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Tuberculosis of the middle ear and mastoid is uncommon nowadays. Two cases of drug-resistant tuberculous mastoiditis in immunocompetent Greek native children are reported and the diagnostic and therapeutic difficulties of this rare condition are discussed.
ABR evaluations were completed for 36 adults (18 males, 18 females) having normal hearing sensitivity and for 91 adult patients having various degrees of sensorineural hearing loss. Amplitudes of waves I and V were compared for ear canal (TIPtrode) electrode and mastoid electrode recordings. Interpeak intervals (I-III, III-V, and I-V) were determined and upper 95% confidence limits defined for normative data. In general, amplitude of wave I was larger when TIPtrodes were used. Wave V amplitude was nearly identical for the two electrodes. Wave I was identified more frequently for TIPtrode than for mastoid recordings of ABR waveforms for the sensorineural hearing loss subjects.
A case of mixed type adenoma of the middle ear and mastoid is presented in which CT showed complete opacification of the middle ear and mastoid air cells with bulging of the tympanic membrane but without ossicular or bony destruction.
OBJECTIVES/HYPOTHESIS: To determine the incidence of otitis media (OME) with effusion on histologic examination in temporal bones with mastoid cavities reduced by the fenestration procedure for otosclerosis. STUDY DESIGN: Temporal bone histologic study. METHODS: Light-microscopic examination of serially sectioned temporal bones. RESULTS: The incidence of otitis media with effusion in temporal bones with prior fenestration operation was not any more frequent than the control group of temporal bones with surgically unaltered mastoid cavity. CONCLUSIONS: There is no increased incidence of otitis media with effusion in temporal bones with prior fenestration operation.
OBJECTIVES: The inflammatory changes of pneumatic space mucosa are thought to affect the development of pneumatic space and the function of transmucosal gas exchange. So, it is assumed that the mucosal change is deeply involved in the onset and healing process of otitis media with effusion (OME). The objective of this study is to investigate whether the growth of the mastoid cells and the middle ear transmucosal gas exchange function in patients with OME are affected by the histopathologic changes in middle ear mucosa, and whether these two factors are changed by the treatment of OME. MATERIALS AND METHODS: From 65 children with OME, middle ear mucosal specimens were collected during indwelling of a tympanic tube, and their histopathologic changes were compared with cell growth area measured on radiographic films and with the change in the middle ear total pressure (METP). RESULTS: Suppression of the cell growth area was stronger and the METP stayed lower in cases with a higher degree of mucosal lesion. Significant expansion of pneumatic area was observed after 2 years of tube indwelling, and the peak METP showed a significant increase after 1.5 years. This increase in the METP was caused by diffusion/absorption of CO2 and O2 and indicated recovery of the transmucosal gas exchange function. CONCLUSIONS: The growth of the mastoid cells and the middle ear transmucosal gas exchange function are closely affected by the subepithelial histopathologic changes in middle ear mucosa, and these two factors recover by the treatment of OME.
OBJECTIVE: The canalith repositioning procedure (CRP) was developed to treat paroxysmal positional vertigo (PPV). Successful CRP results in cessation of PPV and positional nystagmus. Mastoid oscillation (MO) has been advocated to enhance the efficacy of CRP. The authors sought to objectively determine the effect of MO on CRP. STUDY DESIGN: Retrospective review. SETTING: Ambulatory referral center. PATIENTS: Patients with PPV seen from 1993 through 1999 (N = 168). INTERVENTIONS: Canalith repositioning procedure performed without MO (n = 104) and performed with MO (n = 64). MAIN OUTCOME MEASURE: Presence or absence of nystagmus on Dix-Hallpike testing 6 weeks after CRP. RESULTS: Eighty-four percent of patients treated with MO had resolution, and 16% had persistent nystagmus. Seventy-three percent of patients without MO had resolution, and 27% had persistent nystagmus. Although suggesting a trend, the difference did not reach the level of significance (p = 0.151). CONCLUSIONS: Mastoid oscillation does not significantly enhance the efficacy of the CRP.
OBJECTIVE: The objective of this study was to describe the anatomy of the middle temporal artery (MTA) flap and its application in mastoid surgery. STUDY DESIGN: A description of the anatomy and surgical technique. CONCLUSION: The middle temporal flap is extremely useful in lining mastoid cavities, especially those in which poor healing is anticipated. It is available in most cases and is easily harvested and inset. It is particularly useful in revision cases, if present.
Tuberculosis of the middle ear and mastoid is currently a rare disease in developed countries, but this disease still occurs and may cause serious consequences. We report a case of disseminated tuberculosis involving the middle ear, mastoid, lung and central nervous system. Tuberculosis should be considered in the differential diagnosis of chronic ear drainage, especially in young children.
OBJECTIVE: To describe an extremely rare fungal mastoiditis caused by Lecythophora hoffmannii, its recalcitrant behavior to therapy, and eventual successful treatment with adjunctive therapy using polyhexamethylene biguanide (a common swimming pool biocide). STUDY DESIGN: Case report and review of literature of human Lecythophora hoffmannii infections. METHODS: Medline database was searched using the keywords Lecythophora and hoffmannii. All articles that described Lecythophora hoffmannii as the cause of human infection at any site were identified. Literature and patient's records were considered for complete data review and extraction. RESULTS: We present the second known case in the literature of a human infection with Lecythophora hoffmannii. We also present the process to definitively identify and then to successfully eradicate this unusual fungal infection using polyhexamethylene biguanide as adjunctive treatment. CONCLUSIONS: Successful treatment of a chronic Lecythophora hoffmannii fungal mastoiditis involved a combination of radical surgical removal of all apparent infected tissue along with local treatments with polyhexamethylene biguanide, a common swimming pool biocide agent under the brand name Baquacil (Avecia, Manchester, United Kingdom). Given the prolonged course of treatment, this report particularly stresses the importance of concurrent surgery combined with creative local antimicrobial therapy to eliminate an unusual fungal infection in an immunocompetent host.
A 20-year-old white male presented to the family practice department with a 1-month history of right ear pain and loss of hearing. During the month, he had been seen in emergency rooms twice and also by his dentist. He had been treated with pain medications, tooth extraction, and finally, antibiotics. On presentation to the clinic, his right mastoid area showed erythema, tenderness, and swelling that displaced the pinna. He was immediately referred to the otolaryngology department. Imaging studies confirmed coalescent mastoiditis and subperiosteal abscess. He was taken to surgery, where he underwent cortical mastoidectomy and right pressure equalization tube placement. Intraoperative and postoperative intravenous cefotaxime was given. Recovery was complete and uneventful.
A mastoid approach to replace middle ear brain tissue herniation is advocated. Ten patients have been successfully treated without complication over a period of 7 yr with our method which basically makes use of temporalis fascia and pieces of mastoid bone.
The authors have found no studies and little guidance in the literature on the advisability of people swimming with a modified radical mastoid cavity. Two groups of such outpatients were therefore followed up at 2-monthly intervals for 6 months. One group of 56 patients swam (81% without ear protection) and the other group of 55 patients maintained their ears quite dry. Swimming did not increase the incidence of an infected mastoid cavity. The most important risk of swimming was vertigo which occurred in 5% of swimmers.
The aim of this study was to assess whether patients with open mastoid cavities should be advised to avoid water contaminating the ear in order to avoid aural discharge. A detailed history and clinical examination was performed on 53 patients with a unilateral modified radical mastoid cavity of more than 5 years duration. The results showed that it is possible to identify reliably the well-designed trouble-free cavity by the features of its skin lining and the ability to visualize the entire cavity through a size 4 Siegle speculum. A patient with this form of cavity very rarely develops aural discharge following water exposure and need not protect the ear during washing but should do so when swimming because of caloric effects.
Obtaining an adequate meatoplasty when performing mastoid surgery via an endaural approach is not always easy. This paper reviews the different types of meatoplasty available and describes a transposition flap of pretragal skin which can be used to provide a meatoplasty for mastoid cavities, acquired stenosis or congenital stenosis.
Muscle obliteration of the troublesome mastoid cavity is one method of achieving a permanently dry ear, although long-term results are often disappointing. An operation is described, which is a modification of existing techniques and utilizes a temporalis myofascial flap. This procedure has been used on 46 discharging mastoid cavities and produced encouraging results. It provides a simple, safe and reliable solution to the problem.
An electromagnetic device (EMD) for sound transmission from the mastoid process to the petrous part of the temporal bone was designed, built, and analyzed. A theoretical model was developed in order to predict the EMD acoustical performance and the distortion caused by skull bones. This model enabled the investigation of various technical improvements and calibration options. The EMD was miniaturized by using rare earth magnets in the construction of both external transmitter and internal receiver. In vitro implantation of the internal receiver into the mastoid process was carried out by simple mastoidectomy techniques. The input and output powers of the system, including the EMD and skull bones components, were measured and the power transfer function was calculated. The sound, which was generated by the EMD and transmitted through the dry as well as simulated cadaver skull, had high fidelity in spite of some vibratory distortion at the lower sonic frequencies. Results suggest that further development of hearing aids based on electromechanical sound transmission should take into account the specific acoustic response pattern of the skull bones.
Pott's puffy tumor is rarely seen in the modern era of antibiotics. It is usually seen as intracranial complication following inappropriately treated frontal sinusitis. Up until 2001 there have been only 21 pediatric cases reported in the literature and most have been secondary to frontal sinusitis. Only 1 case has been reported following a latent mastoiditis and that has been in an adult [1]. We report a case in a child who developed Pott's puffy tumor following mastoiditis.
Mastoid tympanoplasty with a canal wall-up technique provides better conditions for a healthy skin lining than canal wall-down techniques. The formation of retraction pockets in residual pneumatized cavities is however a major cause of cholesteatoma recurrence with canal wall-up techniques. We have therefore attempted to combine the advantages of both canal wall-down and canal wall-up techniques. The posterior wall is kept up, the mastoid is obliterated with adipose tissue, the attic is exteriorized in the ear canal and hearing is restored with a minimal-size hypotympanic cavity only. Preliminary results from 41 cases with a follow-up of 6 months to 6 years suggest that skin conditions in the enlarged ear canal are adequate and that cholesteatoma do not recur.