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Primary cholesteatoma has been described in a number of sites within the temporal bone. We report an unusual case of primary cholesteatoma, confined to the mastoid, presenting with Bezold's abscess of the anterior cervical triangle, in an otherwise asymptomatic elderly man with normal hearing.
An unusual case of squamous cell carcinoma of the middle ear and mastoid in which syncope was a major presenting feature is reported. No such case has been reported in the literature. A possible explanation is offered.
The administration of antibiotics in otitis media alters the natural course of the disease process. If the antibiotics used are inappropriate, or if dosage or duration of treatment is inadequate, an imminent intracranial complication may be masked. A case of latent mastoiditis presenting with Pott's puffy tumour is described.
This paper reports a new procedure used successfully in the reconstruction of 12 radical mastoid cavities in King Fahd Hospital of the University, Al-Khobar, Saudi Arabia. A composite pedicled flap composed of temporalis muscle and its fascia attached along one border, based posteriorly, is rotated in to the radical cavity. The muscle is used to obliterate the cavity and the fascia is hinged forward as a tympanic membrane graft.
A case of bilateral mastoiditis with subperiosteal abscesses complicating acute otitis media in a two and a half year old girl is presented. Contrast enhanced computerized tomography confirmed the diagnosis of right lateral sinus thrombosis. The aetiology, diagnosis and management of these conditions are discussed.
The first isolated case of agenesis of the mastoid antrum, previously only described in association with the congenital syndromes trisomy 13 and mandibulofacial dysostosis, is reported. The loss of this important surgical landmark may result in disorientation and iatrogenic trauma. The surgeon must be aware of its existence, and where it is suspected the middle fossa dura should be exposed and followed posteriorly until the lateral sinus is encountered.
Critical evaluation of the outcome of surgery for cholesteatoma has favoured open cavity techniques. These methods have however been plagued by an inability to consistently produce healthy well healed cavities. The strength and stability of the normal tympanic membrane depends upon the separation of squamous epithelium from the middle ear mucosa by a fibrous tissue layer. Traditional methods of dealing with the cavity fail to reproduce a similar anatomically stable arrangement. In order to achieve the highest percentage of dry, stable disease-free ears after employing basic surgical principles of wide access to facilitate meticulous removal of all cholesteatoma, we have utilized a vascularized deep temporalis fascia flap for complete coverage of the cavity eliminating all raw areas. This fibrous layer provides the optimal substrate for epithelial resurfacing. Excellent healing even under unfavourable circumstances is ensured by the rich blood supply to the pedicled temporalis fascia flap. Considering patient preferences and cost effectiveness, the optimal treatment for cholesteatoma must be one operation, provided it achieves a dry safe ear. Based upon rational concepts, the 'Hong Kong Flap' technique of reconstructing the mastoid cavity involves a straightforward procedure requiring no special technical skill that consistently achieves this ideal.
Osteoblastoma is a benign bone lesion that mainly affects the long bones and rarely the temporal bones. Very few cases have been reported in the literature. This paper reviews the literature, discusses the differential diagnosis, clinical presentation, and CT scan findings of such a condition and details our experience with a young patient who had a temporal bone (mastoid process) osteoblastoma.
A questionnaire was sent to all Full Members of the British Association of Otolaryngologists to ascertain whether and what type of eye protection surgeons and theatre nurses wear during mastoid surgery. Despite Department of Health recommendations only 58 per cent of surgeons and 19 per cent of theatre nurses routinely wear any form of eye protection.
Forty cases of failed combined approach tympanoplasty were analysed. The commonest cause of failure was adhesions between the facial ridge and the tympanic membrane, causing segmental attico-mastoid malaeration in 51.3 per cent of cases followed-up continually. Other causes were, large dermoids, incomplete removal of squamous epithelium, and eustachian tube obstruction. Eustachian tube dysfunction did not appear to be a major cause of failure.
Patients who have had a mastoidectomy form a considerable long-term follow-up commitment to their local ENT Department. A community-based mastoid aural toilet pilot project run by a GP is described using an operating microscope and suction apparatus in his surgery. To obtain the necessary information about community treatment, an audit was performed of all mastoidectomy patients from a large general practice in Portsmouth: 57 mastoidectomy patients were reviewed. During the project it was possible to transfer to the community microsuction project the long-term care of most of their mastoidectomy patients who were attending the hospital ENT outpatient clinic.
We present the case history of a patient who was severely immunocompromised due to infection with the human immunodeficiency virus (HIV), and who subsequently developed acute mastoiditis due to Aspergillus fumigatus. Fungal otomastoiditis is a rarely reported complication of HIV infection. A high index of suspicion is required in these patients to facilitate early diagnosis and appropriate therapy.
An open radical mastoid cavity presents a handicap to the patient. If elimination of the cavity appears desirable, one should use an operative technique which does not incur the risk of a cholesteatoma redeveloping. In our experience obliteration of the cavity with non-resorbable methacrylate Sulfix-6 is the best way to achieve this. The arguments in favour of this view are presented and the operative technique is described.
A case of benign intracranial hypertension occurring in an 11-year-old boy, and due to lateral sinus obstruction, is reported. Computerized tomographic scan was conclusive, revealing a normal ventricular system and no evidence of a neoplastic lesion. Disappearance of the mastoid air cells and disruption of the trabecular pattern were also shown on the affected side. The diagnosis was confirmed at operation, and the course was favourable. In accordance with other studies cited, our findings suggest that patients suspected of benign intracranial hypertension can be spared invasive neuroradiological procedures if the computerized tomographic scan of the head is normal.
The Scanora (Soredex, Helsinki, Finland) is a multimodal unit for maxillofacial imaging combining narrow beam radiography and pluridirectional spiral tomography. We describe a novel technique for imaging the mastoid process based on a modification of the program for coronal tomography of the ear. This technique is of potential clinical value for implant planning and postoperative evaluation in the temporal bone.
Case report concerning a three years old boy with benign intracranial hypertension. The typical symptoms are results of increased intracranial pressure, associated with headache, vomiting, choked disk, occasionally dehiscence of cranial sutures and sixth nerve paresis. In computed tomography there were no tumor signs. In childhood a possible cause in thrombosis of the lateral sinus following an occult mastoiditis after antibiotic therapy. Mastoidectomy, intensive antibiotic therapy as well as serial lumbar punctures led to complete recovery in most cases.
We investigated the postoperative conditions of ears and the hearing acuity of patients who underwent posterior canal wall reconstruction tympanoplasty for operated ears with open mastoid. The study included 118 ears of 105 patients (57 males, 48 females; age range 5-75 years) and the patients were followed for > 1 year after the final operation. Although 114 ears (97%) were dry after the final operation, retraction pockets and eardrums in a lateral position were observed in 5 ears and in 1 ear, respectively. Ossicular reconstruction was performed in 83 ears and in these the mean air conduction hearing levels were significantly improved after the final operation in those that were subjected to type III and IV tympanoplasty. These results indicate that posterior canal wall reconstruction tympanoplasty can be considered to be an effective procedure.
The effects of obliteration of the mastoid cavity on the growth of residual cholesteatoma were histologically studied in an animal model. A dermal cyst was produced by grafting a piece of autologous auricular skin in the otic bulla of 11 guinea-pigs. Three weeks after grafting, part of the cyst wall facing the cavity was removed and the debris accumulated inside was inserted into the surrounding granulation using a micropick. This procedure simulates the growth mechanism of cholesteatoma residue which sometimes occurs after middle ear surgery in human subjects. In six animals, the bulla was then obliterated with plaster of Paris. The remaining five animals were used as controls. Animals were killed for histological study at 2, 4 or 8 weeks postoperatively. Microscopic examinations revealed that in the obliteration group, severe inflammatory reactions were induced in the otic bulla, although the graft epithelium survived there; dermal cyst reformed in only one of six animals. In the controls, cyst reformation was recognized in all animals. This indicated that severe inflammation induced by plaster prevented growth of the graft epithelium in the otic bulla.