Search PubMed⌕ Search

SEARCH · Search PubMed

Results for “MASTOID”

Search indexed PubMed citations on genomics, clinical trials, systematic reviews and public health. Explore titles, authors and supplied subject terms, then open the PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 55 records · Page 3Linked to original sources
PubMed1997

Shrapnell membrane and mastoid pneumatization.

OBJECTIVE: To assess whether a correlation exists between the degree of pars flaccida (PF) retraction and the degree of mastoid pneumatization. DESIGN: The degree of PF retraction was defined by means of an operating microscope and a pneumatic otoscope. Degree of mastoid pneumatization was assessed planimetrically, using mastoid x-rays. SETTING: Private otologic clinic. PARTICIPANTS: A total of 595 ears, with intact pars tensa, of 332 adult patients. RESULTS: The degree of PF retraction was found to be inversely correlated to the level of mastoid pneumatization. Poorly pneumatized mastoids were associated with PF retractions. The poorer the pneumatization, the deeper the retraction. Well-pneumatized mastoids were associated with normal position of the PF. CONCLUSIONS: This study lends further support to the possibility that the mastoid pneumatic system functions as a middle ear pressure buffer. This possibility gives further explanation as to why ears with poorly pneumatized mastoids tend to develop tympanic membrane retractions and perforations, incus necrosis, or retraction pocket cholesteatoma, while ears with a large pneumatic system are rarely at such risk.

Adult↗
PubMed2000

Organic change of effusion in the mastoid in otitis media with effusion and its relation to attic retraction.

To try to solve the pathogenesis of severe attic retraction viewed from mastoid condition, we examined the residual soft tissue density (RSTD) in the mastoid by computed tomography (CT) in 85 patients (107 ears) with otitis media with effusion (OME) 3 months after tympanostomy tube insertion or later. The incidence of RSTD in the mastoid was significantly higher in OME of adults (52.6%) than in children (24.1%). Ears with severe attic retraction had RSTD significantly more frequently (80%) than those with no or mild attic retraction, and many of the mastoids with severe attic retraction were occupied totally by RSTD. The area of the mastoid (mastoid pneumatization) was significantly smaller, and CT density of the mastoid (sclerotic tendency) was significantly higher in ears with RSTD than in those without. RSTD after tympanostomy tube insertion in the mastoid indicating organic change of effusion was considered one of the important factors relating to the pathogenesis of severe attic retraction.

Adolescent↗
PubMed1999

Computed tomography and the diagnosis of coalescent mastoiditis.

OBJECTIVE: To evaluate the sensitivity and accuracy of temporal bone CT findings for the diagnosis of acute coalescent mastoiditis. DESIGN: CT scans were blindly scored for mastoid bone integrity (air cell septae, sigmoid cortical plate, and lateral cortical wall) by an otologist and 2 neuroradiologists. Scores were analyzed to determine their sensitivity and specificity for acute coalescent mastoiditis. SUBJECTS: Twenty-one patients with acute coalescent mastoiditis or acute noncoalescent mastoiditis and 12 patients with chronic mastoiditis. SETTING: Academic tertiary care facility. RESULTS: Pair-wise interobserver agreement was good to excellent (kappa = 0.4 to 0.83) for the sigmoid plate, the lateral cortex, and the septae. Scores for the sigmoid plate were significantly greater (indicative of greater bone destruction) in the coalescent group than in either the noncoalescent group or the chronic group (P < 0.05). Within the coalescent group, scores were highest for the sigmoid plate, followed by the septae and the lateral wall. Sensitivity and specificity for coalescent mastoiditis were both highest for the sigmoid plate (67% and 90%, respectively). CONCLUSIONS: Erosion of the cortical plate overlying the sigmoid sinus is the most sensitive and specific CT finding for distinguishing coalescent from noncoalescent acute mastoiditis.

Acute Disease↗
PubMed1998

Contemporary presentation and management of a spectrum of mastoid abscesses.

BACKGROUND: The incidence of complications resulting from suppurative otitis media has significantly decreased since the introduction of antibiotics. At the start of the 20th century 50% of all cases of otitis media developed a coalescent mastoiditis. By 1959, the incidence had fallen to 0.4%. Recent studies suggest a current incidence of only 0.24%. Additionally, during the time of Friedrich Bezold (1824-1908), 20% of patients with mastoiditis developed subperiosteal abscess. Interestingly, this has incidence increased; today nearly 50% of patients diagnosed with coalescent mastoiditis have subperiosteal abscess. OBJECTIVE: To review the contemporary presentation, diagnosis, and management of a spectrum of mastoid abscesses. DESIGN: Retrospective case series. SETTING: Hospitals associated with the Department of Otolaryngology/Head and Neck Surgery at the University of California, San Francisco. PATIENTS: Three patients with mastoid abscesses are reported. One patient displayed "classic" Bezold's abscess, with pus escaping the mastoid near the incisura digastrica and tracking along the digastric and sternocleidomastoid muscles into the neck. The second and third patients exhibited temporoparietal swelling secondary to mastoid abscess eroding the root of the zygomatic process, a complication noted by Bezold in 1908 as occurring "in only very rare cases." RESULTS AND CONCLUSIONS: Since only one third of patients show pathologic tympanic membrane changes, and since complaints of otalgia, fever, and tenderness are inconstant, subperiosteal mastoid abscess is frequently a delayed diagnosis. The clinical presentation, pathogenesis, and routes of abscess spread are presented with photographic and radiographic illustration. Medical and surgical management is reviewed, and methods for accurate diagnosis are emphasized.

Abscess↗
PubMed2003

Evaluation of the mastoid air cell system by high resolution computed tomography: three-dimensional multiplanar volume rendering technique.

The mastoid air cell system is an important contributor to the pathophysiology of middle-ear inflammatory disease. The mastoid cavity is not only an air reservoir, but also an active space for gas exchange. Various methods of temporal bone imaging have been designed to investigate mastoid pneumatization. In this study, we examined 100 normal temporal bones for the evaluation of mastoid pneumatization. Mastoid air cell systems were measured by reconstructed axial and coronal high resolution computed tomography (HRCT) images. The reconstructions were made by a three-dimensional multiplanar volume rendering (3D MPVR) technique. The mean volume of the mastoid air cell pneumatization was 7.9 cm(3) (4.0-14.0 cm(3), SD = 2.3 cm(3)). The ears were allocated to the groups with respect to measured mastoid air cell pneumatization. Twenty-eight per cent of the ears have small pneumatization with an air cell system not exceeding 6 cm(3). Fifty-two per cent had an air cell system between six and 10 cm(3), and 20 per cent had an air cell system exceeding 10 cm(3). With its excellent imaging quality and the ability to eliminate bone and soft tissue, HRCT is the best method for evaluating the mastoid air cell system. The 3D MPVR technique must be used to measure the temporal bone/mastoid pneumatization for the best results.

Adolescent↗
PubMed1994

Acute mastoiditis--revisited.

The clinical course and causative organisms were studied in 18 patients with acute mastoiditis, 13 of whom (72%) had no previous history of middle ear disease. Their age ranged from 5 months to 21 years, and duration of middle ear symptoms immediately prior to admission ranged from 1 to 45 days (average 9.7 days). None had undergone a myringotomy prior to admission, while 13 (72%) had been receiving antibiotic treatment for acute otitis media. Three were admitted with intracranial complications. Bacteria were isolated in 10 of the 16 patients in whom samples were available for bacterial culture, and included Streptococcus pneumonia (2), Streptococcus pyogenes (2), Staphylococcus aureus (2), Staphlococcus coagulase negative (2), Klebsiella pneumonia (1), and Pseudomonas aeruginosa (1). Of the 17 patients treated by us, 11 received surgery. Acute otitis media, secretory otitis media, acute mastoiditis, subacute mastoiditis and masked mastoiditis create a continuum. Antibiotic treatment for acute otitis media cannot be considered as an absolute safeguard against acute mastoiditis. When antibiotics are prescribed for acute mastoiditis before culture result is available, an anti-staphylococcal agent should be included. At least some patients with acute mastoiditis develop a primary infection of the bony framework of the middle ear cleft. The prevalence of the intracranial complications in acute mastoiditis is still high and may appear soon after or concomitant with the first sign of acute mastioditis.

Acute Disease↗
PubMed1997

Importance of mastoid pneumatization on secretory otitis media.

Secretory otitis media is the most common middle ear disease of childhood. It heals spontaneously, by medical therapy or by minor surgical procedures in most of the cases. Sequelae such as retraction pockets and adhesive otitis that lead to cholesteatoma rarely occur, but initially it is hard to diagnose which patient will acquire a sequela. It is well known that mastoid pneumatization is poor in the patients who had complications like retraction pocket, adhesive otitis and cholesterol granuloma. The aim of this study was to determine if any relationship exists between mastoid pneumatization and secretory otitis media. Lateral mastoid X-rays of 47 children with secretory otitis media were evaluated. After 2 months of follow-up with medical therapy, 30 of the 47 patients needed ventilation tube insertion. The remaining 17 patients showed total recovery with medicines only. Control X-rays of the operated patients were taken 6 months after the operation. Mastoid pneumatizations of patients healed with medicine were compared with the operated patients. There were statistically significant differences between the mastoid pneumatizations of surgically and medically treated groups. In addition we observed a statistically significant difference between the mastoid areas of the preoperative and the postoperative X-rays. We concluded that mastoid pneumatization might be considered as a prognostic indicator in secretory otitis media. The estimated prognosis is poor when the mastoid pneumatization is poor.

Anti-Bacterial Agents↗
PubMed1979

Prognostic evaluation of secretory otitis media as a function of mastoidal pneumatisation.

Fifty-two secretory otitis media (S.O.M.) ears with protracted course were compared roentgenologically (Schuller projection) with 52 S.O.M. ears which recovered after insertion of a single ventilating tube. Measurements were done first by comparing the pneumatised area millimetrically and later semiquantitatively according to the size of the mastoid cells--grading the mastoid cells from 1 (eburnize) to 10 (very big mastoid cells). S.O.M. ears with protracted chronic course showed an average mastoid area of 312 mm2, their cell size showing on the average a diploic or small-diploic cells--corresponding to grade 3.5. On the other hand, S.O.M. ears which recovered promptly had an average mastoid area of 440 mm2, and their mastoid cells began to show as actual cells (small up to medium cells), corresponding to grade 5.7. The difference, both millimetrically and grade-wise, between the two groups was found to be very significant (P greater than or equal to 0.01). We may conclude that the prognosis of S.O.M. is related to the size of their mastoid cells or alternatively to the amount of air in the middle ear cleft as a whole.

Child↗
PubMed1994

A comparison of mastoid pneumatization in adults and children with cholesteatoma.

The records of 190 adults who presented over a 10-year period with previously untreated aural cholesteatomas were analyzed with respect to age, mode of presentation at the level of the tympanic membrane, and pneumatization of the mastoid. The findings were compared with those obtained in an earlier study of 109 children (aged 13 years and younger) seen over the same period of time. Two main types of cholesteatomas were found in both adults and children, most of them (82.3%) associated with sclerotic or diploic mastoids (i.e., poorly pneumatized mastoids) and the rest (17.3%) with pneumatized mastoids. The former type was found more often in adults (96.3%) than in children (57.8%), while the latter was more frequent in children (42.2% as compared to 3.7% in adults). In both adults and children, cholesteatomas associated with poorly pneumatized mastoids showed mainly an attic and mastoid distribution communicating with a pars tensa or pars flaccida retraction or marginal perforation. Cholesteatomas associated with pneumatized mastoids appeared most often behind an intact drug (the so-called congenital cholesteatomas) and were distributed mainly in the tympanic cavity.

Adolescent↗
PubMed2000

Acute mastoiditis in children: review of the current status.

BACKGROUND: acute mastoiditis is the most common intratemporal complication of otitis media. Its management is still a challenge due to potentially serious consequences. This study was designed to evaluate the recent experience with pediatric acute mastoiditis at our institution and to determine if the incidence of this entity is changing over time. MATERIAL AND METHODS: retrospective review of records of children with acute mastoiditis treated at the hospital of the Medical School at the University of Porto, Portugal, between July 1993 and June 1998. Criteria for the diagnosis of acute mastoiditis were postauricular swelling and erythema, protrusion of the auricle, and evidence of co-existent or recent otitis media. RESULTS: 43 patients fulfilled the entry criteria. Most were boys (69%). Ages ranged from 8 months to 14 years and 4 months; infants represented 40% of the total. Acute mastoiditis was the first recognized sign of otitis media in 48% of patients. More recent years of the study saw an increase in the number of children referred with acute mastoiditis. Upon admission, 56% were under antibiotic treatment, with an average intake of 5.8 days. All patients were hospitalized; 26 cases recovered after intravenous antibiotics plus myringotomy, and the rest required an additional surgical procedure. The most common organisms recovered from cultures were Streptococcus pneumoniae and Streptococcus pyogenes. In our series, associated complications occurred in 13.9%; facial paralysis in one, and involvement of the central nervous system in five. CONCLUSIONS: pediatric acute mastoiditis continues to be a potentially dangerous infection in the antibiotic era. The incidence of this complication may be increasing recently in the community studied. Great care is required of clinicians to reach an early diagnosis in order to promote adequate management and prevent inherently severe complications.

Acute Disease↗
PubMed2001

Acute mastoiditis--the antibiotic era: a multicenter study.

OBJECTIVES: To evaluate the clinical course and identify the causative organisms of acute mastoiditis in a community where most of the patients who develop acute otitis media are treated with antibiotics. METHODS: A multicenter retrospective review of a series of 223 consecutive cases of acute mastoiditis. SETTING: Nine secondary or tertiary academic or non-academic referral centers. RESULTS: Prior to the diagnosis of acute mastoiditis, 121 of the patients (54.3%) had been receiving oral antibiotic treatment for acute otitis media for periods ranging from 1 to 21 days (mean 5.3 days). Samples for bacterial culture were obtained from 152 patients. Cultures were negative in 60 patients. The organisms isolated in the 92 positive cultures were: Streptococcus pneumoniae (15 patients), Streptococcus pyogenes (14 patients), Staphylococcus aureus (13 patients), Staphylococcus coagulase negative (three patients), Pseudomonas aeruginosa (eight patients), Haemophilus influenzae (four patients), Proteus mirabilis (two patients), Escherichia coli (two patients), Klebsiella pneumoniae (one patient), Enterobacter (one patient), Acinetobacter (one patient), anaerobic gram-negative bacilli (one patient), and fungi (two patients). Ten patients had mixed flora. Sixteen patients presented with complications (cerebellar abscess, perisinus empyema, subdural abscess or empyema, extradural abscess, cavernous sinus thrombosis, lateral sinus thrombosis, bacterial meningitis, labyrinthitis, petrositis, or facial nerve palsy). CONCLUSIONS: Antibiotic treatment cannot be considered an absolute safeguard against the development of acute mastoiditis. Early myringotomy for acute otitis media seems to decrease the incidence of complications. The distribution of causative organisms in acute mastoiditis differs from that in acute otitis media. Intracranial complications in acute mastoiditis are not rare. Because of the diversity of causative organisms in acute mastoiditis and the growing resistance of bacteria to the various antibiotics, all means to obtain a sample for culture prior to antibiotic treatment, including general anesthesia.

Acute Disease↗
PubMed1999

Impact of resistant pneumococcus on rates of acute mastoiditis.

OBJECTIVE: To determine whether the rate of acute mastoiditis is rising, specifically as a result of antibiotic-resistant strains of Streptococcus pneumoniae. METHODS: A retrospective chart review of all patients with a discharge diagnosis of acute mastoiditis between July 1, 1987, and June 30, 1997, was performed at our academic, tertiary-care medical center. There were no interventions, and the main outcome measures included the number of cases of acute or coalescent mastoiditis, stratified by pathogen, per year. RESULTS: The rate of acute mastoiditis as a proportion of yearly otorhinolaryngology admissions increased linearly over time (P = 0. 024). Pneumococcal-related rates of acute mastoiditis, expressed as a proportion of yearly hospital and otorhinolaryngology admissions, increased linearly over time (P = 0.002, P = 0.002). All but 1 case of pneumococcal mastoiditis during the past 3 years were caused by penicillin-resistant strains. CONCLUSIONS: The emergence of antibiotic-resistant S pneumoniae may be responsible for an increasing rate of acute mastoiditis.

Acute Disease↗
PubMed1999

Acute mastoiditis in children: is surgical treatment necessary?

Acute mastoiditis in children remains an otological problem. Although the widespread use of antibiotics has reduced the need for surgical intervention, surgery is frequently used in the treatment of acute mastoiditis and its complications. The charts of 44 patients hospitalized with signs of acute mastoiditis were reviewed. In 43.2 per cent of all patients, acute mastoiditis was the presenting sign of acute middle-ear infection. Post-auricular erythema and protrusion of the auricle were the most frequent signs at presentation. All four signs (post-auricular erythema, oedema, tenderness, and protrusion of the auricle) were present in 40.9 per cent of patients. No bacterial pathogen was isolated in 45.5 per cent of ear cultures. Complicated acute mastoiditis was diagnosed in 13.7 per cent of the patients. Eighty-seven per cent of patients responded well to intravenous antibiotics and myringotomy, and in 11.4 per cent mastoidectomy or abscess drainage were performed. We conclude that nearly all patients with uncomplicated mastoiditis recover following intravenous antibiotics and myringotomy. Mastoidectomy should be performed in selected cases, such as cases of complicated acute mastoiditis.

Acute Disease↗
PubMedDate not supplied

Mastoid obliteration by BMP-2/collagen composites: an experimental study using tissue engineering.

PURPOSE: Several materials have been used in the application of mastoid cavity obliteration during surgery for cholesteatoma; however, nothing has won universal acceptance. Through the advancement of tissue engineering, bone morphogenetic protein-2 (BMP-2)/collagen composites have been elucidated as inducers of heterogenic bone formation. This study was performed to investigate whether these composites are potentially obliteration materials for use in the mastoid cavity by using an animal experimental study. MATERIALS AND METHODS: The composites were implanted in the rat mastoid to investigate whether new bone would be tissue engineered in the mastoid and, if so, whether the newly formed bone was stable. The composites were examined histologically over a 24-week period. RESULTS: The composites implanted in the rat mastoid were able to tissue engineer new bone, and the newly formed bone was stable as assessed histologically, with almost normal bone structure, that was not resorbed during the 24-week period. Adverse immunological reactions were not found during our observation. CONCLUSIONS: Bone that was tissue engineered by the BMP-2/collagen composites was stable as assessed by histological examination and persisted in the rat mastoid. The present study shows that the composites have the potential to become real materials for use in mastoid obliteration.

Animals↗
PubMed1998

Mastoid pneumatization in children with congenital cholesteatoma: an aspect of the formation of open-type and closed-type cholesteatoma.

OBJECTIVES: To clarify mastoid pneumatization in children with congenital cholesteatoma and compare their clinical characteristics. STUDY DESIGN: The mastoid pneumatization of 34 children with congenital middle ear cholesteatoma, of 34 age-matched children with unilateral acquired cholesteatoma, and of 17 age-matched control children without middle ear diseases was studied. METHODS: The sizes of the mastoid cells were measured from 1.5-mm sliced semiaxial sections of a temporal bone computed tomography scan. The sum of the two areas from the two images, one showing the lateral semicircular canal and the other, 3 mm below this, was defined as the area of the pneumatized mastoid cells. RESULTS: The mastoid cells in ears of children with congenital cholesteatoma were poorly pneumatized compared with those of control children without middle ear diseases, but were better pneumatized compared with those of children with acquired cholesteatoma. In children with congenital cholesteatoma, the degree of pneumatization in the cholesteatoma side was significantly poorer than that in the opposite side. A well-pneumatized mastoid was seen in ears with no episode of otitis media, in ears with the open-type cholesteatoma, and in ears with ossicular anomalies. CONCLUSIONS: The presence of cholesteatoma matrix accelerates the inflammatory response when middle ear infections occur, and this probably leads to the suppression of mastoid pneumatization. The authors also propose the hypothesis that cholesteatoma in most congenital cases is the open type, and that middle ear inflammation may contribute to the formation of cystic and closed-type cholesteatoma.

Adolescent↗
PubMed2000

Structural changes and protein expression in the mastoid bone adjacent to cholesteatoma.

OBJECTIVE: Cholesteatoma of the mastoid and middle ear causes erosion of nearby bone. In this study we examined the mastoid bone adjacent to cholesteatoma and compared it with normal mastoid bone. In particular, noncollagenous proteins, which have a special structural and functional role in bone, were addressed. STUDY DESIGN: Nine mastoid specimens with cholesteatoma and four normal specimens obtained at surgery were examined. METHODS: Histological and immunohistochemical methods were employed to evaluate the nature of structure and noncollagenous protein content changes in the mastoid bone affected by cholesteatoma. RESULTS: The bone associated with cholesteatoma had structural changes as a noncontinuous periosteum, empty lacunae, irregular cement lines, and, specifically, the appearance of eosinophilic vesicles at the interface between the bone and cholesteatoma Immunohistochemistry demonstrated that noncollagenous proteins were apparently absent in the affected mastoid bone. Bone remote from the cholesteatoma seemed normal. CONCLUSIONS: These findings demonstrate for the first time the changes in the noncollagenous protein content in the mastoid bone affected directly by cholesteatoma These changes could be a result of a direct influence of cholesteatoma-derived products on the osteoblast.

Adolescent↗
PubMed2001

Acute mastoiditis in children: a seventeen-year experience in Dallas, Texas.

BACKGROUND: In the preantibiotic era acute mastoiditis was the most common complication of acute otitis media, often resulting in substantial morbidity and mortality. Since 1989 several investigators have documented an increased frequency of acute mastoiditis in children. METHODS: The medical records of all children with a discharge diagnosis of acute mastoiditis, managed at Children's Medical Center, Dallas, TX, from 1983 through 1999 were reviewed. RESULTS: There were 57 cases of acute mastoiditis during the 17-year period of 1983 through 1999 compared with 57 cases in a 25-year period of 1955 through 1979 reported previously at the same institution. The number of cases of acute mastoiditis per 10,000 hospital admissions increased significantly (regression analysis P = 0.003) during the more recent 17 years. From 1993 through 1999 there were 4.5 cases or more per 10,000 admissions each year, whereas from 1983 through 1992, the incidence never exceeded 4.3 cases per 10,000 admissions (P = 0.018). The median age of the patients was 48 months. Twenty-two patients (38.5%) were younger than 24 months; 17 of these were 12 months of age or younger. Twenty-two (38.5%) patients had no history of previous episodes of acute otitis media. Streptococcus pneumoniae was the pathogen most often isolated from the cultures. Complications of mastoiditis occurred in 20 children (35%). CONCLUSIONS: We conclude that acute mastoiditis continues to be a problem in the post antibiotic era. It occurs mainly in young children and can be the first evidence of ear disease.

Acute Disease↗
PubMed2004

The use of demineralized bone matrix for mastoid cavity obliteration.

OBJECTIVE: To evaluate the use of demineralized bone matrix as a graft material for mastoid cavity obliteration in the treatment and prevention of problematic mastoid cavities. STUDY DESIGN: The study is a retrospective review of patients identified using a computerized otology database. SETTING: Tertiary care referral center. PATIENTS: Patients were included in this study if they underwent mastoid obliteration using demineralized bone matrix. INTERVENTION: Mastoid obliteration was performed for revision of a problematic mastoid cavity (n = 8) or primarily after canal wall down mastoidectomy for recurrent cholesteatoma (n = 3). MAIN OUTCOME MEASURES: Data were collected to evaluate the ability to achieve a dry ear canal. Postoperative healing time and hearing results were also assessed. RESULTS: A dry ear canal was achieved in all patients with a follow-up of 6 to 20 months (average, 14.5 mo). Eight patients (73%) had a well-healed, dry ear canal by their first postoperative visit (9 wk). One patient required 12.5 weeks to heal. Two patients (18%) had more prolonged granulation at the ear canal incision, which resolved in 17 and 28 weeks, respectively. The average preoperative pure-tone average air-bone gap was 47 +/- 14.9 dB (mean +/- SD), compared with postoperative values of 27.6 +/- 12.8 dB (p = 0.0033; paired t test). This represents an average pure-tone average air-bone gap closure of 20 dB. CONCLUSION: The use of demineralized bone matrix as a graft extender in mastoid obliteration allowed creation of a dry, smooth-contoured canal in all patients studied. A significant improvement in hearing was also obtained. Demineralized bone matrix is an acceptable graft alternative for mastoid obliteration.

Adolescent↗