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PubMed1992

Correlation between temporal bone pneumatization, location of lateral sinus and length of the mastoid process.

The relationship between temporal bone pneumatization and the location of the lateral sinus and length of the mastoid process was investigated in 60 fresh frozen adult temporal bones, by plain X-rays, computed tomography and surgical dissection including otomicroscopic findings. Temporal bone pneumatization was classified as small, moderate and large. After drilling, the shortest distances between the middle fossa dura and mastoid tip representing the mastoid length and between the sigmoid sinus and posterior border of external auditory canal were measured and compared to the degree of pneumatization. The distances in the specimens with pathological eardrum and adhesions in the middle ear were compared to the ones without gross pathology. The length of mastoid process was significantly shorter in specimens with small pneumatization than those with large (Mann Whitney P less than 0.001). The specimens with a pathological eardrum and middle ear adhesions had a significantly shorter mastoid length than those without gross pathology. There was no significant difference between degree of pneumatization and the shortest distance between sigmoid sinus and external auditory canal (Mann Whitney P greater than 0.05). It is demonstrated that the 'under-developed' mastoid process can be a consequence of hampered pneumatization.

Adult↗
PubMed1997

Do the complications of mastoid surgery differ from those of the disease?

During mastoid surgery there is a risk to the facial nerve and hearing but at present it is unclear how substantial this risk is. This information is necessary for adequate informed consent to be given, as consent requires information about both the potential risks of the surgery as well as the risks of leaving the disease untreated. The aim of this study is to establish the risks of mastoid surgery and the incidence of complications as a consequence of mastoid disease. The records of all patients undergoing mastoidectomy between 1985 and 1994 were reviewed for preoperative and intra-operative complications. Preoperatively there were 21 (2%) facial nerve palsies, 67 (6.5%) dead ears and 58 (5.7%) intracranial complications of the mastoid disease. If this risk is extrapolated for the population of the Western Cape over a 40-year period (average expected life-span after presentation), the risk of developing a serious complication (facial palsy, dead ear or intracranial) from mastoid disease during this period was 3.8%. The incidence of intra-operative iatrogenic facial nerve palsy was 1.7% (n = 17) and of dead ear was 1.7% (n = 17). Although the comparative risk of developing a severe complication from untreated disease was similar to the risks of surgery (facial palsy, dead ear), the number (58) of intracranial life-threatening preoperative complications presenting in the 10-year period reviewed was significant. These figures provide a base from which otologists can inform patients about the possible risk of mastoid surgery as well as allowing these risks to be compared with the risks of leaving the disease untreated.

Adult↗
PubMed1998

A miniaturized artificial mastoid using a skull simulator.

A miniaturized artificial mastoid of size and weight that allow calibration and measurement of bone conduction hearing aids in a conventional audiometric soundproof box has been developed. Its level of mechanical impedance corresponds to the standard IEC 373 (1990) within the frequency range 250 Hz to 8 kHz. The miniaturized artificial mastoid consists of three parts: coupler, skull simulator (TU-1000), and an external electrical correction filter. The coupler is a highly damped mass-spring system designed to give the miniaturized artificial mastoid mechanical impedance in accordance with the standard IEC 373 (1990). It was found that the miniaturized artificial mastoid yielded results that are in correspondence with results obtained with the Brüel & Kjaer type 4930 artificial mastoid for frequencies above 450 Hz. Thus, at these frequencies, the miniaturized artificial mastoid can be used for audiometer calibration as well as measurement of bone conduction hearing aids.

Bone Conduction↗
PubMed2004

Regeneration of mastoid air cells: clinical applications.

The objective of this study was to establish a method for regenerating mastoid air cells and their functions for clinical use in incurable otitis media. For this clinical study three patients (one male, two female) were randomly selected from patients with severe cholesteatoma about to undergo staged operations. Hydroxy-apatite in three-dimensional, honeycomb-like structures (3D-HA) were used as artificial pneumatic bones. This 3D-HA is made of calcium phosphate and has a high percentage of micropores (90%). Its surface is coated with collagen. At the first stage of tympanoplasty, collagen-coated 3D-HA was put into the opened mastoid cavity and fixed by fibrin glue. Recovery of mastoid aeration and regeneration of the pneumatic air cells of the mastoid cavity were estimated on CT scan images after the first operation. Aeration was recovered in all cases. The mastoid air cells were regenerated in two cases. In the failed case, subcutaneous connective tissues and granulations invaded into the spaces of the 3D-HA. This study demonstrated that mucosa would grow on the surface of a 3D-HA implant and could provide gas exchange functions in the newly opened mastoid cavity. This tissue engineering method may be a possible treatment for intractable otitis media.

Aged↗
PubMed2001

National differences in incidence of acute mastoiditis: relationship to prescribing patterns of antibiotics for acute otitis media?

BACKGROUND: Operating on the principle that most acute otitis media (AOM) episodes resolve without antibiotics, doctors in the Netherlands usually manage AOM in children with initial observation. Prescription of antibiotics is limited to children with a complicated course of AOM and those categorized as high risk. Consequently only 31% of patients with AOM receives antibiotics, compared with >90% in most other countries. OBJECTIVE: To substantiate the suggestion that this restrictive use of antibiotics leads to a higher incidence of acute mastoiditis. METHODS: A comparative study across several European countries, Canada, Australia and the United States was performed in the period 1991 to 1998. The incidence rate of acute mastoiditis was defined as the total number of patients age 14 years and younger discharged from all hospitals with the primary diagnosis of acute mastoiditis, during a specified period (usually 5 years), divided by the number of person years (py) in that same age range and period. The latter was calculated by totaling the midyear population estimate of children age 14 years and younger of each year. The 95% confidence intervals and incidence rate ratios were calculated to compare the observed rates. RESULTS: The incidence rate of acute mastoiditis in the Netherlands, with a low antibiotic prescription rate for AOM, was 3.8/100,000 py; in Norway and Denmark, with high prescription rates, the incidence rate was comparable at 3.5/100,000 py and 4.2/100,000 py, respectively. In all other countries with very high prescription rates, incidence rates were considerably lower, ranging from 1.2 to 2.0/100,000 py. The incidence rate in the Netherlands was about twice that in the United States (rate ratio, 0.5). CONCLUSION: The incidence rate of acute mastoiditis in the Netherlands is higher than in many countries with higher antibiotic prescription rates. Although the potential benefits of restricted use of antibiotics (i.e. cost reduction, fewer side effects from antibiotics and less antimicrobial resistance) are beyond dispute, such strategy may be associated with a somewhat higher incidence of acute mastoiditis.

Acute Disease↗
PubMedDate not supplied

Mastoid condition and clinical course of cholesteatoma.

This study was carried out to establish which type of cholesteatoma is controllable by conservative treatment from the viewpoint of mastoid ventilation. We examined the area of the air cell system and airspace (aeration) in the mastoid cavity by computed tomography and eustachian tube (ET) function by inflation-deflation test in 20 ears (20 patients) with severe attic retraction for over 12 months (retraction pocket group), 16 ears (16 patients) with cholesteatoma which could be controlled only by conservative treatment for over 12 months (nonsurgical group) and 43 ears (43 patients) which required surgery within a year in spite of similar conservative treatment (surgical group). The size of the mastoid air cell system in the retraction pocket group, nonsurgical group and surgical group was 2.9 +/- 1.3, 1.9 +/- 0.7 and 1.5 +/- 0.9 cm(2) on average, respectively, with no significant difference between both cholesteatoma groups (nonsurgical and surgical group). While aeration was observed in the mastoid in 17 of 20 ears (85.%) in the retraction pocket group and in 12 of 16 ears (75.0%) in the nonsurgical group, aeration was present only in 9 of 43 ears (26.5%) in the surgical group, being significantly less in the surgical group than in the nonsurgical group and the retraction pocket group. In all ears in the retraction pocket and nonsurgical groups, and 19 of 30 ears in the surgical group, ET function was poor, there being no significant difference among the three groups. The present clinical observations suggest that progressiveness of cholesteatoma could be related to the ventilatory conditions in the mastoid rather than ET function, and that conservative treatment may be effective when ears with cholesteatoma have aeration in the mastoid.

Adolescent↗
PubMedDate not supplied

Secretory otitis media and mastoid pneumatization.

The objective of this study is to correlate in children with chronic secretory otitis media the extent of pneumatization with morphological and functional end results after therapy. For this purpose we examined 82 children and adolescents (147 ears), who 5 to 8 years previously were treated with insertion of ventilating tubes for chronic secretory otitis media. We evaluated the morphological and functional end results with otomicroscopy, pure tone audiometry, tympanometry and stapedial reflex testing. Roentgenograms of the temporal bones in a lateral projection were taken initially in 96 ears and at time of control in 145 ears. We judged the size of the mastoid air cell system by visual estimation and classified the mastoids according to the extent of pneumatization into three groups: large, middle-sized and small (sclerotic). Twenty-five percent of the ears had sclerotic mastoids at time of control. Statistically significant correlations exist between arrested pneumatization (sclerotic mastoids), major morphological changes in the tympanic membranes and unfavorable functional results. Also the correlation between sclerotic mastoids and the number of tube insertions required in the course of the disease is statistically significant. But no correlation can be established between the physical properties of secretions and the extent of pneumatization. Arrest of pneumatization leading to a small mastoid air cell system constitutes an unfavorable prognostic factor for the final outcome of chronic secretory otitis media.

Adolescent↗
PubMed2000

Plasmacytoma of the mastoid bone: solitary and systemic.

Plasma cell tumours of the mastoid are rare malignancies of haematological origin. Two patients are described with a plasma cell tumour in the mastoid bone. In one patient it concerned a solitary plasmacytoma of the bone and in the other a focus in the mastoid of a recently diagnosed multiple myeloma. Symptoms in these patients were non-specific. Computed tomography (CT) and magnetic resonance image (MRI) scanning showed a non-specific space-occupying lesion in the mastoid. The diagnosis was made on immunohistological examination, that showed diffuse sheets of monoclonal plasma cells in a clear matrix. When a plasmacytoma lesion is found multiple myeloma should always be excluded. Treatment in case of solitary plasmacytoma of the mastoid bone consists of radiotherapy. In case of localization in the mastoid of multiple myeloma the treatment consists of palliative chemotherapy.

Aged↗
PubMed1996

The pars flaccida middle ear pressure and mastoid pneumatization index.

The degree of pars flaccida retraction and the levels of mastoid pneumatization were assessed and correlated in 388 adults with intact pars tensa. Poorly pneumatized mastoids were found to be associated with retraction of pars flaccida; the poorer the pneumatization, the deeper the retraction. Well pneumatized mastoids were usually associated with normal position of the pars flaccida. The pars flaccida was previously also shown to retract in face of ME negative pressure--and its degree can be seen to be an index of ME negative pressure. Thus, the correlation of deeper degrees of pars flaccida retractions with mastoid hypopneumatization (and vice versa) lends strength to the studies which show the mastoid pneumatic system to have a function of a passive ME pressure buffer. This observation lends further evidence as to why ears with poorly pneumatized mastoids are a priori at risk to develop complications such as SOM in adults, tympanic membrane retractions and perforations, incus necrosis or retraction pocket cholesteatoma. Ears with a large pneumatic system are hardly at such risk.

Ear Diseases↗
PubMedDate not supplied

Morphometric examination of the paranasal sinuses and mastoid air cells using computed tomography.

BACKGROUND: The paranasal sinuses and mastoid air cells vary considerably in size and shape from person to person. The main structures are pneumatic. In this study, we investigated the relationship between right and left sides and evaluated the volume changes according to age and sex. METHODS: Of all patients attending the radiology department, 91 cases without paranasal sinuses and mastoid air cells pathology (i.e., inflammation, operation or trauma) were selected for evaluation. Axial computed tomography (CT) scans were obtained for both paranasal sinuses and temporal bones. In all scans, the volumes of each area (maxillary sinus, frontal sinus, sphenoid sinus and mastoid air cell) were calculated and analyzed statistically. RESULTS: The volumes of paranasal sinuses and mastoid air cells increased with age and women had a lower mean volume. There was a positive correlation between right-left and ipsilateral structures (paranasal sinuses and mastoid air cells). CONCLUSIONS: These results are helpful in understanding the normal and pathological conditions of the paranasal sinuses and the mastoid air cells.

Adult↗
PubMed2002

[Acute mastoiditis: an increasing entity].

BACKGROUND: Mastoiditis used to be the most common complication of acute otitis media. However, once antibiotics became widely available, it was rarely reported. Recently, this complication has become more frequent. OBJECTIVES: To determine the frequency of acute mastoiditis in our center in the last few years and to analyze the clinical and bacteriologic characteristics of the patients with this diagnosis. METHODS: Retrospective analysis of all patients admitted to our hospital with a diagnosis of acute mastoiditis from 1994-2001. RESULTS: One hundred patients were diagnosed with acute mastoiditis during the study period. The mean age was 2 years and 10 months (range: 2 months-13 years) and the median age was 15 months. The mean number of episodes was 12.5 cases of acute mastoiditis per year, but 52 % of the cases occurred from 1999-2001. Culture of middle ear effusions was performed in 47 patients, revealing Streptococcus pneumoniae in 17, Haemophilus influenzae in 3, and other pathogens in 10 children. Cultures were sterile in 17 patients. Three children did not respond to medical therapy and required mastoidectomy. CONCLUSIONS: In the last few years, the incidence of acute mastoiditis in our population has increased considerably. This complication is more common in children aged less than 2 years.

Acute Disease↗
PubMed1992

[Mastoiditis--a forgotten disease?].

The symptoms and clinical course of latent mastoiditis in 18. children treated in Polish-American Children's Hospital in Cracow were presented. The ultimate diagnosis of mastoiditis was based on typical findings on antrotomy and the presence of granulation on histology of the tissue obtained during the operation. The main symptoms of latent mastoiditis were: a lack of appetite, chronic or recurrent fever and failure to thrive. 11 children (61%) had experienced more than 3 episodes of acute otitis media before the diagnosis of mastoiditis was established. Bacteria most commonly isolated from the middle ear were those of Staphylococcus, Streptococcus and Proteus species. Radiograms of mastoid processes were negative in up to 45% of those children. The mean duration of antibiotic therapy was 10.7 weeks. After antrotomy complete dissolution of symptoms were observed in 14 patients (78%). It is concluded, that in the presence of symptoms suggesting latent mastoiditis, the possibility of antrotomy, which may shorten the period of ineffective antibiotic therapy, should be considered earlier.

Humans↗
PubMed1998

5-year series of constricted (lop and cup) ear corrections: development of the mastoid hitch as an adjunctive technique.

Despite the multitude of corrective procedures described, adequate surgical correction of the congenital constricted ear remains a challenge. The maintenance of the shape and elevation of the reconstructed upper neohelix poses a particular problem. In the present series, experiences with lop ear correction utilizing standard techniques and the use of the mastoid hitch as a useful adjunct to these procedures are described. A total of 19 ears were reconstructed. There were three type 1, eight type 2a, seven type 2b, and one type 3 deformities (Tanzer classification). A graded sequence of procedures was adopted. Mild deformities were corrected by cartilage scoring techniques; a V-Y advancement of the helical root was added for moderate deformities. Cartilage expansion by a banner flap was required for more severe deformities. A mastoid hitch, whereby the refashioned upper neohelix is sutured to the mastoid fascia, should be used as an adjunct to these procedures to maintain helical elevation and prevent recurrence. Severe type 3 deformities may require autologous auricular reconstruction. Mean follow-up time was 1 year. There were six excellent, seven good, four fair, and two poor results. Two patients who had not had mastoid hitch procedures developed a recurrence of the lop deformity. Adequate surgical correction of constricted ear deformities requires a variety of surgical techniques. The mastoid hitch being used for constricted ear correction has not been described elsewhere. The mastoid hitch is a useful adjunctive procedure that may be used effectively in combination with other procedures.

Adolescent↗
PubMed1984

Acute myelogenous leukemia presenting as atypical mastoiditis with facial paralysis.

Symptomatic otologic involvement by leukemic infiltration is unusual, most often occurring in the already-diagnosed leukemic patient as postauricular mass, acute hemorrhagic otitis media, mastoiditis, cranial neuropathy, vertigo, hearing loss, or leptomeningitis. We think ours is the first reported patient whose leukemia presented as atypical mastoiditis and facial paralysis due to granulocytic sarcoma (chloroma). At mastoidectomy, tan lobulated rubbery tumor filled the mastoid antrum and middle ear cleft. Complete remission and full return of facial nerve function was achieved with 2500 R local radiation and systemic chemotherapy. We discuss the role and extent of surgery in atypical acute mastoiditis when unsuspected middle ear and mastoid tumor, with inconclusive intra-operative histopathologic data, is found.

Adolescent↗
PubMed1991

Mastoid surgery at the Red Cross War Memorial Children's Hospital 1986-1988.

Eighty-three children between ages 0-12 years had mastoid surgery in the three year period 1986-88. The indications were acute mastoiditis (30 children), uncontrolled chronic suppurative otitis media (CSOM) (24 children), cholesteatoma (22 children) and a miscellaneous group (7 children). Forty-seven per cent of those with acute mastoiditis were under one year but the 27 per cent with cholesteatoma as the precipitating cause were 4-12 years. Twenty-three per cent had significant complications. Typmano-mastoid surgery was employed to resolve uncontrolled CSOM. Children were between 2-12 years and 62 per cent were below the 25th centile for weight. Seventy-nine per cent of the tympanic membrane grafts were successful. The children with cholesteatoma were between 3-12 years and 76 per cent were below the 25th centile for weight. Eight of them only presented after the onset of acute mastoiditis. One child had a definite congenital cholesteatoma. Only one had a pars flaccida origin of the cholesteatoma sac and only eight an origin from the postero-superior pars tensa. All had open cavity surgery. When the cavity was lined by temporalis fascia, healing was improved markedly.

Acute Disease↗
PubMed2002

[Therapy of acute mastoiditis].

BACKGROUND: Acute otitis media is a common disease, mostly contracted at childhood. The development of acute mastoiditis has been decreased since the introduction of antibiotics. Currently it is only developed in 0.004 % cases of acute otitis media. But despite of this fact, even today one should not neglect this condition as the complications such as intracranial spread and lateral sinus thrombosis are still life threatening. METHODS AND PATIENTS: In a retrospective study from 01/96 - 09/00 we reviewed the cases of acute mastoiditis as a result of acute otitis media at our department. Additionally we compared study results out of 1972 until 1989 with our current results. RESULTS: Altogether mastoidectomy has been carried out at 157 patients. The cases have steadily increased since 1996. This is confirmed by comparison with study results of previous years. The majority of the patients were between 8 months and 3 years old (60 %). When the patients first presented at our department, the first signs of otitis media were 19.5 days ago in average. 38 % of the patients received no antibiotic treatment before admission. A thickened mucous membrane was seen by the mastoidectomy mostly (58 %). A subperiostal abscess we noted in 8.5 %. The most common isolated bacteria were Streptococcus pneumoniae (33 %) and Streptococcus pyogenes (11 %). The patients stayed at the department about 10 days. In comparison to recent study results the "typical" mastoiditis has decreased. The causative pathogens have not changed. CONCLUSIONS: In the last years we realised an increasing number of mastoiditis at our department. The isolated bacteria are the same as presented in the literature. Early surgery combined with an effective antibiotic treatment can avoid the known complications of mastoiditis.

Acute Disease↗
PubMed2004

Bacteriology of mastoid subperiosteal abscess in children.

OBJECTIVE: Subperiosteal abscess (SA) is the most frequent complication of acute mastoiditis (AM). Of pathogens cultured from the external auditory canal or middle ear during myringotomy, 15% may be different from microorganisms isolated from the SA. We suggest, therefore, that only cultures obtained from the abscess cavity can truly reflect the bacteriology of this complication of AM. The purpose of our study was to analyze the infectious agents which cause SA and mastoid cortex erosion in children. MATERIAL AND METHODS: The medical records of 35 children who underwent mastoidectomy for SA between May 1984 and April 2002 were evaluated. RESULTS: Mastoid cortex erosion was found at surgery in 72.7% of abscesses Purulent discharge was obtained from the SA cavity in 28 cases. The commonest pathogens isolated in these cases, as well as in 18 cases of mastoid cortex erosion, were Staphylococcus aureus and Streptococcus pyogenes, followed by Streptococcus pneumoniae. Hemophilus influenzae, Pseudomonas aeruginosa, Escherichia coli and Klebsiella pneumoniae. Sterile culture was found in 25% of cases. CONCLUSIONS: Mastoid SA is a unilateral disease that can recur. Early administration of anti-Staphylococcus medications should be considered for patients with SA as a complication of AM.

Abscess↗
PubMed1999

A technique of mastoidectomy and meatoplasty that minimizes factors associated with a discharging mastoid cavity.

OBJECTIVES: To present and assess a surgical technique designed to minimize the known causes of a discharging mastoid cavity. STUDY DESIGN: A temporal bone dissection to establish the anatomical relationships on which the surgical technique is based. A presentation of the proposed surgical technique and a prospective assessment of the technique in twenty consecutive mastoidectomies. METHODS: Five temporal bone dissections were performed to establish the relationship between the chorda tympani and the facial nerve when these structures are approached from above. The surgical technique is presented and the mastoid cavities of twenty consecutive patients assessed. The assessment included measurement of the facial ridge height, "kidney-shape" of the cavity, size of the cavity, size of the meatus, and state of the tympanic membrane. RESULTS: In the temporal bone dissections the vertical height between the chorda tympani and the facial nerve at 3/9 o'clock was a mean of 2.01 mm. Nineteen of the 20 consecutive mastoid cavities (95%) performed with the presented technique remained well healed and dry. The mean facial ridge height was 2.7 mm at 3/9 o'clock and 4.8 mm at 6 o'clock. The kidney-shaped measurement was 1.45 mm. The mean size of the cavities was 2.6 mm and 18 of the 20 patients (90%) had an intact tympanic membrane. The mean largest diameter of the meatus was 10.1 mm. CONCLUSIONS: The surgical technique presented produces a mastoid cavity with a low facial ridge and oval shape. These two factors have been previously identified as important in the outcome of mastoid surgery.

Adolescent↗