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PubMed2005

Sigmoid sinus thrombosis following mastoiditis: early diagnosis enhances good prognosis.

Sigmoid sinus thrombosis following mastoiditis is a rare, but potentially life-threatening, condition. Its treatment usually consists of systemic antibiotics and mastoidectomy. In this report, we describe a pediatric case of sigmoid sinus thrombosis following mastoiditis, presenting with nonspecific symptoms such as fever, otalgia, and headache. Diagnosis was based on magnetic resonance imaging. The patient responded very well to intravenous antibiotics with a rapid clinical improvement and complete recanalization of the thrombosed sigmoid sinus. In conclusion, mastoiditis may present few clinical symptoms. In case of treatment failure or new-onset neurologic deficit in children with acute otitis media, life-threatening complications associated with mastoiditis should be considered. Early diagnosis is important, as favorable prognosis can be achieved with conservative management without performing any surgical intervention.

Abducens Nerve Diseases↗
PubMedDate not supplied

Probe-tube microphone measures in patients with open-mastoid surgery: real-ear-to-coupler differences and real-ear unaided responses.

Real-ear-to-coupler differences (RECDs) and real-ear unaided responses (REURs) were measured using a probe-tube microphone system in 15 patients who underwent open mastoid surgery. The results show that RECDs are significantly smaller at higher frequencies (1.5, 2.0, 3.0, 4.0 and 6.0 kHz) in mastoid ears. The intrasubject variability of RECDs measures in these patients is on average 2.6 dB larger than for controls. For REURs, mastoid surgery significantly reduced the mean peak resonant frequency without affecting the amplitude and bandwidth. In operated ears, mean resonant frequency is by a factor of 1.4 lower than that for normal ears. Reduced responses (negative gains) at frequencies above the resonance peak occurred in 7 out of the 15 patients. These reduced responses corresponded to the smaller RECD at the middle and high frequencies. The results support the need for individual RECD measures to be made in operated ears instead of using average values from normal subjects. Otherwise, real-ear measures of the aided response should be made for each patient with open-mastoid cavity and the fitting should be done in terms of the target response at the eardrum rather than by defining a target insertion gain.

Adolescent↗
PubMedDate not supplied

Surgical anatomy of the facial nerve in Chinese mastoids.

Since racial differences in mastoid morphology exist, there may be racial differences in the surgical anatomy of the facial nerve in the mastoid. Thirty Chinese adult temporal bones were dissected. The facial nerve in the mastoid coursed vertically (60.0%), anteriorly (33.3%) and posteriorly (6.7%) in the sagittal plane. In the coronal plane, it coursed vertically (46.7%) and laterally (53.3%). The chorda tympani was found to have extratemporal origin in 53.3% and for the rest, the distance of its origin from the stylomastoid foramen averaged 3.17 mm (range 0.5-6.0 mm). The mean dimension of the extended facial recess was 4.40 mm (range 3.0-6.0 mm). The facial nerve was at a mean of 3.15 mm (range 2.0-5.0 mm) posterior to the most posterior point of the tympanic annulus and partially crossed the tympanic annulus from medial to lateral at this point. In conclusion, the typical surgical anatomy of the mastoid facial nerve as described in the Western literature may not apply to the Chinese.

Adult↗
PubMedDate not supplied

The relationship between traumatic tympanic membrane perforations and pneumatization of the mastoid.

We evaluated the possible relationship between tympanic membrane perforations resulting from blast trauma or slap and pneumatization of the mastoid cells. A total of 25 male patients with tympanic membrane perforations resulting from blast injury (n = 7), slap (n = 17), and football hit (n = 1) and 20 healthy male volunteers without any ear problem had temporal bone computed tomographic scans in the axial plane, parallel to the infraorbitomeatal line, with 2 mm slice thickness and 2-mm intervals using bone algorithm with a ProSpeed Spiral tomography machine. The area of air cells in each slice was measured using trace and area measurement functions of the tomography machine, and by multiplying the resulting area by slice thickness, the volume of each slice was calculated. For each ear, the total of volumes of air cells was calculated by adding the volumes of each slice containing air cells. The calculated volumes of mastoid cells were evaluated by comparing microscopic findings. Both patient and control groups consisted of males, and their ages ranged from 17 to 32 (mean 24.5) years. Microscopic examinations revealed that perforations were frequently located in the lower quadrants and that most of them were less than 3 mm. There were no pars flaccida and marginal perforations. Ossicular chain destruction was noted neither in temporal bone tomographic nor during intraoperative examinations. The mean (+/- SD) volumes of right and left ear mastoid air cells in patient and control groups were 6.92 +/- 2.45 vs. 7.00 +/- 2.59 cm(3) and 9.04 +/- 4.55 vs. 8.95 +/- 4.53 cm(3), respectively, and the differences were not statistically significant. It was found that the level of mastoid pneumatization has no statistically significant effect on tympanic membrane pathologies due to blast or other injuries.

Adolescent↗
PubMed2000

Mastoid pneumatization of the patulous eustachian tube.

The pathophysiology of the patulous eustachian tube (PET) remains unclear. The degree of mastoid cell pneumatization is considered an indicator of chronic inflammation of the middle ear. We used the mastoid cell area to investigate the relationship between past chronic inflammation of the middle ear cavity and a PET in 84 patients (20 to 83 years old). The mastoid cell size was calculated from radiographs and analyzed relative to the history of otitis media (OM). The controls were 100 normal ears. The patients' mastoid cell size was significantly suppressed versus that of the controls, in both 31 PET cases with and 53 PET cases without past OM. We surmise the possibility that the PET ears had experienced inflammation even when the patients had no history of OM and the tympanic membrane showed no OM sequelae. This study indicates the existence of some relationship between a history of chronic inflammation of the middle ear cavity and a PET.

Adult↗
PubMed2001

Volume of mastoid pneumatization: three-dimensional reconstruction with ultrahigh-resolution computed tomography.

The volume of the mastoid air cell system was measured in 69 patients with normal middle ears. All patients underwent axial ultrahigh-resolution computed tomography. Mastoid pneumatization was marked on each axial slice, and 3-dimensional reconstruction was performed. The volumes were measured with a volumetric algorithm. A polyethylene tubing phantom with a density similar to that of bone on computed tomography was devised. The polyethylene tubing was tied in a particular fashion so as to create interconnecting air spaces with a known volume. The phantom was scanned with the imaging parameters used for scanning the temporal bone. The air in the tubing was marked, and 3-dimensional reconstruction for the marked phantom air was performed. The volume of the interconnecting air spaces was measured and found to be identical to its known volume, thereby verifying the accuracy of the method used. The mean mastoid volume was 6.61 cm3. The smallest volume measured was 1.3 cm3, and the largest was 12.7 cm3. The importance of this technique lies in its high accuracy, ease of use, and ability to directly correlate mastoid size and clinical findings.

Adult↗
PubMed1980

Acute mastoiditis in infants and children.

During a 25-year period, 57 cases of acute mastoiditis occurred in infants and young children who ranged in age from 2 months to 12 years of age. All patients had abnormalities of the tympanic membrane and most had fever and localized edema and redness of the overlying skin. Fifty per cent of the infants who were less than one year of age had swelling primarily above the involved ear pushing the pinna out and down. By contrast, older children had swelling of the skin overlying the mastoid process which produced the classical finding of an elevated earlobe. Mastoid roentgenograms were a useful adjunct to diagnosis, revealing concurrent osteomyelitis in 9 patients. A diagnosis of specific bacterial etiology was made in 80 per cent of the patients in whom cultures were performed. Streptococcus pneumoniae, Staphylococcus aureus and Streptococcus pyogenes were the bacteria most frequently isolated. Unusual manifestations or serious complications occurred in 53 per cent of the patients, including one death (due to meningitis). These data indicate that the frequency of serious complications from acute mastoiditis has not declined over the past 3 decades.

Acute Disease↗
PubMed1994

Sclerosis of the mastoid air cells as an indicator of undiagnosed otitis media in children with Down's syndrome.

We hypothesized that many children with Down's syndrome have undiagnosed otitis media. In a 1989 study of lateral neck radiographs of 22 children with Down's syndrome, we found that 64% had sclerosis of the mastoid air cells, indicating untreated or inadequately treated otitis media. We reviewed the lateral neck radiographs of 53 children with Down's syndrome and interviewed their parents regarding the diagnosis of otitis media. Mastoid air cells were found to be sclerotic in 22 (42%) of study subjects; 32% of these had no known history of otitis media. For the 68% of children diagnosed as having had otitis media, the most common symptoms were fever (61%) and cough or coryza (58%). Sclerosis of the mastoid processes was not associated with a high frequency of otitis media (> 20 episodes) or a higher frequency of hearing loss, but was associated with subsequent myringotomy and insertion of a ventilatory tube (P = .038). Our finding of sclerotic mastoids in 42% of children with Down's syndrome raises the possibility that children with Down's syndrome have unidentified or inadequately treated episodes of otitis media.

Adolescent↗
PubMedDate not supplied

Postauricular mastoid cutaneous fistula: a method of closure.

A postauricular mastoid cutaneous fistula may be a complication of chronic ear disease or ear surgery or both. Simple closure is often unsuccessful because of the necrotic skin edges, and it may result in a larger fistula. This paper illustrates a method of closing a large postauricular mastoid cutaneous fistula. The steps include excising the fistula, everting the mastoid epithelium toward the external auditory meatus, covering the undersurface of the everted skin edges with an anteriorly based periosteal flap, covering the flap with bone paté, placing a free graft of abdominal fat, and closing the defect with a rotational skin flap. This technique closes the fistula and obliterates the mastoid cavity.

Adipose Tissue↗
PubMed1976

Management of the mastoid air cell system in chronic otitis media.

The influence of the Mastoid Air Cell System in Chronic Otitis Media is subject to much speculation. Does a mastoidectomy influence the surgical results following chronic inflammatory ear surgery? An understanding of the pathology associated within the mastoid air cell system is necessary before a discussion of the need for a mastoidectomy can be presented. Most mastoid air cell systems are sclerotic in chronic otitis media patients. The report summarizes one author's experiences with the influence of mastoidectomy upon surgical reconstruction for chronic inflammatory diseases of the ear. Emphasis is directed toward the eustachian tube rather than the mastoid air cell system.

Cholesteatoma↗
PubMed1980

Size of the mastoid air cell system in children with middle ear effusion.

The mastoid air cell system probably functions as an air reservoir. Among adults with chronic otitis media a small mastoid air cell system is prevalent In cases of chronic nonpurulent middle ear effusion among children, the reports have been contradictory concerning the size of the mastoid air cell system. In the present investigation, white children with long-standing problems of middle ear effusion have been examined by means of X-rays of the mastoid process in the lateral projection and the size of the air cell system measured by planimetry. The size of the air cell system was found to be significantly smaller in comparison with normal white children.

Child↗
PubMed1991

A histopathological study of the relationship between otitis media and mastoiditis.

From a total of 1408 human temporal bones, 229 with otitis media or mastoiditis were selected; other contributing diseases were excluded. Of this group, 19.2% had an obstruction of the aditus ad antrum with pathologic tissue, usually granulation tissue. Although pathologic fluid and tissue were usually distributed throughout the middle ear and mastoid, in some cases, the most severe conditions were restricted to the mastoid. Pathologic conditions were more severe in cases with obstruction. An interesting observation was that columnar epithelial cells, goblet cells, and mucoid effusion were not observed in the mastoid, suggesting a restriction of secretory cells to the middle ear proper. It appears that obstruction of the aditus ad antrum contributes to the pathogenesis and accentuates pathologic conditions in otitis media.

Granulation Tissue↗
PubMed1993

Long-term results of mastoid cavities grafted with cultured epithelium prepared from autologus epidermal cells to prevent chronic otorrhea.

Chronic otorrhea and recurrent infection from open mastoid cavities are common and troublesome clinical problems for which there is no very satisfactory treatment. The authors have previously described a simple procedure to solve this problem, using autologous cultured keratinocyte layers grafted onto the unepithelialized open mastoid cavities. All procedures are carried out on an outpatient basis without anesthesia, except for local anesthesia for the skin biopsy. Twenty-six patients with 28 "difficult" mastoids, in which otorrhea had been present from 2 to 32 years, have been grafted with a follow-up period varying from 10 to 18 months. Seventeen mastoid cavities became symptom-free as a result of this technique. There were 4 failures, and partial success was shown in 7 cavities as judged by both the patient and by clinical examination.

Adolescent↗
PubMed2004

[Mastoiditis in adults: diagnostic and therapeutic aspects].

The purpose of the present study is to report our experience in the diagnosis and treatment of mastoiditis in adults. Five patients with an active chronic otitis and mastoiditis were presented. All of them had a history of chronic ear discharge for long period of time and have been diagnozed and treated sufficiently. All relevant data were analyzed from the medical records. The most common symptoms of the disease were otalgia, otorrhea and hearing loss, but the physical signs of mastoiditis (swelling, erithema and tenderness of the retroauricular region) were presented in all cases. Localization and enlargement of the pathological process within the middle ear spaces was determined by CT. All patients were treated surgically and with intravenous antibiotics. In one patient the other treatment was applied due to a specific (TBC) process in the ear. Early diagnosis and adequate treatment (surgery combined with an effective antibiotics therapy) is most important to prevent a serious complications of mastoiditis (extracranial and/or intracranial).

Adult↗
PubMedDate not supplied

Occlusion effect: bone conduction speech audiometry using forehead and mastoid placement.

The occlusion effect (OE) was determined for bone conduction speech reception thresholds (SRTs) in 24 normally hearing subjects using forehead and mastoid placement. Results indicated that the OE was about 3 dB greater using forehead as opposed to mastoid placement. The intersubject variability of the OE is similar for the forehead and mastoid positions. The formula for effective masking for bone conduction speech should be equal to the minimum masking level for bone conduction speech plus the air-bone gap of the nontest ear plus 18 dB to account for the OE when using mastoid placement.

Acoustic Stimulation↗
PubMed1980

Investigation of the mastoid electrode contribution to the brain stem auditory evoked response.

The auditory nerve and bran stem responses recorded at the vertex and mastoids were closely examined in normal subjects using a larynx electrode as a neutral reference point. With monaural stimulation, significant activity was found at the vertex and both mastoids, and the wave-forms at the ipsi- and contralateral mastoids were consistently different. With binaural stimulation the small amplitude mastoid response were largely in phase with the vertex response. The implications of the findings are discussed.

Acoustic Stimulation↗
PubMed1998

[Acute mastoiditis in infants: penicillin-resistant Streptococcus pneumoniae and its therapy].

Seven patients with acute mastoiditis are reported. They were treated at Chiba Children's Hospital from 1991 to 1996. Patients included one 4-year-old child and 6 one-year-old infants. Except the 4-year-old girl whose body weight was 17 kg, all infants body weights were under 11 kgs. Chief complaints were ear discharge, retroauricular swelling and high fever (> 38 degrees C). Streptococcus pneumoniae was isolated in the 6 infants. One patient was diagnosed with penicillin-sensitive Streptococcus pneumoniae (PSSP), three patients were diagnosed with penicillin-insensitive Streptococcus pneumoniae (PISP) and the remaining patients were diagnosed with penicillin-resistant Streptococcus pneumoniae (PRSP). All 7 patients had developed otitis media subsequent to acute mastoiditis. The otitis media or earlier upper or lower respiratory infections had been treated with penicillin or cephalosporin by oral administration for more than a week. As to the therapy of acute mastoiditis, all of the patients received intravenous antibiotics. One (PSSP case) treated in 1991 received ABPC, and the others treated after 1995 received PAPM/BP for 5 to 8 days. None of the patients required mastoidectomy. In conclusion, antibiotics such as PAPM/BP with myringotomy were administered intravenously for the first treatment of acute mastoiditis in infants, as PISP and PRSP were commonly detected in the culture. We also considered that the proper administration of antibiotics could make the infants free from operation.

Acute Disease↗
PubMed1990

[Mechanical impedance of the human mastoid and forehead--a critique of the mechanical coupler of the IEC373].

Mechanical impedances of human mastoids and foreheads were measured on frequencies from 250 to 6300 Hz for 80 young adults by means of B&K impedance head (#8000) and shaker (#4810) as main parts of the measuring setup. The measurements revealed the following problems in the IEC373 (1971/1981) which had defined the mechanical impedance characteristics of the mechanical coupler for calibration of bone vibrators in audiometric use. The average impedance levels of the mastoids differ significantly from those of the foreheads in middle and high frequencies. The impedance levels of the IEC373 mechanical coupler are higher than those of the present measurements of the mastoids and the foreheads. The differences exceeded the tolerance limits of IEC373 (1981) in every frequency. These findings strongly suggest that the coupler is neither the artificial mastoid nor the artificial forehead but a coupler having a specified impedance, therefore, disregard for effect of the type of bone vibrator on the Reference Equivalent Threshold Force Level, as seen in ISO7566, should be revised and that the RETFL should be determined for an each type of bone vibrator.

Adult↗