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PubMed2005

Unusual recurrence in ureters and maxillary sinus of Langerhans cell histiocytosis involving mastoid bone.

We present a case of Langerhans cell histiocytosis (LCH) diagnosed in the mastoid bone. The tumor recurred in the ureter and maxillary sinus mucosa two years later. The diagnosis of LCH was based on morphology and immunohistochemistry. Involvement of the ureter and the maxillary sinus in LCH is extremely rare. To the best of our knowledge, this is the first case of LCH affecting the mastoid bone in a 16-year-old boy and recurring later in the ureter and maxillary sinus mucosa.

Adolescent↗
PubMed1983

Manifest mastoiditis in childhood: a current critical review.

We made a follow-up study on forty children from our patient material, which had been operated because of manifest mastoiditis. We could establish the following: the number of operations has been increasing in recent years while there has been a significant drop in the number of cases with a preceding phase of otitis. A very characteristic pathological alteration, viz. the proliferation of granular tissue was found during the operation indicating that a short anamnestic period is illusory since before the mastoiditis manifests itself, there has obviously been a latent, long-lasting inflammatory process which apparently goes on without symptoms. Antibiotics, their excessive and unnecessary dosage, together with viral infections reducing immunity, may play a considerable role in the occurrence of these characteristic changes.

Anti-Bacterial Agents↗
PubMed1999

Surgical modification of the difficult mastoid cavity.

This retrospective study used a computerized otologic database to identify patients undergoing revision surgery for a draining cavity unresponsive to medical therapy, with at least a 2-year follow-up. The surgical intervention involved partial mastoid obliteration and restoration of the middle ear space by use of cartilage reconstruction of the tympanic membrane. Ossicular reconstruction was achieved with either a partial or total ossicular replacement prosthesis. Because this technique involved contouring the mastoid cavity, the problems that usually occur, such as drainage or debris collection, were alleviated. In addition, re-establishment of the middle ear space often restored hearing. A completely dry cavity was achieved in 18 of 20 patients. An overall statistically significant improvement in hearing (P < 0.05) was obtained, with the mean pure-tone average air-bone gap decreasing to 16.1 dB from 36.5 dB. This technique has proven to be a useful adjunct in the surgical management of the chronically draining cavity.

Adolescent↗
PubMed2004

Management of iatrogenic facial nerve palsy and labyrinthine fistula in mastoid surgery.

A 6-year review of complications of mastoid surgery between June 1995 and June 2001 revealed five cases with serious iatrogenic complications from mastoid surgery, of which four were facial nerve palsy and two were labyrinthine fistula. One of these patients had concomitant facial nerve palsy and labyrinthine fistula. There were two cases of complete facial nerve palsy (House Brackmann grade VI) and two cases of incomplete palsy (House Brackmann grades IV and V). The second genu was the site of injury in three of the four cases. Of the four cases with facial nerve palsy, two patients had full recovery (House Brackmann grade I), one recovered only to House Brackmann grade III, and one was lost to follow-up. Both patients with labyrinthine fistula had postoperative vertigo and profound sensorineural hearing loss. The site of iatrogenic fenestration was the lateral semicircular canal in both cases.

Adult↗
PubMed1975

Masked diabetic mastoiditis.

Seven cases of elderly diabetics suffering from ths so-called 'malignant external otitis' are presented. Chandler (1968) and others consider that this disease is localized to the external ear canal. We do not agree and believe that it is due to a masked middle-ear infection extending through the tympano-mastoid cells to the mastoid process, sparing the antrum and bulging into the floor of the external meatus. In time, extension to petrous apex results in petrositis and a fatal end in many cases.

Adult↗
PubMed1976

Secretory otitis media due to a hair-bearing dermoid of the mastoid cavity.

A case of persistent unilateral secretory otitis media occurring in an elderly patient is described. The aetiology of the condition proved to be due to a dermoid lying in the mastoid cavity. The clinical, radiological and histological features are described, with comments as to the association which might have existed linking these two conditions. Comment is made concerning the aetiology of dermoid cysts within the mastoid antrum.

Aged↗
PubMed1989

An avoidable occupational hazard during mastoid surgery.

Conjunctival innoculation is a previously unrecognized hazard for the otologist during mastoid surgery. This experiment assess the spread of droplet contamination during temporal bone dissection. The results suggest that otologists and assistants should wear eye protection during exposure of the mastoid antrum by drilling.

Acquired Immunodeficiency Syndrome↗
PubMed1991

Use of hearing aids by patients with closed mastoid cavity.

Twenty-five patients who had undergone a closed-cavity tympanomastoidectomy in our Unit and wore a hearing aid in the operated ear were reviewed, and information was recorded on the use of the aid, and the patients' impression about it. The information obtained was analysed and compared with similar data from 39 hearing aid users of similar age with no history of ear surgery. Eighty per cent of the patients with a closed mastoid cavity were satisfied with the aid, and no significant difference was found between the two groups regarding the impression about the aid (chi square 3.06, p = 0.08), or the problems with it, which, in most of the cases, were related to several changes of mould (chi square 2.19, p = 0.13). The various recorded parameters are discussed, and it is concluded that the patients with a closed mastoid cavity can tolerate a hearing aid in the operated ear at least as well as the control subjects with no ear surgery.

Attitude↗
PubMed1991

Mastoid obliteration with the temporoparietal fascia flap.

Obliteration of persistently discharging open mastoid cavities is one surgical option to achieve a dry ear. All the currently described techniques involve the use of random pattern local tissue flaps or free grafts. Ten patients have undergone obliteration procedures using the vascularized temporoparietal fascia flap. This resulted in rapid epithelialization by six weeks in seven out of 10 cases. The remaining three patients have persistent non healed areas over the medial attic wall, but are not troubled by otorrhoea. The indications, technique and complications of mastoid obliteration by this axial pattern flap are described.

Adolescent↗
PubMed1992

Distribution of topical antibiotic preparations in mastoid cavities.

Topical antibiotic preparations are widely prescribed in the treatment of infected mastoid cavities with no knowledge of the distribution of the preparation within the cavity. This study ascertains the distribution of drop and spray preparations within mastoid cavities and suggests methods of delivery to maximize coverage.

Administration, Topical↗
PubMed1992

Experimental studies on the acoustic properties of mastoid cavities.

This study investigated the effects of open-mastoid surgery upon ear canal resonance. In particular an attempt was made to alter resonant properties by obliterating each cavity with silastic foam. The results from this study showed that open-mastoid surgery significantly decreased resonant frequency without producing an effect upon either the peak amplitude or the quality of the resonant peak as defined by the Q-factor. Restoring the natural resonance properties of an operated ear, if indicated, is likely to be a difficult objective to achieve in surgical terms.

Acoustics↗
PubMed1995

Tuberculoma of the mastoid.

Tuberculoma is a rare but known complication of tuberculosis. It rarely occurs in the mastoid bone. When it occurs in the middle ear cleft, it can lead to intracranial complications if there is a delay in the diagnosis and management. A rare case of tuberculosis of the middle ear cleft which presented as tuberculoma of the mastoid bone with infranuclear facial palsy is described. The tuberculoma was removed and a canal wall down tympanomastoidectomy was performed. Post-operatively the patient was kept on antituberculous therapy. The various problems encountered in the diagnosis and management of this case are discussed.

Child↗
PubMed1997

Facial nerve palsy in mastoid surgery.

The risk of facial nerve injury during mastoid surgery has decreased substantially since the advent of the microscope and the otological drill. However, the facial nerve remains at risk during mastoid surgery with the present day incidence suggested to be one per cent. Despite the severity of this complication there are no recent studies that accurately quantify the incidence or discuss its management. The aims of this study were to identify the risk of facial nerve injury for both the specialist as well as the trainee specialist and to review a management protocol for this complication. During the 10-year period from 1985 to 1994, 1024 consecutive mastoidectomies were reviewed. A total of 17 palsies was identified, seven were complete and 10 were incomplete. Of the seven complete palsies, four patients had decompression only and recovered to House Brackmann Grade 2 or better while three patients had decompression and grafting, of these, two were available for follow-up and recovered to House Brackmann Grade 4 only. All the partial palsies, barring one lost to follow-up, who were treated conservatively with pack removal, toilet and topical therapy recovered to House Brackmann Grade 2 or better. A management protocol followed for the above patients is presented and the results analysed. Specific operations and manoeuvres which may put the facial nerve at risk intra-operatively are also discussed.

Clinical Protocols↗
PubMed1999

Further experience with fat graft obliteration of mastoid cavities for cochlear implants.

Obliteration of old mastoids and wet middle ears with autologous abdominal fat seems to be a reliable technique to render chronically discharging mastoid cavities or open middle ears dry and closed. This paper is the third in the series and looks at the intermediate results at five years. Of the 16 patients (one bilateral) 94.1 per cent of the ears are still dry and uninfected with closed external meati. Recurrent cholesteatoma was found in two patients at implantation and removed.

Abdomen↗
PubMed2006

Septate fungal invasion in masked mastoiditis: a diagnostic dilemma.

Invasive fungal mastoiditis is a rare entity, seen almost entirely in immunocompromized patients. It has been reported primarily in patients with leukaemia and more recently with acquired immunodeficiency syndrome. A literature search revealed only a few reports in diabetic patients, in whom the invasive fungus was identified as mucormycosis in all cases. We report the first case in the English literature of invasive septate fungal mastoiditis in a diabetic patient with intact tympanic membranes.

Aspergillosis↗
PubMed2001

[Vertigo in suction of open mastoid cavities ("radical surgery cavities")].

BACKGROUND: Vertigo during suction-cleaning of open mastoid cavities is caused by cold stimulation of the vestibular organ. In clinical and model-experimental measurements we tried to estimate the physical background and the dimension of this temperature drop. METHODS: Using different techniques like thermo-probes, thermovision, or additional model experiments temperature changes during suction were measured in 5 volunteers with open mastoid cavities. These registrations were carried out with special regard to the moisture of the cavity-walls. RESULTS: Distinct temperature changes during suction were observed. In moist cavities superficial temperature decrease was much higher than in dry ones. Using additional model experiments, temperature conduction towards e.g. the horizontal semicircular canal could be simulated. DISCUSSION AND CONCLUSIONS: Among other mechanisms like replacement of sucked-off air by colder air, or taking away warm air close to the cavity walls, effects of evaporative cold seem to be very significant. This could be demonstrated by moistening cavity walls in patients as well as in model experiments. The conclusion to keep the cavity walls as dry as possible is already a clinical demand. In this paper, the physical background and the dimensions of thermal effects during suction-cleaning could be elucidated.

Body Temperature Regulation↗
PubMed1992

[The acoustics of the open mastoid cavity (so-called "radical cavity") and its modification by surgical measures. II. Clinical studies].

The acoustic resonance of a severely altered outer ear channel (radical mastoid cavity) is investigated in a series of 18 patients who underwent revision surgery by means of in-situ measurements of the sound-pressure-level near the tympanic membrane. While the average volume of the open cavity differs from the normal ear channel for the factor 2.5, the size of the external meatus is--in average--only 20% larger. This leads to an average frequency in patients with open cavity of 1939 Hz, more than 1000 Hz less than in a series (n = 20) of normal ears (average resonance frequency: 2942 Hz). The altered acoustic behaviour of the open cavity leads to partial extensive discrepancies of the resonance-caused sound-pressure augmentation in the frequencies of 3 and 4 kHz, which are important for speech perception. The average difference is more than 10 dB (SPL). Proved surgical techniques of cavity obliteration and meatoplasty can lead to a nearly normalized acoustic behaviour of the outer ear in a statistic significant way. Due to these surgical procedures, an average postoperative resonance frequency of 2421 Hz could be reached in our patients. Especially, the resonance-caused sound-pressure augmentation in 3-4 kHz could nearly be equalized to such of a normal outer ear. Differences in the acoustic behaviour of the outer ear as can be found between patients with an open mastoid cavity and normal ears can almost be eliminated surgically.(ABSTRACT TRUNCATED AT 250 WORDS)

Acoustics↗