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At least 181 records · Page 10Linked to original sources
PubMed2006

Storage of the incus in the mastoid bowl for use as a columella in staged tympanoplasty.

OBJECTIVE: To evaluate whether the incus of the cholesteatomatous ear preserved in the mastoid bowl during the first stage of planned two-stage tympanoplasty can tolerate long-term implantation and be used in ossicular reconstruction during the second stage. METHODS: The study group included 24 ears of 23 patients who underwent staged tympanoplasty for the treatment of middle ear cholesteatoma. At the first stage, after removing the incus to eradicate the middle ear disease, it was returned to the mastoid bowl and stored there until use at the second stage. The average interval between the two stages was 8.3 months (range 6-12 months). RESULTS: The incus was identified in all cases at the second stage: 10 incudes were found to be covered with a thin mucosa layer, 12 were buried in fibrous or granulation tissue, and 2 were joined to the surrounding bone. Residual cholesteatoma was found in six ears, either in the attic (three ears) or tympanic sinus (three ears). It never occurred in the mastoid bowl where the incus had been preserved. In 19 cases, the incus was available as a short columella for ossicular reconstruction. The remaining five cases were reconstructed using a hydroxyapatite ossicle as a long columella, since the stapes superstructure was missing at the second stage. In one case, the stored incus underwent remarkable absorption between stages. CONCLUSION: Preservation of the incus in the mastoid bowl is an effective option in planned two-stage tympanoplasty, when the incus is considered useful for ossicular reconstruction at the second stage.

Cholesteatoma, Middle Ear↗
PubMed2005

The computed tomographical and tympanometrical evaluation of mastoid pneumatization and attic blockage in patients with chronic otitis media with effusion.

OBJECTIVE: To assess the relation between mastoid size and attic blockage in COME patients treated with ventilation tube insertion and prognosis regarding tympanometric compliance and computed tomography findings of temporal bones. MATERIAL AND METHODS: Twenty-four ears of 15 patients with chronic otitis media with effusion were selected prospectively. The ages of patients were between 5 and 13 years old and eight of them were females. All patient received medical treatment for 10 days. Ventilation tubes were inserted with or without adenoidectomy or adenotonsillectomy to the unimproved patients. Postoperative compliances were measured on first day, first week, and first month and the tympanometric results were compared each one with others and with mastoid pneumatization degree using computerized tomographic findings. RESULTS: The hearing thresholds were between 23 and 43 dB in left ears and between 22 and 45 dB in right ears. Mastoid pneumatization and aditus were normal and open in three (12.6%); sclerotic and open in eight (33.3%); sclerotic and blocked in 13 patients (54.1%), when the temporal bones assessed by computerized tomography. The mean compliance values of patients elevated postoperatively in regard with time and this increase was significant. There was a significant statistical relation between mastoid pneumatization and compliance of the ears. CONCLUSION: Tympanometric assessment may be considered as a valuable and cost-effective method rather than CT in the evaluation of aditus blockage and residual soft tissue of the tympanomastoid region.

Acoustic Impedance Tests↗
PubMed2005

Acute otitis media and mastoiditis following cochlear implantation.

OBJECTIVE: To examine the incidence of acute otitis media (AOM) and mastoiditis in children after cochlear implantation (CI) and to evaluate the role of mastoidectomy in decreasing the rate of AOM in implanted children by comparing two surgical techniques: the Posterior tympanotomy approach (MPTA, with mastoidectomy) and the Suprameatal approach (SMA, without mastoidectomy). METHODS: A retrospective study was conducted on 234 children up to 16 years of age who underwent CI between 1993 and 2003 in our department. The children were divided into two groups according to the surgical technique that had been used for the implantation: the MPTA group and the SMA group. RESULTS: Part of the children with a history of pre-implantation AOM (22 of 29 in MPTA group and 26 of 38 in SMA group) did not suffer from AOM post-CI (p=0.59), and an incidence of AOM after CI in children who did not have history of AOM prior to implantation (13 patients of MPTA group and 15 patients of SMA group) was unrelated to surgical approach (p=0.65). The incidence of pre-implantation AOM was similar for the two groups and declined after CI unrelated to performing of mastoidectomy in surgical technique. Overall, 47 children (20.1%) had post-CI AOM compared to 67 children (28.6%) who had pre-CI AOM. Mastoiditis developed in 11 children (4.7%), all 11 in the MPTA group. A subperiosteal abscess was incised and drained with the retroauricular approach in three of these children and the others were managed with intravenously administered ceftriaxone 50mg/kg/day for 3-5 consecutive days, followed by a course of oral cephalexin until there is complete clinical resolution of the effusion in the middle ear. The implants were preserved in all cases. Seven out of 11 children with mastoiditis had no history of AOM prior to implantation. CONCLUSIONS: AOM and mastoiditis represent common complications of CI that can be successfully treated with the prompt use of antibiotics. However, the subperiosteal abscess could require surgical drainage. In our opinion, the decrease of incidence of AOM in implanted children is the result of natural history of otitis media and is unrelated to the surgical approach.

Abscess↗
PubMed2006

Systematic facial nerve monitoring in middle ear and mastoid surgeries: "surgical dehiscence" and "electrical dehiscence".

OBJECTIVES: To evaluate and systemize intraoperative facial nerve monitoring (IOFNM) in middle ear and mastoid surgeries. STUDY DESIGN AND SETTING: A prospective study. METHODS: IOFNM was performed in 100 patients undergoing middle ear and mastoid surgeries. We checked "surgical dehiscence" under microscopes, and also estimated the minimal threshold of electric current needed to change the electromyography of facial muscles using Nerve Integrity Monitor (NIM)-2 (Xomed, Minneapolis, MN, USA). RESULTS: Forty-three percent of cases showed "surgical dehiscence" and responded to electric stimulation of 0.7 mA or less. "Electrical dehiscence" (<or=0.7 mA) was presented in 73 (73.0%) cases, and 82.2% of these cases responded to 0.4 mA or less. The mean threshold of minimal electrical stimulation was 0.29 mA for tympanic segments and 0.41 mA for mastoid segments. CONCLUSIONS: We recommend an electrical stimulation of 0.7 mA for the first screening and 0.4 mA for the second exploration in order to define the facial nerve using intraoperative NIM-2 monitoring in middle ear and mastoid surgeries.

Adolescent↗
PubMed2000

Intracranial complications of acute mastoiditis.

OBJECTIVE: Oral antibiotic use may have changed the incidence and microbiology of otitic intracranial complications. We reviewed cases of acute mastoiditis to document: (1) incidence of intracranial complications; (2) risk factors; and (3) identify pathologic organisms. METHODS: A retrospective study of children at a tertiary care children's hospital with acute mastoiditis from July, 1986 through June, 1998. RESULTS: 118 children with acute mastoiditis were identified. Eight patients (6.8%), ages 20 months to 14 years, had intracranial complications related to acute mastoiditis. Three children had a sigmoid sinus thrombosis, two children had an epidural abscess, and two children had both complications of sigmoid sinus thrombosis and epidural abscess, and a sigmoid sinus thrombosis and meningitis was present in one child. Pre-admission oral antibiotics were administered for an average of 10 days in seven of the eight patients. Persistent otorrhea and/or otalgia were present in all patients. Intraoperative cultures were negative in four cases (50%). Organisms isolated included: Streptococcus pneumoniae (2); Proteus mirabilis (1); Pseudomonas aeruginosa (1); and coagulase negative Staphylococcus (1). Multi-drug resistant organisms were documented in only one case. All patients underwent a contrast enhanced CT of the temporal bones and brain. Surgical management included complete mastoidectomy in all patients and a pressure equalization tube in seven of the eight cases. CONCLUSIONS: Our review did not document an increase in the incidence of otitic intracranial complications. Persistent otalgia or otorrhea while on oral antibiotics with associated neurologic symptoms are ominous signs suggestive of a complication. Multi-drug resistant organisms are uncommon whereas negative intraoperative cultures are common.

Acute Disease↗
PubMed2000

Acute mastoiditis: predictors for surgery.

To estimate the incidence of acute mastoiditis and identify predictors for mastoid surgery, a retrospective case record study of 38 children hospitalised for acute mastoiditis in Oslo from 1989 to 1998 was performed. Median age at diagnosis was 18 months and 13 (34%) of the children received mastoidectomy. Compared to the period 1970-1979, the incidence of mastoidectomy was significantly reduced. Only seven children (18%) had experienced acute otitis media prior to the current episode. Symptom duration of 6 days or more prior to hospitalisation and elevated white blood cell counts and C-reactive Protein were predictive for mastoidectomy ((OR = 5.0 (1.0-22.8), (OR = 24.5 (2.5-240) and OR = 10.5 (1-108.8)). Furthermore, total time from symptom onset to hospital discharge was significantly higher in children who received mastoidectomy. We suggest early referral to an otolaryngologic department in children suspected of acute mastoiditis.

Acute Disease↗
PubMed2001

Intracranial complications of acute and chronic mastoiditis: report of two cases in children.

OBJECTIVE: The clinical picture of mastoiditis, sigmoid sinus thrombosis and brain abscess has changed with the advent of antibiotics. A delay in the recognition of intracranial complications in children and in the institution of appropriate therapy may result in morbidity and mortality. Increased mortality of the children has been correlated with the neurological status of the patient on admission to hospital. METHOD: A retrospective study was made of two children with acute mastoiditis and sigmoid sinus thrombosis and chronic mastoiditis with cerebellar abscess treated in 1997 in the ENT Department of the Medical University of Gdansk. RESULTS: We present two cases of intracranial complications in children (13 and 11 years old) originating from acute and chronic otitis media. The first case, of a 13-year-old boy with sigmoid sinus thrombosis as a complication of acute otitis media took its course as a typical Symonds Syndrome. Mastoidectomy, thrombectomy and jugular vein ligation associated with antibiotics and edema-reducing drugs and anticoagulants proved to be successful. The second case of an 11-year-old boy with exacerbated chronic otitis media with cholesteatoma and mastoiditis, was complicated by suppurative meningitis, cerebellar abscess, perisinual abscess and sigmoid sinus thrombophlebitis. Neurosurgical approach by suboccipital craniotomy and abscess drainage was ineffective. Otological treatments of modified radical mastoidectomy, thrombectomy, jugular vein ligation, perisinual and cerebellar abscess drainage associated with wide-spectrum antibiotics and edema-reducing drugs were performed with a very good outcome. After 3 years of follow-up the patients remain without any neurological and psychiatric consequences. CONCLUSION: The authors show different courses of both presented complications and imaging techniques and surgical procedures performed in these children. The sigmoid sinus trombosis with Symonds Syndrome may be difficult to diagnose due to previous antibiotics valuable in establishing the diagnosis and the extent of disease. The successful therapy is based on understanding of pathogenesis of the intracranial complication and the cooperation of an otolaryngologist, a neurologist, a neurosurgeon and an ophthalmologist.

Acute Disease↗
PubMed2003

Acute mastoiditis caused by Moraxella catarrhalis.

Acute mastoiditis is the most frequent intratemporal complication of otitis media. The bacteriology of acute otitis media is changing continuously and it differs markedly from the bacteriology of acute mastoiditis. Moraxella catarrhalis (M. catarrhalis) is the third most common bacteria found in acute otitis media, and in recent years its importance as an etiological factor of acute otitis media has markedly increased in certain geographic areas. However, there are no reports of acute mastoiditis caused solely by M. catarrhalis. This report describes a case of a 2-year-old girl with acute mastoiditis and M. catarrhalis in the bacterial culture of middle ear effusion.

Acute Disease↗
PubMed2003

Clinical significance of incidental magnetic resonance image abnormalities in mastoid cavity and middle ear in children.

OBJECTIVE: Magnetic resonance imaging of the head may reveal incidental findings in paranasal sinuses. The purpose of this study was to discover whether similar changes could be identified in the mastoid cavity and middle ear as well. METHODS: A group of 50 children undergoing magnetic resonance imaging of the head for suspected intracranial pathology were prospectively gathered. Their parents completed a questionnaire concerning each child's medical history connected with acute otitis media. Otoradiologists evaluated the pictures for mastoid cavity and middle ear and paranasal sinus abnormalities. RESULTS: In six (12%) children, magnetic resonance imaging detected abnormalities resembling acute inflammatory changes, although none had had acute otitis media during the preceding last 3 months. Abnormalities detected in the paranasal sinuses were not correlated with abnormalities in the mastoid cavity and middle ear. CONCLUSIONS: High signal intensity in magnetic resonance images from the mastoid cavity and middle ear may be incidental and without any clinical significance. These findings must be interpreted together with knowledge of the child's medical condition and clinical examination of the ears.

Acoustic Impedance Tests↗
PubMed1999

Acute mastoiditis in children--our experience.

The incidence of acute mastoiditis and the number of complications has changed since the 1950s, despite the increasing antibiotic effectiveness. Other series concluded that the incidence of acute mastoiditis is rising in the recent years, which can be justified by the antibiotic resistance of the microorganisms and the absence of paracentesis in the treatment of acute otitis media. Our aim is to approach risk factors, clinical presentation, diagnosis and treatment of acute mastoiditis. We reviewed 62 clinical records of patients in pediatric age, observed in D. Estefania Hospital Lisbon, between January 1993 and December 1997. There was a relative homogenous distribution during the 5 years of the study period. The patient age ranged from 5 months to 14 years. They all were treated with intravenous antibiotics. The mean duration of treatment was 7.4 days. We registered 15 complications: 14 retroauricular subperiosteal abscesses and one subdural empyema. The most common isolated microorganism was Streptococcus pneumoniae. We found no statistic difference (P > 0.1) in the incidence of acute mastoiditis between the 5 years of the study.

Acute Disease↗
PubMed1991

Pinch grafting of the open mastoid cavity.

Secondary pinch skin grafting was performed on the mastoid cavities to promote healing of the mastoid wound after ear surgery using the open technique. Pinch grafts (multiple small grafts of the epidermal layer) were transplanted in 20 patients, soon after the mastoid cavities were covered with healthy granulation tissue in a mean of 28.5 days after the initial surgery. The grafts adapted well in 18 of the 20 patients. Epidermization was complete in a mean of 11.1 days after grafting, that is, within 40 days after the initial ear surgery. On the other hand, epidermization in 10 cases without grafting was completed in a mean of 83.3 days after the ear surgery. Thus, the pinch grafts reduced healing time by more than 40 days. The secondary application of pinch grafting was beneficial for healing of exposed mastoid cavities caused by use of the open technique tympanoplasty or radical mastoidectomy.

Cholesteatoma↗
PubMed1989

Recurrent meningitis associated with meningioma of the mastoid cavity.

A 53-year-old female patient who presented with recurrent meningitis as a result of a meningioma, is reported. The meningioma was found to be wholly contained within the left mastoid antrium. To our knowledge this is the first reported case of a meningioma localised to the mastoid antrium. The patient had been assessed in the ENT department on two separate occasions, 17 years and 19 years previously for nebulous symptoms related to the left ear which had cleared spontaneously. Following a second episode of pyogenic meningitis, both of which were associated with aural symptoms, radiological examination suggested an intramastoid pathology which prompted mastoid exploration. Histological examination of the mass confined to the mastoid antum provided the diagnosis of meningioma. There was no clinical or radiological evidence of extratemporal spread of tumour.

Female↗
PubMed1992

Unusually large mastoid antrum ('mega antrum').

Patients 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.

Adolescent↗
PubMed2005

[Acute mastoiditis in children, a retrospective analysis about a period of 25 years].

BACKGROUND: During the last years the classical signs of the acute mastoiditis have changed. Aim of the following study was to examine the change of symptoms as well as the change of incidence. METHODS/PATIENTS: The records of 113 children who received mastoid surgery due to acute mastoiditis were retrospectively investigated. Data covered a regional group of patients during a period of 25 years (1979 - 2003). RESULTS: Considering the drop of the birthrate from 1991 in the East German countries, there was a significant increase of the incidence of acute mastoiditis. The patients had a mean age of 2,5 years. The classical symptoms like "retroauricular swelling, tenderness and protrusion of the auricle" were only noted by 47 children (41.6 %). Preoperative complications appeared as facial palsy, abscess and septic lateral sinus thrombosis in 11 children. Bacterial cultures, taken during surgery yielded in 55.7 % Streptococcus pneumoniae. The therapy contained a surgical intervention combined with antibiotics. CONCLUSIONS: An early surgical treatment by mastoidectomy or antrotomy supported by antibiotics represents the safest method to avoid complications.

Acute Disease↗
PubMed2002

Relationship between mastoid pneumatization and middle ear barotrauma in divers.

OBJECTIVES/HYPOTHESIS: Previous studies have shown a relationship between eustachian tube function and size of mastoid pneumatization, as well as eustachian tube function and middle ear (ME) barotrauma. The purpose of this study is to investigate a possible relationship between size of mastoid pneumatization and ME barotrauma in sports scuba (self-contained underwater breathing apparatus) divers. STUDY DESIGN: Prospective, blinded. MATERIAL AND METHODS: Twenty-four sports scuba divers (48 ears), who were fit to dive in the predive and otolaryngologic examination, were included in the study. Size of mastoid pneumatization was measured by simplified rectangular dimension method on a mastoid x-ray taken at Schüller's view. Divers were counseled to refer to the investigators if any symptoms occurred during and/or after diving. All symptomatic ears were examined within 24 hours of diving by the same investigator, who was blinded to the degree of pneumatization. RESULTS: ME barotrauma occurred in 15 ears (31%) of 11 divers (46%) at one time or another. The median degree of pneumatization in ears with barotrauma (22.9 cm2) was significantly smaller than that in unaffected ears (34.1 cm2; (P <.001). Furthermore, findings showed that with increasing degree of pneumatization, there was a decreasing risk of symptomatic barotrauma (P <.001). No barotrauma occurred in ears with a pneumatization greater than 34.7 cm2. However, barotrauma occurred in all 3 ears with a pneumatization degree smaller than 13.6 cm2. CONCLUSION: Our findings indicate an inverse relationship between size of pneumatization and risk of symptomatic ME barotrauma in sport scuba divers.

Barotrauma↗
PubMed2003

Cost-effectiveness of intraoperative facial nerve monitoring in middle ear or mastoid surgery.

OBJECTIVES: Despite the utility of intraoperative facial nerve monitoring in reducing the risk of iatrogenic facial nerve injury during neurotologic surgery, its routine use during primary or revision surgery remains controversial. One of the major barriers to its acceptance is cost. This study evaluates the cost-effectiveness of intraoperative facial nerve monitoring during middle ear or mastoid surgery. RESEARCH DESIGN/METHODS: A simple decision analytic cost-effectiveness model and a societal approach were used to evaluate three cohorts of individuals who received (1) intraoperative facial nerve monitoring for both primary and revision middle ear or mastoid surgeries, or (2) facial nerve monitoring for revision surgeries only, or (3) no monitoring for any middle ear or mastoid surgeries. RESULTS: Our results strongly favored the use of intraoperative facial nerve monitoring in all patients undergoing middle ear or mastoid surgery, adding about $222.73 to $528.00 US dollars to the total cost. The strategy to monitor primary and revision surgeries had the greatest effectiveness and lowest cost, with an average quality-adjusted life-year (QALY) of 45.68 at an average cost of $238 US dollars. Facial nerve monitoring in revision patients only had similar QALYs (45.67) and higher costs ($292.1). Finally, the strategy not to monitor had the lowest QALY (45.65) and highest cost ($449.8). The analysis was robust across a wide range of changes in both costs and probabilities. CONCLUSIONS: Facial nerve monitoring is cost-effective, and its routine use should be adopted to reduce the risk of iatrogenic facial nerve injury during otologic surgery.

Cost-Benefit Analysis↗
PubMed2002

Primary inverted papilloma of the middle ear and mastoid.

OBJECTIVE: Inverted papilloma (Schneiderian-type papilloma), involving the middle ear and mastoid as a primary lesion or as an extension of a sinonasal papilloma, is an extremely rare occurrence. STUDY DESIGN: The study design was a case report format with a review of the literature. Epidemiologic, diagnostic, therapeutic and follow-up problems are discussed. SETTING: Academic, tertiary referral hospital. PATIENT AND METHODS: The patient underwent Wullstein type I tympanoplasty and complete mastoidectomy, revealing obliteration of the pneumatic cells by polypoid tissue. The middle ear was completely filled by polypoid tissue. Histopathologic examination revealed an inverted papilloma of the middle ear and mastoid. CONCLUSION: Literature reports indicate that inverted papillomas of the middle ear and mastoid differ pathogenically and epidemiologically from sinonasal inverted papillomas. Recurrence rates and association with squamous cell carcinoma are higher in Schneiderian-type papillomas of the middle ear than in inverted papillomas of the nose and paranasal sinuses. Long-term follow-up after removal of inverted papilloma of the middle ear and mastoid is mandatory. Magnetic resonance imaging is the first follow-up examination to perform.

Ear Neoplasms↗
PubMed2005

Canal wall reconstruction tympanomastoidectomy with mastoid obliteration.

OBJECTIVES: This study was designed to evaluate the authors' experience with canal wall reconstruction (CWR) tympanomastoidectomy with mastoid obliteration in the treatment of chronic otitis media with cholesteatoma. STUDY DESIGN: Institutional review board approved retrospective case review. METHODS: Retrospective review was performed of all patients undergoing CWR tympanomastoidectomy with mastoid obliteration from 1997 to 2004. Data included pre- and postoperative audiometry, findings at second look surgery with ossiculoplasty, and postoperative complications including wound infection and canal wall displacement. RESULTS: One hundred thirty ears in 127 adults and children underwent the procedure. Mean time postoperative was 48 (range 2-94) months. A second look ossiculoplasty was performed in 102 (78%). Percentage of ears that remain safe without evidence of recurrence was 98.5. The postoperative infection rate decreased from an initial rate of 14.3% to 4.5% for the last 88 ears after protocol modification. Recurrence occurred in two (1.5%) patients, requiring conversion to a canal wall down mastoidectomy. CONCLUSIONS: A CWR technique can provide improved intraoperative exposure of the middle ear and mastoid without creating a mastoid bowl and reduces the incidence of recurrent disease. A single procedure is used for all patients with acquired cholesteatoma, including children.

Adolescent↗