bony erosion
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Author(s):  
Shay Shemesh ◽  
Judith Luckman ◽  
Tal Marom ◽  
Oded Kraus ◽  
Sharon Ovnat Tamir

Abstract Introduction High-resolution computed tomography (HRCT) scans of the temporal bone are used to assess the bony erosion of the middle-ear structures whenever cholesteatoma is suspected. Objective To study the differences in HRCT Hounsfield unit (HU) index measurements of middle-ear bony structures between an ears with and without cholesteatoma. Methods A retrospective study of 59 patients who underwent surgery due to unilateral cholesteatoma. The HRCT HU index of the scutum, of three middle-ear ossicles, of the lateral semicircular canal (LSCC), and of the fallopian canal was measured in both ears. A comparison was made between the cholesteatoma and the non-cholesteatomatous ear (control). All measurements were conducted by an otolaryngologist. To assess the interobserver bias, 10% of the samples were randomly and independently assessed by another otolaryngologist and a neuroradiologist who were blinded. Results The average HU index was lower in the ear with cholesteatoma when compared with the non-cholesteatomatous ear. While the differences were statistically significant regarding the measurements of the scutum (516.02 ± 311.693 versus 855.64 ± 389.999; p = 0.001), the malleus (1049.44 ± 481.765 versus 1413.47 ± 313.376; p = 0.01), and the incus (498.03 ± 264.184 versus 714.25 ± 405.631; p = 0.001), the differences in the measurements of the LSCC (1042.34 ± 301.066 versus 1154.53 ± 359.609; p = 0.69) and of the fallopian canal (467.19 ± 221.556 versus 543.51 ± 263.573; p = 0.108) were not significantly different between both groups. The stapes was immeasurable in both groups due to its small size. Conclusion Hounsfield unit index measurements are a useful tool that may aid in the diagnosis of early-stage cholesteatoma.


2021 ◽  
Vol 2021 ◽  
pp. 1-4
Author(s):  
Kohei Matsuo ◽  
Satoshi Tanaka ◽  
Masayuki Sakata ◽  
Hiroki Takeda ◽  
Akihiro Nagata ◽  
...  

Primary nasopharyngeal mycobacteriosis is a rare disease. We present a case in which skull base bone erosion appeared and was alleviated during the course of the treatment. Bone complications occur in osteoarticular mycobacteriosis, but their occurrence in primary nasopharyngeal mycobacteriosis has not been reported. A 77-year-old immunocompromised Asian woman presented with a right occipitotemporal headache. An ulcerative mass covered with a thick yellowish discharge was found in the roof and posterior walls of the right nasopharynx. Because histopathological examination indicated the presence of mycobacterial infection, we began using antituberculosis medication for the treatment because of the possibility of primary nasopharyngeal tuberculosis. However, this was followed by glossopharyngeal and vagus nerve paralysis. Computed tomography (CT) showed a diffuse enhancing mucosal irregularity in the nasopharynx with bony erosion of the external skull base. Deep tissue biopsy was repeated to differentiate it from malignant lesions, and drainage of pus from the right nasopharynx was confirmed. Subsequently, the headache, neurological findings, and the yellowish discharge disappeared, and the bony erosion of the external skull base was alleviated. Surgical intervention should also be considered for drug-resistant mycobacteriosis. We concluded that mycobacteriosis should also be considered apart from carcinoma even if CT shows a diffuse enhancing mucosal irregularity with bone destruction in the nasopharynx.


2021 ◽  
Vol 14 (5) ◽  
pp. e239161
Author(s):  
Amrita Virdi ◽  
Khaled Borghol ◽  
Bethan Edwards ◽  
Neal Barnard

Trichilemmoma is a benign tumour which arises from the hair follicle root sheath, and commonly occurs in the head and neck area. Malignant transformation and locally aggressive growth of these tumours are very rare. Surgical excision remains the mainstay of management, with scarce evidence for other treatment modalities. We describe our experience of a malignant trichilemmal tumour which demonstrated bony erosion with intracranial extension. Our patient was treated with radical radiotherapy, with a good response at 6 months of follow-up. This case highlights the need to consider malignant potential in recurrent skin lesions, along with the potential for trichilemmoma to erode bone, necessitating the consideration of different treatment modalities.


2021 ◽  
Vol 14 (3) ◽  
pp. e240460
Author(s):  
Neal Rajan Godse ◽  
Giuseppe Vittorio Staltari ◽  
Katherine Doeden ◽  
Grant Shale Gillman

A 67-year-old man presented with progressive diplopia. On evaluation, he was noted to have bilateral palsies of cranial nerves III, IV and VI as well as a unilateral right true vocal fold paralysis. CT and MRI studies demonstrated a T2-bright left ethmoid mass with no evidence of bony erosion. Direct visualisation demonstrated a polypoid appearing mass of the left sphenoethmoid recess. Operative biopsy was pursued with final pathology demonstrating benign seromucinous hamartoma. Subsequent blood work demonstrated high titres of anti-acetylcholine receptor antibodies consistent with myasthenia gravis. The patient was started on pyridostigmine with improvement in his ocular cranial neuropathies.


2021 ◽  
Vol 12 ◽  
Author(s):  
Michele Cavaliere ◽  
Antonella Miriam Di Lullo ◽  
Camilla Russo ◽  
Massimo Mesolella ◽  
Elena Cantone ◽  
...  

Purpose: The aim of the study is to compare the accuracy of unstructured preoperative Computed Tomography (CT) reports from non-tertiary diagnostic centers with intraoperative findings in a large cohort of patients with Chronic Otitis Media (COM) undergone surgery.Methods: From 2012 to 2019, a total number of 301 patients were considered for our purposes. All patients with clinical evidence of COM had preoperative non-contrast high resolution CT scan of the temporal bone in non-tertiary diagnostic centers, performed within 3 months before surgery.Results: The accuracy of CT reports was analyzed in terms of nature, anatomical site, disease extension, bony erosion, vascular structures abnormalities relevant to surgical planning, and Eustachian tube patency. Compared to post-surgical findings, CT reporting critical analysis revealed a tendency to overestimation of bony erosion, coupled to underestimated description of facial canal/lateral semi-circular canal, vascular structures, and Eustachian tube.Conclusion: Discrepancies between CT reports and surgical findings in middle ear opacification can be at least in part due to limited expertise of general radiologists in ENT neuroimaging. To limit this lack of information and the limited accuracy of middle ear structures depiction, here we propose a structured checklist to adopt in the case of a temporal bone CT scan for COM, in order to optimize the communication with surgeons and provide all the crucial information for an accurate surgical planning.


2021 ◽  
pp. 014556132198945
Author(s):  
John Levinson ◽  
Isolina R. Rossi ◽  
Edward C. Kuan ◽  
Bobby A. Tajudeen

Isolated primary sphenoid sinusitis is a rare occurrence, estimated to make up less than 3% of sinus infections. The posterior anatomic location of the sphenoid makes treatment challenging when it becomes infected. Complications involving intracranial extension to surrounding structures often result in cranial nerve deficits due to their proximity. A single case of chronic sphenoiditis with direct extracranial extension into the prevertebral space is reported with a discussion on clinical presentation, diagnosis, and management. A 46-year-old female patient with diffuse headaches radiating into the neck and throat was evaluated in the office. Computed tomography demonstrated sphenoiditis with direct extension into the prevertebral space. Imaging revealed a purported route of direct extension through the clinoid and directly into the clivus to form an abscess in the longus colli muscle. The patient underwent endoscopic surgical management including drainage of the prevertebral abscess and has since made a full recovery. This is the first reported case of direct extension of sphenoiditis into the prevertebral space. The findings highlight the importance of aggressive treatment of chronic sphenoid infections to prevent detrimental complications. Computed tomography imaging proved an advantageous imaging modality to demonstrate bony erosion and sinus tracts from the skull base to the deep neck space.


2021 ◽  
Vol 12 ◽  
pp. 215265672199625
Author(s):  
Stephen Bennett ◽  
Sheneen Meghji ◽  
Farahnaz Syeda ◽  
Nazir Bhat

Meningitis remains a rare but potentially life-threatening intracranial complication of acute rhinosinusitis. We describe a case of a 62-year-old man with a background of chronic rhinosinusitis who presented to hospital with confusion, fever and bilateral green purulent rhinorrhoea. After immediate sepsis management, urgent contrast-enhanced computed tomography head revealed opacification of all paranasal sinuses and bony erosion of the lateral walls of both ethmoid sinuses. He was treated with intravenous antibiotics, topical nasal steroids, decongestants and irrigation. Following a turbid lumbar puncture and multidisciplinary discussion, he was admitted to the critical care unit and later intubated due to further neurological deterioration. After 13 days admission and rehabilitation in the community he made a good recovery. This case highlights the importance of timely diagnosis and appropriate management of acute rhinosinusitis and awareness of the possible complications. Joint care with physicians and intensivists is crucial in the management of these sick patients.


2020 ◽  
Vol 22 ◽  
pp. 100825
Author(s):  
Holger Schlag ◽  
Christoph Hoffmann ◽  
Jens Castein ◽  
Jonathan Neuhoff ◽  
Frank Kandziora

2020 ◽  
Vol 6 (4) ◽  
pp. 736-742
Author(s):  
John J. Bowman ◽  
Charles C. Edwards II

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