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We describe the case of a pleomorphic adenoma of the middle ear and mastoid, with extension into the posterior cranial fossa. The lesion was characterized by extensive bony destruction and close proximity to the facial nerve. Ectopic or choristomatous salivary gland tissue within the middle ear cleft is the most probable origin of this tumor.
Inverted papillomas of the paranasal sinuses have been characterized by their unusually benign histologic features, their ability to grow rapidly with bony destruction, and their tendency to recur if not adequately treated. The association of inverted papilloma with squamous cell carcinoma is well described, but malignant transformation is relatively rare. We report a case of a multiply recurrent inverted papilloma that spread to the middle ear and mastoid and eventually underwent malignant transformation with skull base invasion. Pathologic examination demonstrated many of the characteristics associated with malignant transformation. In addition, progesterone receptors were demonstrated that may have stimulated this tumor during the patient's pregnancy. To our knowledge, no similar cases have been reported in the literature.
A temporoparietal craniotomy as the approach of choice employed by the authors is presented for the surgical correction of dural herniation into the mastoid cavity in our series of four cases of middle fossa defects caused by previous operative procedures (mastoidectomy for removal of cholesteatoma) performed elsewhere. At the Triological Meeting a color movie accompanied the presentation of this paper.
The patient with persistent foul drainage from a previously operated-on mastoid cavity has a serious problem that requires aggressive attention from the otologic surgeon. The ear must be carefully evaluated in the office. Careful cleaning of the cavity and effective application of medication will dry up many of these cavities. Revision surgery of the ear requires a systematic approach using all the techniques of modern otologic surgery. This means the use of a post-auricular incision and wide bone removal combined with bone removal combined with obliteration techniques and grafting of the middle ear. This approach was used in 29 ears in 27 patients. Rapid healing and a trouble-free, dry ear was obtained in 26 patients or 90% of the operated-on cases.
We present herein a rare case of osteoma mixtum of the mastoid. The main features of the osteoma were demonstrated clearly by preoperative tangential X-ray projection. Histological studies revealed the osteoma to be composed of multiple small foci of ossification on the outer layer with a large single inner mass. Subsequent examinations revealed that the osteoma had arisen from the parietosquamosal suture.
The authors report a case of septic venous sinus thrombosis (VST) and meningitis occurring as an early complication of mastoiditis caused by Fusobacterium necrophorum. CT scan was normal, and cerebral angiography was required to diagnose the VST. The evolution was favourable with appropriate antimicrobial therapy and steroids.
We describe the MRI features of sigmoid sinus thrombosis following mastoiditis in a 3-year-old girl. The features consisted of increased signal from the sinus on T2-weighted images and absence of flow on MR venography. It is concluded that MRI enabled a timely diagnosis of this life-threatening disease. MRI, as a non-invasive technique that does not use ionizing radiation, should be considered the investigation of first choice, especially in young patients.
Resistance to erythromycin is usually associated with resistance to penicillin in Streptococcus pneumoniae isolates. Over the last few years, however, an increase has been detected in the number of Streptococcus pneumoniae isolates obtained from children with acute otitis media complicated by acute mastoiditis. These isolates are characterized by a penicillin-susceptible and erythromycin-resistant antibiotic profile. This observation prompted a review of the microbiology database and analysis of all Streptococcus pneumoniae isolates with this peculiar antibiotic profile at a university hospital in Madrid, Spain.
We report a case of infection of a mastoid cavity after mastoidectomy had been performed for chronic otitis media with cholesteatoma. The infection was caused by Staphylococcus intermedius after a pet dog had licked the patient's ears. Bacterial strains from the dog's saliva and the otorrhea in the patient were confirmed to be identical by pulsed-field gel electrophoresis analysis. The possibility of an oral transmission route of S. intermedius from pets to humans should be noted.
The area of the mastoid pneumatization was measured planimetrically on lateral X-ray pictures of the ears of 232 patients with acute otitis media. In the present otitis media patients the mean size of the air cell system as a function of the age was similar to the values given in earlier investigations of "normal" populations. The size of the air cell system was classified as small, medium-sized or large as a function of the age based upon the mean +/- 1 S.D. There were 61 patients who had no previous history of otitis media. However, 10% of these patients had a small air cell system and only 15% a large cell system, which indicated that many had suffered from otitis media which had not been recognized. The size and clouding of the air cell system had a significant prognostic value with regard to healing and eventual outcome of the disease.
Congenital aural atresia occurs approximately once in every 20,000 live births, although the incidence of otitis media in aural atretic children should not differ from the rest of the population, detection is difficult. Unless severe, the infection usually goes unnoticed, especially with the use of antibiotics. A two-year-old male with congenital aural atresia presented with fever and facial nerve paresis. As his illness progressed, he developed mastoiditis with subperiosteal abscess and sigmoid sinus thrombosis. Literature review showed this to be the first reported case of sigmoid sinus thrombosis in congenital aural atresia. Diagnosis and management are presented.
INTRODUCTION: The physiological function of the mastoid air cell system (MACS) with respect to middle ear (ME) pressure-regulation remains controversial because predictive mathematical models and experimental data to formulate and test hypotheses are lacking. OBJECTIVE: A mathematical description of MACS volume effects on the rate of ME pressure change is presented; the agreement between published data and model prediction is examined for consistency with the hypothesis that the MACS acts as a functional rate-limiter of ME pressure change, and an explanation for the relationship between MACS volume and otitis media is discussed. METHODS: The mathematical description shows that the value of a single, free parameter, termed the "MACS buffering efficiency" (M) determines if MACS volume affects the rate of ME pressure change caused by diffusive gas exchange. The MACS serves no rate-limiting function for M=0, acts as a gas sink for M>1 and acts as a gas reserve (rate-limiter) for M<1. RESULTS: Fitting the model equation to published adult human data yielded an estimate for M of 0.2. This implies that larger MACS volumes are associated with lesser rates of change in ME pressure caused by diffusive gas exchange and lesser required frequencies of effective Eustachian tube openings to maintain near ambient ME pressures. CONCLUSION: If well-controlled studies confirm M<1 for children and adults, larger MACS volumes will increase the time required to develop sufficient ME underpressures to cause otitis media by hydrops ex vacuo during transient or prolonged periods of Eustachian tube dysfunction.
We report a case of antral-mastoid cholesterol granuloma, invading the middle cranial fossa, clinically showing a sudden onset of neurological symptoms. The histopathologic, diagnostic, and therapeutic aspects of this lesion are commented.
The osteomas of the mastoids are slow growing benign tumors, made predominantly of mature bone. Clinically these tumors are asymptomatic, except for cosmetic deformities, and they are usually casual radiological findings. Surgical treatment is indicated for symptomatic osteomas. In Spain only sixteen cases of extracanalicular osteoma have been described in the literature. Two new cases are reported and a review of the literature is presented.
This clinical report describes a 64-year-old woman with a bony defect in the mastoid process after mastoidectomy and who experienced vertigo on cold and windy days during winter. The patient noticed that packing a piece of paper or cotton into the defect prevented the vertigo. The patient refused surgical repair, so a silicone prosthesis was fabricated to fill the defect completely. Electronystagmography confirmed the effectiveness of the prosthesis to prevent nystagmus. Although surgical repair is ideal, prosthesis repair of the defect may prove to be effective in some patients.
Otitis media is a multifactorial, multifaceted disease that manifests itself in the middle ear, mastoid, and eustachian tube. To select a rational therapy, physicians must have an understanding of the anatomy, function, and pathology of the organs involved and of the mechanisms of disease. The purpose of this article is to provide surgical principles in tympanomastoidectomy and an overall concept of the procedures available. Simple mastoidectomy is described in detail as a general approach.
We report a 2-month-old boy with severe congenital neutropenia (SCN), who developed acute necrotizing otitis media and coalescent mastoiditis due to methicillin-sensitive Staphylococcus aureus. The infection fulminantly progressed within a day to a subtotal perforation of the tympanic membrane, destructive bony changes of ossicles, lateral subperiosteal abscess, and suppurative labyrinthitis. Despite the combined treatment with intravenous antibiotics and granulocyte colony-stimulating factor, the infection resulted in mixed hearing impairment. Much attention should be given to prompt diagnosis of otomastoiditis in SCN, a rare congenital disorder, since resultant acoustic sequelae may affect subsequent speech development and intellectual ability.
Mycobacterium tuberculosis is a rare cause of mastoiditis, but diagnosis is often delayed, with potentially serious results. We present the case of a 7-year-old child who failed to improve even once the diagnosis was made and appropriate medical treatment initiated. At mastoidectomy, a bony sequestrum was found which had not been evident on CT scanning. We review the diagnosis and management of this condition and suggest that failure to respond to drug therapy even in the absence of demonstrable complications be added to the list of indications for surgical intervention.