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PubMed1996

Outcome of residual cholesteatoma and hearing in mastoid surgery.

OBJECTIVE: To review 12 years of the senior author's experience with mastoid surgery for cholesteatoma. DESIGN: Retrospective review. SETTING: Northwestern University Medical School. METHODS: Available records included 97 mastoid procedures for cholesteatoma: 54 with intact canal-wall and 43 canal-wall-down. MAIN OUTCOME MEASURES: Residual cholesteatoma, pure-tone audiometry, and speech audiometry were compared for both groups. RESULTS: Residual disease rate was 11 of 54 (20%) for intact canal-wall procedures and 2 of 43 (5%) for canal-wall-down procedures. Average follow-up was 2 years. Hearing was preserved postoperatively, and neither procedure demonstrated clear superiority in this regard. CONCLUSION: While canal-wall-down mastoidectomy provides a lower residual disease rate with equal hearing outcome, the role of intact wall mastoidectomy remains a viable choice in certain clinical situations.

Adult↗
PubMed1996

[Acute mastoiditis in childhood. A study of 15 cases].

We present 15 cases of acute mastoiditis diagnosed in previously healthy children. Diagnostic criteria were the presence of acute otitis media, retroauricular inflammatory signs and radiographic alteration of the mastoid bone. The average age of the children was 3 years, with a range between 5 months and 7 years. Two children were younger than 1 year of age. The lesion was unilateral in all cases. Blood analysis revealed an increased erythrocyte sedimentation rate, being higher than 66 mm in the first hour in all patients. In 4 children it was higher than 110 mm. Ten children received previous antibiotic therapy for acute otitis media and five children did not. Among these 10 treated children, antibiotic therapy was unsuitable in 3 cases. All patients were treated on admission with i.v. antibiotic therapy. Tympanostomy was performed in 5 of 6 cases with the entire eardrum. Mastoidectomy was performed in 3 patients due to poor results of the treatment. The evolution was successful in all cases.

Acute Disease↗
PubMed1996

Mastoid abscess: underlying disease and management.

Despite a reduction in the incidence, subperiosteal mastoid abscesses (MAs) are still seen today with significant potentials for morbidity and even mortality. I present a series of 19 patients, seen over a 5-year period, with particular emphasis on the underlying disease and management. Ten abscesses (52.6%) succeeded acute suppurative otitis media (AOM); and nine (47.4%) resulted from chronic suppurative otitis media (CSOM). Eighty percent of those with AOM were younger than 10 years, whereas 77.8% of those with CSOM were older than 10 years. Fifty percent of the MAs that resulted from AOM had cortical mastoidectomy. The other five patients were treated with a less invasive method: antibiotics and incision and drainage without mastoid surgery. In eight MA cases caused by CSOM, the management of the abscess as well as the underlying disease was performed in one stage. Two-stage treatment occurred in one case. The study supports the recently recognized increasing role of CSOM in the etiology of MA, especially in adolescents and young adults. The controversy over the management of this disorder is discussed.

Abscess↗
PubMed1997

Anatomical results with titanium implants in the mastoid region.

We report our experience with titanium implants for extra-aural rehabilitation in the mastoid region with a bone-anchored hearing aid (BAHA) and auricular prosthesis. The purpose of this study was to evaluate the clinical status of the soft tissue adjacent to 63 skin-penetrating devices in 43 patients and to compare our findings with those of other reports. Forty-four fixtures have been implanted in 36 patients for the BAHA and 19 in seven patients for the auricular prostheses. The evaluation concerns osseointegration, pain in the mastoid area, skin reaction around the abutment and removal of the abutment. Three implants extruded; one due to trauma and two with no explanation. Follow-up ranged from 3 to 60 months after surgical implantation. The first outpatient check-up was performed at three months after implantation and then every six months. The soft tissue reaction around the percutaneous unit was classified at each control according to the classification proposed by Holgers et al. There was no irritation (type 0) in 87.5% of the controls for the BAHA group and in 87.2% for the group of auricular prostheses. No adverse skin reactions were noted in 61.36% of the BAHA group and in 66.66% of the auricular prosthesis group. Results of this study confirm the skin's ability to tolerate a skin-penetrating unit made of pure titanium. The importance of reducing the thickness of the skin around the implant and of local hygienic conditions is emphasized.

Adolescent↗
PubMedDate not supplied

[Mastoid obliteration in open cavities].

The obliteration of a large or irregular mastoidectomy cavities with hard-to-control areas is a common problem for ENT surgeons. Numerous obliteration techniques have been proposed in the last 50 years. We report our experience of obliteration of mastoid cavities in 74 ears using autogenous mastoid cortical bone chips and rib cartilage. Our procedure, a partial obliteration with meatoplasty, has yielded good results. Almost 92% of these ears were dry three years after surgery. There were no cases of recurrent cholesteatoma between bone chips.

Cartilage↗
PubMed1998

Mastoiditis: a case-based review.

Mastoiditis was a common complication of otitis media in the preantibiotic era. Because its incidence has decreased dramatically in recent years, its diagnosis can be delayed or missed, particularly in infants and young children. This delay can result in significant morbidity and increased costs, owing to longer inpatient treatment and surgical intervention. We offer a current, case-based review of the pathogenesis, presentation, and treatment of mastoiditis.

Female↗
PubMed1998

[Acute mastoiditis in children].

We retrospectively studied seventeen cases of acute mastoiditis admitted to the Paediatric Ward of S. Francisco Xavier Hospital during 8 years and 8 months. Seven patients were admitted in 1995. We found no reason for this increase. Eleven children were male and 5 were under 2 years of age. All cases, except one of post-traumatic mastoiditis, occurred after acute otitis media. Only 5 children referred symptoms for more than seven days before admission. Seven patients had surgery. The surgical group of children had a longer period of illness when compared to those only treated medically (7.6 versus 3.9 days). Tympanocentesis was performed in 6 patients, but it did not affect the outcome of the illness. In three children there were complications: Bezold abscess, labyrinthitis and cholesteatoma. The latter was the only patient in our series with permanent hearing loss.

Acute Disease↗
PubMed1999

Magnetic resonance imaging of the temporomandibular joint: diagnostic difficulty caused by extensive pneumatization of the mastoid air cells.

OBJECTIVE: During routine MR imaging of temporomandibular joints we have observed that an area of low signal is sometimes identified within the temporal bone overlying the glenoid fossa on proton-density sequences. This finding at times simulates a mass. CT in this situation has demonstrated marked pneumatization of the mastoid air cell extending to that portion of the temporal bone overlying the glenoid fossa. We undertook a clinical study to determine the frequency and appearance of such a finding. DESIGN AND PATIENTS: We reviewed the images of 12 patients who underwent both MR and CT examinations of their temporomandibular joints. The authors, by consensus, graded all 24 joints using a four-point scale for the presence and appearance of a low-signal area overlying the glenoid fossa on the MR images prior to seeing the corresponding CT images. We then compared our grading with the findings on CT to assess for the presence and extent of pneumatization of the temporal bone overlying the glenoid fossa. RESULTS: Of the 24 joints reviewed there was identical extent of low signal on MR imaging and extent of pneumatization on CT in 22 of 24 joints. In two of the 24 joints assessed there was overestimation of pneumatization due to extensive sclerosis secondary to surgery. CONCLUSION: The findings of an area of low signal overlying the glenoid fossa on a T2-weighted scan of a nonoperative temporomandibular joint is often due to extensive temporal bone pneumatization of the mastoid air cells. Recognition of the nature of this finding will avoid mistaking it for a fibrous or osseous lesion. Patients with previous operative history may, however, require further investigation with CT.

Adult↗
PubMed1997

Management of acquired cholesteatoma of the middle ear and the mastoid by combined approach tympanoplasty: a long-term view.

Mastoid cavities following surgery for cholesteatoma of the middle ear and the mastoid can be subject to recurrent infections, life-long attendance for cavity cleaning and restrictions in social activity. These problems may be avoided with a successful combined approach tympanoplasty. One hundred and forty-one patients (151 ears) treated by combined approach tympanoplasty, followed over a period ranging from 5 to 23 yr were analysed. The results are presented with an average follow-up of 14.5 yr. A fixed retraction pocket, recurrent cholesteatoma or conversion to a cavity was regarded as a failure. Failures and evidence of future failures in the form of fixed retraction pockets occurred in the first 5 yr. By not including cases with a follow-up period of less than 5 yr, we have attempted to achieve stable long-term results; 73.5% of the cases were successful. The success rate could be improved further and should provide an acceptable method of treatment.

Adolescent↗
PubMed1998

Permanent mastoid vent: a new treatment for persistent eustachian tube obstruction.

To date, there is no satisfactory treatment for persistent eustachian tube blockage or negative pressure in the middle ear. Conventional ventilation tubes are usually either occluded or extruded with time. A new treatment of percutaneous mastoid vent provides permanent ventilation to the middle ear cleft without putting a tube through the eardrum. A titanium tube is inserted through the skin into the mastoid antrum using the established technique of osseo-integration and hence becomes truly permanent. It can also be connected to a CPAP machine to re-inflate a collapsed eardrum. Initial trials consist of six vents inserted and followed up for 6-16 months. There was no sign of extrusion or a foreign body reaction. However, an inner Teflon tube is essential to keep the vent patent for permanent ventilation to the middle ear cleft.

Equipment Design↗
PubMed2005

Aspergillus mastoiditis in a patient with systemic lupus erythematosus: a case report.

Fungal mastoiditis caused by Aspergillus fumigatus predominantly occurs in immunocompromised patients. Invasive temporal bone mycoses are rare. They are usually associated with host immunodeficiency, are difficult to diagnose, and many cases are fatal. Treatment consists of antifungal chemotherapy, surgical debridement, and attempts to control the underlying immunological condition. Published reports describe patients with previous ear pathology and associated facial nerve dysfunction. We report a case in a patient with systemic lupus erythematosus. A good outcome followed surgical debridement and the use of a new triazole antifungal agent, voriconazole. Our patient's facial nerve function was unaffected. The presence of normal facial nerve function, however, does not exclude the possibility of invasive fungal mastoiditis.

Case Reports↗
PubMed2000

Surgical correction of cryptotia with superiorly based superficial mastoid fascia and skin paddle.

An approach for the correction of cryptotia using a superiorly based superficial mastoid fascial flap and a skin paddle is introduced. The buried portion of the auricle was exposed through an incision made along the upper part of the helix, followed by an appropriate correction of the deformed cartilage. Protrusion of the upper portion of the auricle was accomplished using anchoring sutures. A small skin paddle was elevated from the caudal portion of the auricular sulcus with the superiorly based superficial mastoid fascia as the nutrient pedicle and transferred to the temporal skin defect. The procedure was performed in eight auricles in a total of seven patients with cryptotia. A satisfactory contour and protrusion of the auricle were maintained postoperatively, leaving the scar within the auricular sulcus.

Adolescent↗
PubMed1994

Juxtaposition lipoma to the mastoid seventh nerve.

The precise embryological source for fat in juxtaposition to the vertical portion of the seventh nerve in the mastoid is unknown. Seventeen percent of 240 temporal bones disclosed various amounts of fat adjacent to this portion of the nerve. Shiny areas of fat granules are occasionally seen around, and perhaps at first glance mistaken for, the seventh nerve during mastoid surgery. The radiographic appearance of fat in this area has not been described. Bilateral 1-cm ovoid images were interpreted in a 16-year-old girl as seventh nerve neuromas or perhaps hemangiomas, but were surgically proven to be a lipoma in the only ear operated on. Lipoma should be considered in the differential diagnosis for a mass in this location which demonstrates increased T1 signal, progressive decreased signal on T2-weighted images, and has signal intensity isodense with that of fat.

Adipose Tissue↗
PubMed1992

[Reverse flow axial island flap in the mastoid region].

Anatomical and clinical studies on the reverse flow axial island flap in the mastoid region were reported. The studies in the dissection of 9 cadavers with a total of 17 sides and the observations in 6 operations proved that the blood in the superfacial temporal artery could flow reversely into the postauricular artery through the anastomotic branches to nourish the mastoid island flap. So the island flap wit a fascia pedicle containing the superficial temporal vessels could be transferred to various region of the face through subcutaneous tunnel to repair deformities of the orbit, nose, eyes and cheek in one stage operation. This reverse axial island flap has been utilized in 18 cases. 16 flaps survived. All cases were followed up for 2 to 7 years. The results were satisfactory.

Adolescent↗
PubMed1975

Infectious mononucleosis, mastoiditis, and facial paralysis.

To our knowledge this is the first report of a patient with infectious mononucleosis associated with a mononuclear granulomatous mastoiditis and facial paralysis. Pathologic examination of tissue from this patient, removed at the time of radical mastoidectomy, provides a basis for further speculation about the relationship between facial paralysis and infectious mononucleosis.

Adolescent↗
PubMed1976

Mycobacterium fortuitum mastoiditis.

Improved techniques of bacteriologic identification have led to increasing recognition of the clinical significance of the atypical or anomymous mycobacteria. Mycobacterium fortuitum, included in group IV of Runyon's classification because of its characteristic rapid growth, is widespread in nature as a saprophyte. Its facultative pathogenicity has received increasing attention in the literature recently with reports of a number of isolated infections, epidemics, and deaths. We report a case of mastoiditis due to M fortuitum and discuss the pathogenesis and treatment. This is the first known report of the organism causing otolaryngologic disease.

Atypical Bacterial Forms↗
PubMed1982

Granulocytic sarcoma (chloroma) initially seen as acute mastoiditis.

Granulocytic sarcoma (chloroma) is a localized tumefaction of immature granulocytes that is typically seen in association with myelogenous leukemia. The primitive cell population seen in biopsy material may be misinterpreted as histiocytic lymphoma or other sarcoma unless additional studies are performed. We saw a 36-year-old woman with promyelocytic leukemia in remission who had the signs and symptoms of an acute coalescent mastoiditis. Histologic examination of the surgical specimen, however, demonstrated a granulocytic sarcoma. Our case exemplifies some of the difficulties that may be encountered in the diagnosis of granulocytic sarcoma and illustrates the point that symptoms of an inflammatory process in a patient with a diagnosis of leukemia must be regarded with a degree of suspicion.

Adult↗
PubMed1983

Mastoid subperiosteal abscess.

Subperiosteal abscess was the indication for surgery in every child with acute mastoiditis who underwent mastoidectomy at our institution since 1972. Nineteen such patients are discussed herein. Positive bacteriologic findings included Streptococcus pyogenes in three patients, Streptococcus pneumoniae in three patients, Mycobacterium tuberculosis in two patients, and enterococcus in the one patient with cholesteatoma. Cultures were more often positive for causative bacteria when taken directly from the abscess before or shortly after beginning antibiotic therapy.

Abscess↗