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Radiation injury of the temporal bone is a common occurrence following external beam treatments. Injuries can be mild, consisting of radiation otitis media, or more extensive, including bone and soft tissue necrosis with infection and intracranial complications. Pathogenesis of radiation-induced temporal bone injury along with treatment programs are discussed.
Preservation and usefulness of human gross temporal bones that have been dissected or drilled have always been a problem. This article describes application of the technique of plastination developed by von Hagens to the temporal bone. The use of this technique permits development of a collection of both anatomically dissected and surgically drilled temporal bones which can be studied by the otolaryngologist at any level. The procedure involves impregnation of the specimen with uncured polymers--a silicone rubber of medium viscosity followed by curing in a vapor bath. The advantages of this technique are that the plastinated temporal bone can be studied and handled without any unpleasant odor and there is no need for liquid preservation. The potential problem of the specimen drying out and becoming useless is thus avoided.
PURPOSE: To review the CT and MR characteristics of temporal bone malignancy, and to evaluate the relationship between malignancies of the temporal bone and parotid gland. METHODS: A group of 15 surgical patients with diagnosis of temporal bone malignancy were retrospectively reviewed. These included 11 cases of primary temporal bone malignancy and four cases of secondary carcinoma of the temporal bone from a primary tumor of the parotid gland. Three primary temporal bone malignancies were recurrences, and two secondary tumors were parotid recurrences. RESULTS: Five of the 11 patients with primary temporal bone malignancy had parotid infiltration (45%). All four patients with secondary temporal bone destruction caused by parotid carcinoma had erosion of the mastoid, two with erosion of the external auditory canal, and one of the middle ear. CONCLUSIONS: It is important radiographically to recognize the close relationship between malignancies of the temporal bone and parotid gland, because either may secondarily invade the other. Suspicion of malignancy in either the temporal bone or parotid gland necessitates complete imaging of the other structure. Temporal bone or skull base erosion were best seen on CT at bone algorithm. MR with and without infusion provided excellent delineation of soft-tissue tumor margins, muscle infiltration, intracranial extension, and vascular encasement.
The importance of computed tomography (CT) in analyzing temporal bone diseases has increased, and the ability to reconstruct the temporal bone structures in three dimensions from multiple CT films has been required. In order to facilitate the visualization of temporal bone structures, we tried reconstructing temporal bone CT images three-dimensionally using a personal computer, and evaluated the possibility of using three-dimensional CT images clinically. Temporal bone CT scan films from five cases of cholesteatoma and a case of otosclerosis as control were examined. Four temporal bone structures (temporal bone contour, middle ear, mastoid, and inner ear) and cholesteatoma, extracted from enlarged black and white CT films, were inputted to the personal computer. Data import and image reconstruction procedures were performed using commercially available software. Our results indicate that three-dimensional reconstructions contribute to visualizing temporal bone structures spatially, and to choosing surgical approaches in difficult cases, such as petrous bone cholesteatoma. In conclusion, three-dimensional reconstructions using a personal computer is useful in the diagnosis and treatment of cholesteatoma.
HYPOTHESIS: Contamination of archival human temporal bones with extraneous deoxyribonucleic acid may represent a potentially significant problem in the analysis of nucleic acids isolated from archival specimens. BACKGROUND: During the past decade, there has been growing interest in the development of molecular biologic techniques that can be applied to the investigation of pathologic changes in archival human temporal bones. The impetus for the development of these techniques is in part related to the fact that the temporal bone collections represent a repository of archival material compiled over decades, which is not available from living patients. METHODS: An archival human temporal bone specimen from a male patient with the Mohr-Tranebjaerg syndrome (formerly called DFN-1) and a well-characterized mutation was analyzed for the presence of the mutation by a standard method for extraction, isolation, amplification, and sequencing of deoxyribonucleic acid. The experiment was repeated four times. RESULTS: The deoxyribonucleic acid sequence from three of four extractions was normal. The known mutation was easily and repeatedly demonstrated in a blood sample from the same individual. Because Mohr-Tranebjaerg syndrome is X-linked, there is only one allele, and therefore there is no potential endogenous source to account for the normal sequence that was amplified. Contamination of the tissue sections by extraneous deoxyribonucleic acid presumably occurred during acquisition and processing of the temporal bone. CONCLUSIONS: Contamination of archival temporal bones with exogenous deoxyribonucleic acid is a significant potential problem that must be considered in the interpretation of the results of deoxyribonucleic acid retrieved from archival sections. The authors recommend collecting blood samples from temporal bone donors in the future to ensure the availability of a reliable source of deoxyribonucleic acid.
Although malignant melanoma is known to metastasize to various sites including the temporal bones, there have been few studies on temporal bone histopathology in malignant melanoma. Here we describe the temporal bone histopathology of 5 patients (10 temporal bones) who died of malignant melanoma with multiple metastasis to many internal organs and bones. We investigated the temporal bone based on the following three points: 1) the presence of metastatic lesions in the temporal bone, 2) inner ear pathology, and 3) the distribution of melanin in the inner ear. Normal melanin distribution was also studied in 35 temporal bones of patients without malignant melanoma. Metastatic malignant melanoma was observed in 5 temporal bones from 3 patients, in two of whom the internal auditory canal was involved bilaterally by melanoma cell infiltration. In the remaining patient (one ear), metastatic melanoma was found along the dura mater of the posterior cranial fossa to the mastoid air cells. In the former two patients, the inner and outer hair cells as well as the stria vascularis showed degenerative changes to various extents. In particular, the inner ear changes were severe in the ear with the decongestion of the inner ear vessels. Melanin was found in the modiolus, stria vascularis, osseous spiral lamina, membranous labyrinth, and endolymphatic sac, as previously reported. The amount of melanin in the inner ear increased with age in the control patients, but was greater than in the controls, in all of the cases of malignant melanoma except one, in which metastatic lesions were present in the internal auditory canal with marked congestion of the inner ear vessels.
OBJECTIVE: To examine the etiology, presentation, and management of temporal bone fractures in children. STUDY DESIGN: Case control. METHOD: Retrospective review of a level I pediatric trauma center from July 1, 1990 to November 1, 1996 identified 680 patients. Inclusion criteria of age less than 14 years and only blunt temporal bone trauma identified 122 patients, with 97 charts available for review. The criteria for temporal bone fracture consisted of both clinical and radiologic information. Only patients with temporal bone fractures confirmed by computed tomography, a complete otolaryngology examination, and audiometric evaluations were included in the study. The data were analyzed with the Kruskal-Wallis analysis of variance (ANOVA) for examining the three separate age groups of fractures. Chi-squared analysis was used to compare these data with previously published adult and pediatric temporal bone fracture series and to examine the three separate age groups of fractures. RESULTS: The review identified 72 children with 79 temporal bone fractures: 47 boys and 25 girls. The patients ranged from 6 months to 14 years of age, with a bimodal distribution of patients with peaks at 3 years and 12 years of age. The most common causes of fractures were motor vehicle accidents (47%), falls (40%), biking accidents (8%), and blows to the head (7%). Common presenting signs and symptoms included hearing loss (82%), hemotympanum (81%), loss of consciousness (63%), intracranial injuries (58%), bloody otorrhea (58%), extremity fractures (8%), and facial nerve weakness (3%). The most common causes of temporal bone fractures were falls and motor vehicle accidents. Forty-two patients were noted to have bloody otorrhea and possible cerebrospinal fluid leak. Twenty-four received intravenous antibiotics. No patient developed prolonged otorrhea or meningitis during hospitalization and the follow-up period. The classification of fracture patterns was longitudinal, 54%; transverse, 6%; oblique, 10%; squamous, 27%; and other, 3%. Hearing loss was found in 59 patients, with conductive hearing loss being the most common finding in 56% of the patients, followed by sensorineural hearing loss in 17% and mixed hearing loss in 10%. CONCLUSIONS: Pediatric temporal bone fractures are associated with falls and motor vehicle accidents. There is a high incidence of associated intracranial injuries and hearing loss, but facial nerve injuries are uncommon. Timely management minimizes complications.
The use of thawed frozen temporal bones offers advantages over fresh bones in the study of middle-ear and inner-ear mechanical function. We show, however, that freezing and thawing can cause a reduction in the magnitude of the input impedance of the stapes and cochlea Z(SC) in unfixed temporal bones from human cadavers of as much as a factor of 3-10 over the frequency range 25 Hz-7 kHz. Z(SC) is considered to be the sum of the impedances of the annular ligament Z(S) and the cochlea Z(C) and has been shown to be controlled by Z(S) below 1 kHz and by Z(C) at higher frequencies [Merchant et al., 1996. Hear. Res. 97, 30-45]. Experiments in which the inner ear was opened, drained, and refilled identified two mechanisms by which freezing and thawing can cause a reduction in the magnitude of Z(SC) (/Z(SC)/). Freezing can allow air to enter the inner ear, with the result that /Z(C)/ is reduced above about 1 kHz; and freezing can reduce /Z(S)/ which causes a reduction in /Z(SC)/ below 1 kHz. Changes in the phase angle of Z(SC) induced by freezing were small and were consistent with changes in /Z(SC)/. Removing air from the inner ear returned Z(C) to near its value in fresh bones, but /Z(SC)/ remained lower in some thawed bones by a factor of 2-3. Investigations of middle-ear function for which Z(SC) is critical should use fresh temporal bones only or should allow for the possible reduction in /Z(SC)/ in thawed frozen bones.
OBJECTIVES: Inverting papilloma of the temporal bone is exceedingly rare. The objective is to familiarize the clinician with the clinical presentation and prognosis of this entity. STUDY DESIGN: Retrospective case study and literature review. METHODS: Published reports of inverting papillomas originating in the temporal bone were reviewed in conjunction with two cases presenting at the University of Texas Medical Branch (Galveston, TX). RESULTS: Inverting papillomas of the temporal bone are frequently associated with persistent middle ear effusion and ipsilateral sinonasal tumors and display a higher incidence of malignancy. CONCLUSIONS: Successful management of these tumors requires an aggressive surgical resection. Adjuvant radiation therapy is recommended in patients with malignant changes.
Fractures of the temporal bone result from direct trauma to the temporal bone or occur as one component of a severe craniocerebral injury. Complications of temporal trauma are hemotympanon, facial nerve paralysis, conductive or sensorineur hearing loss, and leakage of cerebrospinal fluid. Early recognition and an appropriate therapy may improve or prevent permanent deficits related to such complications. Only 20-30% of temporal bone fractures can be visualized by plain films (7). CT has displaced plain radiography in the investigation of the otological trauma because subtle bony details are best evaluated by CT which even can be reformatted in multiple projections, regardless of the original plane of scanning. Associated epidural, subdural, and intracerebral hemorrhagic lesions are better defined by MRI.
The temporal bones of a man with poorly differentiated lymphocytic lymphoma, who had had a bilateral conductive hearing loss and incomplete left-sided facial palsy, were obtained. Sections were prepared for histologic study by staining with hematoxylin and eosin and were examined under the light microscope. The left temporal bone showed marked tumor cell involvement, not only of the lateral part of the cartilaginous portion of the eustachian tube (ET) where the tensor veli palatini muscle had been partially destroyed, but also in the anterior part of the temporal bone. A serous middle ear effusion was present, but the lumen of the ET was unaffected by tumor or inflammation. The pathological findings in the right temporal bone were similar to those in the left, although the cartilaginous part of the ET and its surrounding structures were not available for study. The pathogenesis of otitis media with effusion appeared to be secondary to functional ET obstruction, due to the dysfunction of the tensor veli palatini muscle as a result of the tumor destruction. This case is the first to be reported in which functional ET obstruction, secondary to tumor invasion of the active muscle dilator of the ET, has been histologically confirmed.
Cancers of the temporal bone are rare. Cervical metastases occur in approximately 10% of cases and are much more likely once disease extends beyond the confines of the temporal bone. Nonlymphatic spread of squamous cell carcinoma is usually a late event resulting in metastatic deposits in the lung, bone, liver and brain. This chapter discusses detection of distant metastases and provides a recommended schedule for interval patient evaluation.
Cavernous haemangioma of the temporal bone is a rare lesion and nearly always of limited extent. A case of a large and rapidly progressive temporal bone haemangioma in a child is presented. Negative angiography led to biopsy at which profuse and troublesome haemorrhage was encountered. Subsequent Red Blood Cell labelled scan demonstrated blood pooling in the lesion. The combination of positive RBC labelled scan and negative angiography can only occur in lesions in which blood pooling takes place, enabling biopsy with its hazards to be avoided. The tumour was resected using a skull base, infratemporal approach. Morbidity was minimal. There was no evidence of recurrence at a 15 month follow-up.
CT scan of the temporal bone has become a frequently ordered test for diagnosis of temporal bone pathology. We retrospectively examined our experience with CT scans of the temporal bones in 124 consecutive children from January 1983 to September 1984 in an attempt to assess its usefulness in diagnosis and treatment of ear disease in children. Patients were divided into six categories according to their pre-scan diagnosis, (trauma, congenital aural atresia, dizziness, facial nerve paralysis, middle ear disease, congenital sensorineural hearing loss) and CT findings were compared to data found by physical examination, by otologic studies such as audiogram and BSER, by other x-ray studies and ultimately compared to findings at surgery when applicable. CT was found to be instrumental in diagnosing middle ear disease; gave necessary preoperative information in children with aural atresia; delineated most temporal bone fractures; ruled out gross inflammatory, neoplastic, or traumatic etiologies in dizzy patients and in facial nerve abnormalities; and provided anatomic information about the inner ear in patients with sensorineural hearing loss. In our group of patients with sensorineural hearing loss, a 6.8% incidence of anatomic malformations was found by CT. However, CT had major limitations in stapes and oval window areas, especially in cases of perilymph fistulas. CT use was also limited in children because of the difficulty in achieving projections that require active patient cooperation.
Fibrous dysplasia of the temporal bone is a rare disease which may lead to progressive stenosis of the external auditory canal with conductive hearing loss. Sensorineural hearing loss has usually been attributed to involvement of the otic capsule or inner auditory canal. The case of fibrous dysplasia of the temporal bone in 11 years old girl was described. The conductive hearing loss with sensorineural component improved after surgical treatment.
The temporal bone findings of a patient with VATER syndrome are reported. The VATER syndrome is a nonrandom association of anomalies including vertebral, anal, tracheoesophageal, radial, and renal defects. This patient had multiple congenital anomalies: tracheal agenesis with associated laryngoesophageal cleft and tracheoesophageal fistula, tetralogy of Fallot, single umbilical artery, and imperforate anus with cloaca. To our knowledge, there have been no reports of the temporal bone findings in the VATER syndrome. Our patient had anomalous configuration of lateral semicircular canal and an abnormally high location of the utricle and saccule. The VATER syndrome seems to be due to faulty mesodermal development during the first five weeks of gestation, which, according to the findings reported here, can also involve the temporal bones as well.
OBJECTIVE: To explore the influence of inflammatory pathology change of otitis media upon cartilage-mucosa at the eustachian tube isthmus (ETI). METHOD: The cartilage-mucosa at ETI and bone-mucosa on the tympanic promontory of 32 temporal bones with otitis media were observated histopathologiclly in comparison with 50 normal temporal bones under light microscopy. RESULT: The eustachian tube isthmus in all the 32 temporal bone with otitis media and in 50 normal temporal bone were unblocked. The thick-measures and pathology observations of the cartilage-mucosa on ETI in the temporal bones with otitis media revealed there was no obviously inflammatory change and no significantly difference in comparison with the normal control group. But there was obviously inflammatory pathologic change on the bone-mucosa of tympanic promomtory of temporal bone with otitis media. The demarcation line of completely different inflammatory reaction in middle ear cleft was exactly at the connective line between cartilage and bone of eustachian tube. CONCLUSION: With the specifically histologic structure, the cartilage-mucosa on eustachian tube is possessed of very strong function of natural defence for inflammatory desease, and it almost is impossible to lead to obstruction of eustachian tube by inflammatory influence upon the cartilage-mucosa.
Pathological changes in the temporal bone are described in a case of polyarteritis nodosa in a 48 year old man in whom the onset of sudden unilateral deafness and vertigo occurred seven months prior to death as one of the early manifestations of the disease. The patient had received only a seven week course of prednisolone and, earlier, a two week course of anti-inflammatory agents. Autopsy revealed involvement of the arteries supplying the kidneys, testes, and pancreas. Changes within the temporal bone were seen bilaterally and there was thickening of the mucosa of the middle ear. Inner ear involvement was mainly limited to the cochlea, the deaf ear showing more pronounced changes. These changes included loss of the organ of Corti in the hook portion of the basal coil, absence of the tectorial membrane, and atrophy of the stria vascularis. The scala tympani was obliterated by fibrosis and new bone formation. The scala media showed hydrops, and a marked decrease in the spiral ganglion cells and nerve fibers supplying this portion of the cochlea was evident. Focal changes were seen throughout the remainder of the cochlea. The vestibular structures showed no detectable pathologic changes. Small vessel arteritis was found in the dural and subacuate vessels in both temporal bones.