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Mastoid canals (tunnels) were observed in 41 (7.7%) of 265 dry human skulls. The canals were 2-27 mm long. This feature has not been reported before. dissection of 30 mastoid regions in cadavers showed that the canals contained a branch of the occipital artery and a vein. It is possible that during development of the mastoid process the squamous temporal bone ossifies over the vessels, giving rise to the canals.
The authors report two cases of mastoid osteoma: it is a rare benign tumor attached to the cortex of the mastoid bone, approximatively fifty cases have been described in the english language literature and eight in the french literature. The clinical and radiological characteristics combined with histopathologic evidence demonstrate the diagnosis of mastoid osteoma, the most common type being the compact osteoma. Differential diagnosis should be considered with others benign bone-forming lesions (osteochondroma, chondroma, osteoblastoma, exostosis, fibrous dysplasia...) and with malignant lesions (osteosarcoma...). Surgical removal proposed for cosmetic deformity is a simple procedure for the vast majority of small osteomas. Early surgical intervention is recommended to avoid the evolution toward giant osteoma with potential risks of surgical complications.
This is a report of a case of coalescent mastoiditis seen in a 3-year-old child with severe congenital neutropenia. Pseudomonas aeroginosa was the main bacterial species recovered from the affected ear. Modified radical mastoidectomy was done and appropriate antibiotics administered. Operative wound infection with delayed wound healing was the hallmark of the postoperative follow-up period. Large spectrum oral antibiotics in addition to regular wound cleansing was an effective adjunct to therapy. On last follow-up operative wound was healed and mastoid cavity was clean. Occurrence, treatment, clinical and microbiological aspects of coalescent mastoiditis were described and discussed.
OBJECTIVE: Ongoing controversy regarding the surgical management of Meniere's disease has prompted us to review the effectiveness of the endolymphatic mastoid shunt procedure in the control of vertigo. In the current managed care environment in which outcome measures, cost effectiveness, and procedural efficacy must be demonstrated, the surgeon can no longer rely on anecdotal or empirical observations regarding the effectiveness of a treatment paradigm. STUDY DESIGN: Retrooperative case review. SETTING: A tertiary care center. PATIENTS: The records of 327 patients with presumed Meniere's-related vertigo referred to the University of Cincinnati Medical Center were reviewed. One hundred nine patients underwent endolymphatic mastoid shunt. Our study population consists of 96 of these patients that were available for 5 years follow-up. INTERVENTIONS: Endolymphatic mastoid shunt for the control of medically refractory vertigo. MAIN OUTCOME MEASURE: Control of vertigo. RESULTS: Using the Arenberg anatomic classification system, patients with a type I endolymphatic sac achieved 68% control of vertigo, those with a type II endolymphatic sac had a 92% control rate, and patients with a type III endolymphatic sac achieved 78% relief. CONCLUSIONS: Based on an assessment of outcome variables, we conclude that there remains a definite role for endolymphatic shunt surgery in the contemporary approach to patients with Meniere's disease.
The function of the mastoid cavity is still unknown. In the present article a theory of its main function is presented. The mastoid cavity is of vital importance in the non-immunological defence of the middle-ear. It is the most important site for the production of secretions that "wash" the middle-ear free of bacteria and viruses. The mucociliary system and the gravitation force, if the body is in erect position, transports the secretions through the two openings of the ear, the aditus and antrum and the ostia of the Eustachian tube, to be expelled into the epipharynx. Based on this theory pathological disorders of the ear are discussed as well as the effect of ventilation tubes on otosalpingitis and recurrent otitis media. Other plausible mastoid cavity functions are also discussed.
Two cases of acute coalescent mastoiditis with subperiosteal abscess are presented. Cultures from both abscesses resulted in bacteria resistant to commonly prescribed oral antibiotics. Historical perspectives on acute mastoiditis as well as the emergence of multi-drug resistant bacteria will be discussed. Current diagnostic evaluation and effective therapy for acute mastoiditis will also be reviewed.
We operated on 54 ears using the canal-down procedure consisting of one-stage tympanoplasty with mastoid obliteration for non-cholesteatoma otitis media with lesions in the ossicular chain and compared the results with those of patients treated with the canal-up procedure. Complications, such as mastoid problems, which have been observed in surgery with the simple canal-down procedure, were not observed in operations combining mastoid obliteration. The success rate for our procedure as evaluated by postoperative hearing levels, according to the standards established by the Japan Society of Clinical Otology, Committee on Nomenclature 1987, was 77.4% with tympanoplasty (ceramic P type) with reconstruction of the ossicular chain; 70.6% with reconstructive surgery using T type ceramic; and 50.0% with reconstructive surgery using the patient's own bone. Overall, the success rate was 72.2%. Our procedure seems to be superior to the canal-up procedure with respect to improvement of hearing levels in the treatment of patients with chronic otitis media associated with lesions in the ossicular chain.
We present a series of three patients with mastoid air cell effusions associated with adjacent lateral sinus thrombosis. In all of these cases, the findings support the hypothesis that the mastoid effusion is secondary to sinus thrombosis rather then the other way around. Also shown is the chronology and natural evolution of mastoid air cell effusion secondary to sinus thrombosis as seen on planar imaging.
Some skull base procedures require extensive dissection of the facial nerve. This can be difficult at the mastoid tip, where the nerve is approximated to soft tissues. The nerve was dissected in this area in 15 cadaver specimens. The mean angle at which the facial nerve leaves the mastoid tip in 117 degrees . This information should aid the skull base surgeon in the identification of the facial nerve at the mastoid tip.
Early versions of the Beltone artificial mastoid system were designated as model 5A. Later versions were designated as model 5B due to design modifications which changed the mechanical impedance parameters. The theoretical impedance characteristics of the 5B were considerably lower than for a comparison 5A. Compared with a B & K model 4930 (new pad) artificial mastoid, the 5B had a lower impedance (closer to ANSI values) from 500 to 2000 Hz and a slightly higher impedance at 250, 3000, and 4000 Hz. Discrete and continuous output voltage measurements with a constant input revealed that the performance of the 5B was also different compared with a 5A and the B & K model 4930 for different vibrator types. Bone conduction thresholds for a Radioear B-70A, B-71, and B-72 vibrator were obtained on 30 trained normal-hearing listeners. Adjusted threshold force levels needed to achieve normal-hearing bone conduction thresholds are presented for calibrating bone vibrators in clinical use with a Beltone 5B artificial mastoid.
Three temporal bones were serially sectioned to study the postoperative fate of the meatally based postauricular musculoperiosteal flap. In all three ears, the flap sealed off the middle ear effectively from the mastoid cavity and in one, with resected canal wall, formed a new soft posterior wall with good meatus. All flaps contained viable muscle, fat, collagen, reticulin, and elastin, and were richly vascularized. In two flaps, small granulating foci of infection were noted. In two temporal bones, from a child with hypogammaglobulinemia, small cholesterol cysts formed behind the falp during the delayed healing of the mastoid wounds.
To our knowledge, atypical mycobacterium has not previously been implicated in de novo acute mastoiditis. We encountered a case in which Mycobacterium avium was the causative agent in acute mastoiditis, in the absence of any bacterial infection.
We report the case of a 5-month-old female infant who developed a progressive unilateral retroauricular swelling without further symptoms in the first 5 months of life. The otherwise healthy infant was breast fed and had no history of previous otitis media. The clinical suspicion of silent mastoiditis was confirmed by CT scans and the intraoperative finding of an abscess due to Streptococcus pneumoniae. The onset is unusual, since mastoid pneumatization develops only after birth, and it is presumed that maternal antibodies should protect the infant from serious infections within the first months of life.
We describe the case history of a 70-year-old female patient presenting with bilateral hearing disturbance, facial paralysis, and vertigo. Radiological tests of temporal bone revealed soft tissue in the mastoid and tympanic cavities, and T1 weighted MRI revealed prominent Gd enhancement of the middle skull basal meninges. Middle ear inflammation appeared to induce pachymeningitis and to exacerbate associated symptoms, leading to a decline in the patient's overall condition. Bilateral mastoidectomies were effective in improving her general condition. Her hearing improved only on the right side because ossiculoplasty was performed only on that side. Her facial movement progressively improved and pachymeningitis diminished over time. We speculate that removal of the infectious granulation within the middle ears and mastoids ameliorated the acute inflammation. The etiology remains unknown in this case.
UNLABELLED: Acute mastoiditis (AM) is an uncommon but serious complication of acute otitis media (AOM). In the pre-antibiotic era, AM was seen more frequently than it is today, but it was rare in infants. However, in the last two decades an increase in the incidence of AM in infancy has been reported in the literature. During the years 1990-2002, we treated 113 patients with 128 episodes of AM; of them, 24 were infants (median age 6 months; 18 males) who suffered from 26 episodes of AM. Twenty developed AM as a complication of their first episode of AOM. One of the four infants with a prior history of AOM suffered from common variable immunodeficiency. A significant increase in the incidence of AM in infants was recorded during the study period (P = 0.01). The most common presenting clinical signs were post-auricular swelling and fever >38 degrees C (77% and 77%, respectively, of all patients). Seventeen episodes of AM were not treated with prior antibiotics. Tympanocentesis was performed in all episodes of AM. Middle ear fluid culture was positive in 17 (65%) of the 26 AM episodes. The most common pathogens cultured were Streptococcus pneumoniae (10 infants, 58% of all pathogens, 3/10 intermediately susceptible to penicillin) followed by Streptococcus pyogenes (4, 23%), non-typable H. influenzae (2, 12%) and S. aureus (1, 6%). Temporal bone CT showed bone destruction in 14 patients; 3 infants had subperiosteal abscesses and 3 lateral sinus thrombosis. Ten infants underwent mastoid surgery due to non-resolution of symptoms and signs with antibiotic therapy. Eight underwent cortical mastoidectomy with two patients undergoing ventilation tube introduction only. The remainder of the infants healed with conservative treatment. CONCLUSIONS: (1) A significant increase in the incidence of AM in infants was recorded over the last decade, though a specific reason for this trend remains uncertain; (2) Most of the cases of AM followed the infant's initial AOM episode, and most of the infants had not received prior antibiotic therapy; (3) The clinical signs and symptoms of AM were more severe in infants than in older patients; (4) While S. pneumonia was the most common pathogen isolated in middle ear fluid cultures, the involvement of S. pyogenes in AM was higher than that reported in AOM.
From the 80's and facing the different approaches available to asses which one offered more benefits between all of them, the surgery to the demand has its place. The objective of this work is to determine the audio-surgical results in the patients with aticomastoidectomy to demand with reconstruction of later wall or stuffing of the mastoid cavity, and to show the results three years later. A prospective and descriptive study in 22 patients who underwent a mastoidectomy to demand using outologous cartilage for the reconstruction of the later wall, and bone powder obtained from the surgical drilling to fill up the mastoid cavity.
A 10-year review of acute mastoid abscess treated surgically in Belfast revealed a total of 24 cases, 12 of which were found to have an underlying cholesteatoma. The surgical management of these 12 cases is outlined but despite a desire to maintain an intact canal wall, 9 of them to date have ended up with an open cavity. The danger of conservative management and the possible association between acute mastoid abscess and cholesteatoma, especially in developed countries, is stressed.
PURPOSE: To study how antibiotic treatment and an early decision to aspirate subperiosteal abscesses can reduce hospitalization periods and costs in patients with acute mastoiditis. PATIENTS AND METHODS: During a 10-year period, 134 patients were diagnosed with acute mastoiditis at the Department of Ear, Nose, and Throat and Head and Neck Surgery (Kaplan Medical Center, Rehovot, Israel). The diagnoses was based on physical findings of retroauricular swelling and erythema and tenderness, with protrusion of the auricle forward and downward. The majority of patients (77) reached medical treatment during the first 3 days of their disease. Wide myringotomy and intravenous antibiotic treatment, aspiration, and complete cortical mastoidectomy were the treatment options. RESULTS: With the administration of wide myringotomy and intravenous antibiotic treatment, 115 patients recovered; nine received aspiration and did not need surgery; and only 15 patients who received the antibiotic treatment needed a complete cortical mastoidectomy. CONCLUSION: With the wise use of antibiotics and early decision to aspirate subperiosteal abscesses, the hospitalization period, the cost, and the need for surgery can be reduced.