 ◽  
Author(s):  
Nathaniel W. Yang
Keyword(s):  
Soft Tissue ◽  
Middle Ear ◽  
Bone Erosion ◽  
Cell System ◽  
Ct Imaging ◽  
Radiologic Diagnosis ◽  
Soft Tissue Density ◽  
Acquired Cholesteatoma ◽  
Ear Effusion

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

scholarly journals Micro-CT imaging of Thiel-embalmed and iodine-stained human temporal bone for 3D modeling

2021 ◽  
Vol 50 (1) ◽  
Author(s):  
Sebastian Halm ◽  
David Haberthür ◽  
Elisabeth Eppler ◽  
Valentin Djonov ◽  
Andreas Arnold
Keyword(s):  
Soft Tissue ◽  
Temporal Bone ◽  
Middle Ear ◽  
3D Modeling ◽  
Soft Tissues ◽  
Ct Imaging ◽  
Micro Ct ◽  
Data Set ◽  
Iodine Staining ◽  
Tissue Structures

Abstract Introduction This pilot study explores whether a human Thiel-embalmed temporal bone is suitable for generating an accurate and complete data set with micro-computed tomography (micro-CT) and whether solid iodine-staining improves visualization and facilitates segmentation of middle ear structures. Methods A temporal bone was used to verify the accuracy of the imaging by first digitally measuring the stapes on the tomography images and then physically under the microscope after removal from the temporal bone. All measurements were compared with literature values. The contralateral temporal bone was used to evaluate segmentation and three-dimensional (3D) modeling after iodine staining and micro-CT scanning. Results The digital and physical stapes measurements differed by 0.01–0.17 mm or 1–19%, respectively, but correlated well with the literature values. Soft tissue structures were visible in the unstained scan. However, iodine staining increased the contrast-to-noise ratio by a factor of 3.7 on average. The 3D model depicts all ossicles and soft tissue structures in detail, including the chorda tympani, which was not visible in the unstained scan. Conclusions Micro-CT imaging of a Thiel-embalmed temporal bone accurately represented the entire anatomy. Iodine staining considerably increased the contrast of soft tissues, simplified segmentation and enabled detailed 3D modeling of the middle ear.

scholarly journals Imaging features of hemangioma in long tubular bones

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Lei Cao ◽  
Jin-Xu Wen ◽  
Shu-Man Han ◽  
Hui-Zhao Wu ◽  
Zhi-Gang Peng ◽  
...  
Keyword(s):  
Soft Tissue ◽  
Plain Radiograph ◽  
Ground Glass Opacity ◽  
Plain Radiography ◽  
Long Bone ◽  
Imaging Features ◽  
Mri Imaging ◽  
Soft Tissue Density ◽  
Tissue Density ◽  
Hyperintense Signal

Abstract Background To investigate the imaging features of hemangiomas in long tabular bones for better diagnosis. Methods Twenty-four patients with long bone hemangiomas confirmed by pathology were enrolled. Nineteen patients had plain radiography, fourteen patients had computed tomography (CT) and eleven had magnetic resonance imaging (MRI). The hemangioma was divided into medullary [13], periosteal [6] and intracortical type [5]. Results Among 19 patients with plain radiography, eleven patients were medullary, three periosteal, and five intracortical. In the medullary type, the lesion was primarily osteolytic, including five cases with irregular and unclear rims and one lesion having osteosclerotic and unclear rims. In three patients with the periosteal type, the lesion had clear rims with involvement of the cortical bone in the form of bone defect, including two cases with local thickened bone periosteum and one case having expansile periosteum. Five intracortical hemangiomas had intracortical osteolytic lesions with clear margins. Among 14 patients with CT imaging, 8 cases were medullary, three periosteal, and three intracortical. Among 8 medullary hemangiomas, one had ground glass opacity, and seven had osteolytic, expansile lesions like soft tissue density with no calcification. In three periosteal cases, the lesion was osteolytic with thickened periosteum and narrowed medullary cavity. In three intracortical hemangiomas, the lesion was of even soft tissue density with no calcification. Among 11 patients with MRI imaging, seven were medullary, two periosteal, and two intracortical. Among 7 medullary lesions, six were of hypointense signal on T1WI and hyperintensesignal on T2 WI. In two periosteal cases, the periosteum was thickened, with one case being of equal signal, and the other having no signal. Two intracortical hemangiomas were both of slightly low signal on T1WI but hyperintense signal on T2WI. Conclusions The long bone hemangiomas had characteristic cystic honeycomb-like presentations in plain radiograph. CT and MRI imagings are helpful for diagnosis of hemangiomas in long bone.

INCIDENCE OF CRANIAL NERVE PARALYSIS IN POLIOMYELITIS IN RELATION TO PRESENCE OR ABSENCE OF TONSILS

PEDIATRICS ◽  
1958 ◽  
Vol 21 (1) ◽  
pp. 94-105
Author(s):  
F. H. Top
Keyword(s):  
Facial Nerve ◽  
Cranial Nerves ◽  
Age Group ◽  
Real Difference ◽  
Satisfactory Explanation ◽  
Nerve Paralysis ◽  
Cranial Nerve Paralysis ◽  
Significant Difference ◽  
The Central Nervous System ◽  
The Common

Evidence is presented from data covering the period 1940 to 1952 which corroborates the conclusion of previous studies that prior tonsillectomy probably adversely affects the occurrence of brainstem paralysis (bulbar and bulbospinal) in poliomyelitis. Neither this study nor any preceding studies relating to this problem have proved the contention. On the basis that the hypothesis is correct, an attempt is made to find an answer by studying the incidence of the common paralysis of cranial nerves (VII, IX and X and XI) in bulbar and bulbospinal cases of poliomyelitis on the basis of presence or absence of tonsils. Rates of incidence of paralysis of cranial nerves, not adjusted for age, indicate a decidedly higher proportion of paralysis of the facial nerve (VII) among nontonsillectomized patients whereas tonsillectomized persons are preportionately more affected by palatal and pharyngeal paralysis (nerves IX and X). Paralysis of the facial nerve appears from two studies to occur more commonly at earlier ages, particularly in the age group 0 to 4 years. However, age adjustment did not erase, although it did somewhat lower, the TR/TP ratio. This finding lends credence to a real difference but can only be applied to this study, as Paffenbarger in a smaller study found no significant difference in frequencies of paralysis of the facial nerve between groups with tonsils removed and tonsils present, and Southcott, also in a small study, found paralysis of the facial nerve more common among tonsillectomized patients with bulbar (includes bulbospinal) involvement. The differences noted for palatal and pharyngeal paralyses (nerves IX and X) in the unadjusted rates as between tonsillectomized and nontonsillectomized patients remain statistically different and in some instances significant when corrections for age are made. The results of this study are suggestive but give no entirely satisfactory explanation for the differences noted. Various explanations previously offered are cited and briefly discussed. Perhaps more definitive studies in animals along the approach suggested by Southcott will prove more fruitful, namely, labelling virus by some radioactive element in order to trace the route it takes to the central nervous system.

Comparison of the application of artificial ossicles and autologous ossicles in the reconstruction of a damaged ossicular chain

2018 ◽  
Vol 132 (10) ◽  
pp. 885-890
Author(s):  
L Zhao ◽  
J Li ◽  
S Gong
Keyword(s):  
Facial Nerve ◽  
Temporal Bone ◽  
Pure Tone ◽  
Bone Fractures ◽  
Pure Tone Audiometry ◽  
Ossicular Chain ◽  
Facial Nerve Paralysis ◽  
Temporal Bone Fracture ◽  
Nerve Paralysis ◽  
Ossicular Reconstruction

AbstractObjectiveTo evaluate the therapeutic effect that the titanium partial ossicular reconstruction prosthesis and autologous ossicles have on hearing loss after reconstruction of a damaged ossicular chain.MethodsForty-two medical records of treatments carried out from 2013 to 2015 for ossicular chain damage with facial nerve paralysis due to temporal bone fractures were reviewed. The study assessed: causes of damage, pre-operative pure tone audiometry findings, types of intra-operative ossicular chain damage, intra-operative ossicular chain repair methods (titanium partial ossicular reconstruction prosthesis or autologous ossicles) and post-operative pure tone audiometry results.ResultsThe titanium partial ossicular reconstruction prosthesis was used in 26 cases; the average air–bone gap was 32.3 ± 5.3 dB pre-operatively and 12.8 ± 5.3 dB post-operatively. Autologous ossicles were used in 16 cases; the average air–bone gap was 33.4 ± 4.5 dB pre-operatively and 17.8 ± 7.8 dB post-operatively.ConclusionOssicular chain reconstruction is an effective way of improving hearing in patients with ossicular chain damage. The results suggest that repair with either the titanium partial ossicular reconstruction prosthesis or autologous ossicles can improve hearing following ossicular chain injury with facial nerve paralysis caused by a temporal bone fracture.

scholarly journals Facial nerve palsy as the first sign of late breast cancer metastasis to the temporal bone

2021 ◽  
pp. 40-40
Author(s):  
Zoran Dudvarski ◽  
Nenad Arsovic ◽  
Milovan Dimitrijevic ◽  
Sasa Jakovljevic ◽  
Novica Boricic ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Hearing Loss ◽  
Facial Nerve ◽  
Temporal Bone ◽  
Cancer Metastasis ◽  
Metastatic Breast ◽  
Breast Cancer Metastasis ◽  
Facial Nerve Paralysis ◽  
Nerve Paralysis ◽  
Radiological Diagnostics

Introduction. Late metastases of malignant tumors in the temporal bone are very rare lesions. They can be asymptomatic for a long time, and usually manifest themselves in the form of hearing loss, dizziness, tinnitus, and paralysis of the facial nerve. Modern radiological diagnostics and explorative surgery with biopsy are essential for diagnosis. Case report. We present a rare and unusual case of a 66-year-old female patient with a facial nerve paralysis that appeared as the first sign of metastatic breast cancer in the temporal bone 10 years after treatment. A sudden hearing loss and dizziness occurred six months later and value of CA 15-3 was elevated. Scintigraphy pointed to susceptible metastatic deposits of the axial skeleton, without lesions in the temporal bone. Finally, repeated computerized tomography revealed osteolytic changes of the temporal bone six months after that. Immunohistochemical analysis of mastoid tissue samples confirmed that it was a breast cancer metastasis. One year after palliative radiotherapy and oral hormone therapy, a patient has a good general condition with better function of the facial nerve. Conclusion. A high degree of clinical suspicion sometimes requires repeated radiological diagnostics in order to detect osteolytic metastatic changes in the temporal bone, but also in other bone structures within the hematogenous dissemination of the malignant disease.

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