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The most common serious consequences of trauma to the temporal bone are hearing loss and facial nerve paralysis. In order to prevent these sequelae, radiologic evaluation is often necessary. CT offers specific information about the extent of injury, including the presence of bony fragments that need removal in order to free the facial nerve.
In the present study we examined whether pathologic changes can exist in the facial nerve in chronic otitis media (COM) when facial nerve function is clinically normal. In so doing, 20 human temporal bones were examined. Each case had a premortem history of COM without facial paralysis. Nine normal temporal bones were also studied. Signs of degenerative neuropathy involving the facial nerve were found in 2 out of the 20 cases studied. In the first of these 2 cases the tympanic segment of the facial nerve showed focal areas of demyelinization, as well as hypertrophy and proliferation of the Schwann cells but without loss of the axons. These areas were also occasionally associated with increased numbers of mast cells. In the second case the most striking finding was the presence of small dark globules in the mastoid segment of the facial nerve. These formations were assumed to be products of cellular and myelin degeneration. Our studies suggest that COM may be associated with degenerative changes in the facial nerve without clinical impairment of its function. Nonetheless these changes may have the potential for the development of facial paralysis during COM.
A patient had paralysis of multiple lower cranial nerves (VII, IX, X, XI, and XII) and oculosympathetic fibers, and ipsilateral conductive hearing loss. Histologic analysis of a surgical biopsy of the temporal bone revealed metastatic adenocarcinoma of prostatic origin. This is only the second reported case in the English literature (seventh in the world literature) of prostatic adenocarcinoma metastasizing to the temporal bone.
The surgical experience with 74 glomus tumors of the temporal bone is presented. The article proposes new refinements in the classification of type C and D tumors and describes in detail the technique of blind sack closure of the external auditory auditory canal, double ligation of the sigmoid sinus and the use of a special infratemporal fossa retractor. The postoperative treatment and intraoperative management of the internal carotid artery, facial nerve and cranial nerves IX, X, XI and XII including the technique and results of a new type of V-VII anastomosis are discussed.
OBJECTIVES: To describe an isolated ossifying fibroma of the mastoid cavity that did not invade the inner ear and middle ear cavity. STUDY DESIGN: Case report. SETTING: Department of Otolaryngology, College of Medicine, Pusan National University, a tertiary care center in Busan, South Korea. PATIENTS AND INTERVENTION: A 34-year-old woman had an episode of acute right ear otalgia. A computed tomography scan and magnetic resonance imaging scan showed a well-circumscribed, lobulated, 3 x 3 x 3-cm sized tumor mass that was localized to the temporal bone with bony erosion including tegmen mastoid and partial bony destruction and no invasion of the middle and inner ear. A large tumor mass was removed through a simple mastoidectomy. The permanent pathological report confirmed the diagnosis of ossifying fibroma. The patient returned with complaints of recurring right otalgia, 3 years postsurgery. The previous mastoidectomy cavity was filled with a red sandpaperlike lesion; a 3 x 2-cm sized bony defect was also found,and the dura was exposed after removing the eroded tegmen mastoid. Permanent pathological diagnosis was again an ossifying fibroma,and there were no postoperative complications. CONCLUSION: To prevent clinically evident recurrences and potentially life-threatening complications, early complete resection is advised in aggressive and recurring ossifying fibroma involving the temporal bone. Close long-term postoperative follow-up with physical examinations and temporal bone computed tomography will offer the greatest chance of early detection of recurrence.
Bilateral involvement of the temporal bones is a rare manifestation of eosinophilic granuloma, a disease characterized by solitary or multiple foci of osteolytic damage. We report two cases in which the ambiguous and unusual initial symptoms and clinical course constituted a difficult diagnostic problem. In each case, the therapeutic approach used was different: the first was treated with a combination of radiotherapy and corticosteroids and the second with a combination of chemotherapy and corticosteroids. We have reviewed the literature, and the possible symptoms and clinical course are described. We report our views on the diagnostic and therapeutic aspects of the disease.
Seventy-seven patients with glomus tumors involving the temporal bone were treated by surgery, irradiation, and combined therapy. The therapeutic success rate for the surgery group was 91 percent for glomus tympanicum and 78 percent for glomus jugulare tumors. The success rate for radiation therapy was 30% in glomus jugulare tumors. Patients with extensive lesions treated by combined therapy had a therapeutic success rate of 60 percent. The clinical response of glomus jugulare tumors to radiation therapy was 65 percent. Surgery appears to be the best method for eradication of the tumors; however, with large extensive lesions, combined therapy offers a better prognosis than either modality alone.
We present two cases of central giant cell granuloma in the temporal bone. CT showed an enhancing tumor causing a smoothly margined temporal squamosa and floor of the middle fossa. External carotid angiograms showed tumor stain mainly supplied by the temporal branches of the internal maxillary artery. In one case, MR images showed a hypointense mass on both T1- and T2-weighted images that was thought to reflect the pathologic character of this lesion.
Cochlear input impedance was measured in 6 temporal bones taken from 3 dogs by use of a newly developed ceramic device. The device was composed of two ceramic bimorph elements, one for activation of the stapes and the other to pick-up vibration of the former element in the form of an electric output, which varies in accordance with the magnitude of cochlear impedance. Average impedance in the dogs was 2.3 Mohm at 2 kHz, 6.3 Mohm at 4 kHz and 17.8 Mohm at 6 kHz. Effect of closure of the round window was also investigated by placing dental cement on the window. In 3 ears, the impedance increased mainly below 4 kHz, while in the remaining 3 ears no such change occurred. This was probably because the closure was complete in the former but not in the latter.
Despite an increasing incidence of gunshot wounds to the temporal bone, there is little in the literature regarding management of survivors of these serious injuries. Twelve patients were treated for such wounds between 1986 and 1994. The most frequent presentations were cranial nerve injury, especially facial paralysis (9 patients), hearing loss (7), vascular injury (4), and vestibular dysfunction (3). Persistent cerebrospinal fluid otorrhea was uncommon (1 patient) in this series. Computed tomography and audiovestibular testing were helpful in evaluating the severity of injury and guiding the surgical approach when necessary. Electroneurography was helpful in evaluating facial nerve function; however, documented disruption of the facial nerve canal in itself was considered an indication for surgical exploration. Other indications for surgical intervention included evidence of dural tear, vascular injury, and severe disruption of the external auditory canal.
OBJECTIVE: The congenital cholesteatoma of the temporal bone is a rarer disease which might easily be misdiagnosed and wrongly treated. The clinical material and management of five cases are hereby introduced in order to call common attention. METHOD: There were 4 males and 1 female with age rage 10-48 years old. All cases revealed intact drum membrane. The complaints of these 5 cases are: 2 cases suffered from facial palsy; 2 cases from purulent bloody otorrhea; 1 case from otalgia. Among these five congenital cholesteatomas, four cases were originated from petromastoid region and 1 case from undeveloped. external ear canal. Surgical managements were performed after preoperative radiological examination in these five cases. RESULT: In each case, the diagnosis was confirmed by pathological examination and the disease was cured by operation. CONCLUSION: If a patient is suffered from facial palsy or otorrhea or otalgia, but the eardrum is intact, the correct diagnosis and suitable treatment of the congenital cholesteatoma are easily to be delayed and failed. Radiological evaluation, carefully topical examination and paying attention to this disease play important role in the early diagnosis and surgical management, thus the serious complications might be avoided.
OBJECTIVE: We sought to test the reliability of a radiologic marker in identifying the vertical portion of the facial nerve in axial computed tomography (CT) temporal bone scans. STUDY DESIGN AND SETTING: At a tertiary care academic center, we used, with a random sample of 25 CT scans, a marker (the "B-line") to identify the facial nerve. The variations in distance from this marker to the facial nerve were measured. RESULTS: This marker, which consists of a tangent line extrapolated from the posterior border of the basal turn of the cochlea, fell within 1 mm of the facial nerve on average. The average distance from the midpoint of the posterior border of the basal turn of the cochlea to the facial nerve was 11 +/- 1 mm. CONCLUSION: This is a very reliable marker for the vertical portion of the facial nerve. SIGNIFICANCE: This marker can be used to rapidly find the facial nerve, even in diseased or postsurgical temporal bones.
Plasma cell granulomas are uncommon, benign tumors comprised primarily of mature plasma cells and are a distinct entity, separate from plasmacytomas. They are rarely found in the head and neck, and have never been reported in the temporal bone. This case represents the first report of a plasma cell granuloma originating in the temporal bone. Treatment options include surgical removal and radiation therapy.
Irradiation of the central nervous system may cause significant morbidity, including endocrine dysfunction and intellectual impairment. The authors report a case of bilateral temporal bone encephaloceles in a 21-year-old man who had received prophylactic central nervous system irradiation for acute lymphocytic leukemia in early childhood. Endaural encephaloceles are uncommon, and most occur as a complication of mastoid surgery. The etiology, clinical features, radiological diagnosis, and surgical treatment of temporal bone encephaloceles are discussed.
We report a 74-year-old woman with primary CD5-positive diffuse large B-cell lymphoma (DLBCL) of the temporal bone. The patient was admitted because of a mass in the left external auditory canal. She was treated with eight courses of CEOP therapy (rituximab was added from the sixth course) followed by radiotherapy of 40 Gy, and complete remission was achieved. The occurrence of malignant lymphoma in the temporal bone, which is an extremely unusual site, may have depended on the peculiarity of CD5-positive DLBCL.
Histiocytosis X (HX) is a rare disease. There are many questions and debates in its etiology, pathology, clinical type and therapy. To enhance the recognition of otolaryngologists in HX of the ear and temporal bone and the level of diagnosis and therapy, 30 years' results of 21 patients with HX of the ear and temporal bone proved by histiopathology were reviewed, 18 patients were cured (85%), 6 cases were residual of diabete insipidus and dwarfism (28%), 3 cases died (14%). The clinical classification system should be based on the extention of diseases. Surgical curettage, radiation therapy are mainstays of treatment; chemotherapy should be used in patients with aggressive and disseminate diseases and etiology of histiocytosis should be studied on immune system that potentially aid in therapy.
OBJECTIVE: (a) To report computed tomography findings of eight new cases with Waardenburg's syndrome (WS) type I and review reported temporal bone radiographic and histopathological findings in WS with hearing loss; (b) To determine the frequency of inner ear pathologies that may contraindicate cochlear implantation. METHODS: A review of 1166 pediatric patients with sensorineural hearing loss revealed 12 cases (1%) with WS, whose family screenings disclosed additional 12 subjects with the same disorder. Among these 24 cases, eight had WS type I and were subjected to computed tomography scanning of temporal bone. Imaging findings of 28 cases reported previously in English literature were evaluated together with our eight patients. RESULTS: Malformation of the inner ear was found in none of the nine WS type I cases evaluated here, while the frequency of internal acoustic canal malformation was 11%. Regardless of the subtypes of the syndrome, 6 of 36 cases (17%) had radiological abnormality of the inner ear. Malformation and/or absence of the semicircular canals were the most common congenital abnormality of the inner ear. Hypoplasia of the cochlea was present in 3 of 36 cases (8%). CONCLUSIONS: Abnormality of bony labyrinth in WS with congenital deafness is not a frequent finding, particularly in WS type I. Therefore, the otologist and audiologist must keep in mind that most of these cases are suitable for cochlear implantation regarding inner ear anatomy.
CONCLUSIONS: This prosthesis has the advantage of rapid adjustment at the time of insertion in order to achieve optimal tension and, as a result, optimal sound transmission. OBJECTIVE: To test the acoustic performance of a new, adjustable incus replacement prosthesis in a human temporal bone model. MATERIAL AND METHODS: Experiments were performed in seven human temporal bones, before and after removal of the incus and insertion of the prosthesis. The input comprised 406 pure tones ranging in frequency between 0.1 and 10 kHz at an intensity of 80 dB SPL at the tympanic membrane. The output measurement was stapes footplate displacement, determined by means of a laser Doppler vibrometer. Three lengths of the prosthesis were investigated: optimal, optimal +0.2 mm and optimal +0.4 mm. RESULTS: The optimal-length prosthesis produced similar results to those of an intact middle ear. The slightly longer prostheses decreased middle ear sound transmission at all test frequencies, except those near 1.5 kHz.