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Noninvasive imaging of the normal temporal bone. Comparison of sagittal surface coil magnetic imaging and high-resolution computed tomography.

High-resolution computed tomography (HRCT) is a noninvasive technique for evaluating the middle ear for primary and recurrent cholesteatoma. However, a limitation of HRCT is that it cannot differentiate between cholesteatoma and granulation tissue. Magnetic resonance imaging (MRI) is a noninvasive, nonradiologic technique that has been effective in demonstrating histochemical differences between various soft tissues. We present images from a normal living subject's temporal bone in the sagittal plane obtained with both HRCT and MRI. Anatomic correlates in the same cut planes are presented. The HRCT provided excellent detail of the bony landmarks within the temporal bone and was used as the reference for the MRI. The soft-tissue structures such as cranial nerves, cochlea, vestibule, and semicircular canals were identified.

Humans↗

Clarion 1.2 standard electrode array with partial space-filling positioner: radiological and histological evaluation in human temporal bones.

The purpose of this study was to evaluate whether use of a positioner for situating the Clarion 1.29 standard electrode array in close proximity to the modiolus, causes damage to fine intra-cochlear structures, and to provide a comparison with results obtained for insertions of the array performed without a positioner. The study was performed in seven freshly frozen human temporal bones. Electrode location and intra-cochlear trauma was analysed using cross-sectional imaging and histological analysis. Insertion of the Clarion array did not reveal major trauma. The devices inserted with the positioner showed a consistently closer location of the electron array towards the modiolus, however, insertion resulted in significant displacement of both the electrode array and the positioner resulting in severe destruction of the basilar membrane and osseous spiral lamina along the length of the basal and middle turns. The devices inserted with the positioner resulted in major trauma to the basilar membrane and osseous spiral lamina. Therefore, systematic safety studies in larger samples of human temporal bones should be performed and the results carefully evaluated before implantation can be recommended unreservedly.

Basilar Membrane↗

Temporal bone histopathology in deafness due to cryptococcal meningitis.

This paper reports on a patient who survived an attack of cryptococcal meningitis eight years prior to his death. A bilateral sensorineural hearing loss had been noted a short time before the patient was admitted to the hospital, and was the only complication after he recovered from the disease. Histopathologic study of the temporal bones showed a similar pattern of pathology in both ears, the most striking finding being a severe loss of spiral ganglion cells in Rosenthal's canal, and of cochlear nerve fibers in the osseous spiral lamina and internal auditory meatus. The vestibular nerve was mostly free from pathology. The organ of Corti was atrophic but the hair cell population appeared to be almost normal. A slight number of cryptococci were observed in limited areas of the cochlear and the saccular nerves in the internal auditory meatus. The severe pathology of the cochlear nerve was compatible with audiologic evaluations, which pointed to a retrocochlear lesion. Thus, this case demonstrates some characteristic aspects of cryptococcal infection of the temporal bone: The primary site of invasion was the cochlear nerve in the internal auditory meatus and the modiolus, leading to the loss of ganglion cells and nerve fibers, while the vestibular nerve appears to have been resistant to infection.

Cochlear Nerve↗

Metastasis to the temporal bone, secondary to carcinoma of the bladder.

An 80-year-old man was seen in the clinic with a two month history of pain, bleeding and deafness in his left ear; accompanied by a left facial palsy. Six months earlier, anaplastic carcinoma of the bladder had been diagnosed and treated with radiotherapy. On examination there was a mass in his left external auditory canal and VII, VIII, IX and X left cranial nerve palsies. Histology of a biopsy was identical with his original bladder tumour. He received a course of palliative radiotherapy but died shortly after. Post-mortem demonstrated the left temporal bone metastasis extending into the middle and posterior cranial fossae. There was no evidence of residual bladder tumour, or other primary tumour. Temporal bone metastases are probably more common than generally thought. Presentations like this may become more common as cancer therapy improves, with patients surviving longer and presenting later with metastatic disease.

Aged↗

[Rapid interactive 3-D imaging of the temporal bone with "direct volume rendering"].

INTRODUCTION: For the first time, the relatively new method of interactive direct volume rendering (dVR) allows for a fast and direct three-dimensional visualization of spiral CT data without any manual, explicit segmentation. This study was performed to prove whether dVR is capable of providing a meaningful three-dimensional visualization of the structures within the temporal bone. PATIENTS AND METHODS: In ten patients a three-dimensional visualization of the structures of the inner and middle ear was performed from spiral CT data on a commercially available graphics workstation. RESULTS: The cochlea and semicircular canals were visualized in good quality in all patients. The ossicles and bony facial canal were visualized in good or fair quality in most cases. The time needed for the visualization of the data and all target structures was less than 15 min in all cases. CONCLUSIONS: Three-dimensional visualization of the structures within the temporal bone from high-resolution spiral CT data using dVR is easily performed in a very short time on standard graphics workstations. This allows integrating three-dimensional visualizations into routine clinical work.

Computer Graphics↗

A case of meningoencephalic herniation of the temporal bone.

A case of cerebrospinal fluid leakage from a meningoencephalic herniation of the temporal bone is presented. Computed tomography and magnetic resonance imaging were useful for a diagnosis of meningoencephalic herniation. After surgical treatment, no recurrence was observed during a 6-month follow-up period.

Cerebrospinal Fluid Otorrhea↗

An anatomical, morphological and electrophysiological study of the rabbit facial nerve in the temporal bone.

Anatomical, histological and electrophysiological features of the rabbit facial nerve in the temporal bone are described for research purposes. Based upon the findings the rabbit intratemporal facial nerve is surgically accessible and consists of a constant axon number and myelin sheath thickness. As a valid model the rabbit intratemporal nerve can be readily utilized for research studies in nerve regeneration pertinent to the facial nerve in this region.

Animals↗

Paragangliomas of the temporal bone.

Recent advances in diagnosis and surgical therapy of glomus tumors of the temporal bone have been made. These advances make it possible for surgeons to benefit patients affected by this locally aggressive and morbid tumor. More sensitive diagnostic modalities and a physician alertness make early surgical cure a possibility. Careful planning and observation of basic surgical principles help to minimize morbidity and improve functional results.

History, 19th Century↗

Pneumatization of the temporal bones in a Greenlandic Inuit anthropological material.

The degree of pneumatization of the temporal bones correlates with exposure during childhood and adolescence to infectious middle ear diseases (IMED), both acute and chronic. The pneumatized area as seen on cranial X-rays can be measured. This was applied to an anthropological material in order to develop methods for assessing ancient populations' exposure to IMED. Fifty-six Greenlandic Inuit (Eskimo) crania were examined. The crania were sexed and measured. X-rays were taken bilaterally, using the projection of Runström II, and the pneumatized area was measured planimetrically by computer. In blind trials it was found that the inter- and intraobserver variation was non-significant; that the degree of pneumatization of the temporal ossa did not reflect cranial size or sexual dimorphism; and that the pneumatized areas correlated bilaterally. Asymmetry in the size of the pneumatized areas, an indicator of exposure to IMED, was found in 5 crania (9%).

Female↗

Paragangliomas of the petrous temporal bone.

The natural behaviour, clinical diagnosis and treatment of paragangliomas of the petrous temporal bone are reviewed. Nine patients with this tumour treated at Groote Schuur Hospital are presented; 2 patients had tympanic paragangliomas and 7 jugular paragangliomas. Surgical excision is recommended as the primary treatment. However, in poor-risk patients or when tumour growth is extensive, irradiation may be of benefit. Although rare, this eventually life-threatening lesion can be successfully removed if diagnosed early enough.

Adult↗

Medullary carcinoma of the thyroid metastatic to the temporal bone.

We report a case of proven thyroid medullary carcinoma, metastatic to the temporal bone. Review of the otolaryngology literature demonstrates that this is the first such report. The patient presented with symptoms, physical examination, and imaging studies suggestive of a glomus jugulare tumour. The pre-operative diagnosis of metastatic thyroid medullary carcinoma, however, was made, based on a history of medullary carcinoma of the thyroid with previous metastases as well as an elevation in calcitonin levels. Histological examination of the surgical specimen confirmed the diagnosis.

Carcinoma, Medullary↗

Sector computerized tomography of temporal bone and base of skull.

The field of computerized tomography (CT) scanning has been one of the great medical advances of the 20th century. The field is developing rapidly with new hardware and software becoming available on a monthly basis. At the Cleveland Clinic Foundation, patients have been studied by using a sector computerized tomography scanner that has the capability of not only improved spatial resolution but also software programs, with the ability to reconstruct data using different algorithms. This versatility in reconstructing the raw data has resulted in a remarkable improvement in the ability to study the temporal bone and the base of the skull. This paper will present technical data in reference to this new generation of scanner and also show examples of the type data that are becoming available to the otolaryngologist studying lesions of the base skull and temporal bone.

Cranial Fossa, Posterior↗

Evaluation of the temporal bones of a multichannel cochlear implant patient.

In this report we detail the temporal bone findings of a 57-year-old patient who underwent placement of a Nucleus 22-channel electrode 7 months prior to his death. Audiometric testing postoperatively demonstrated suprasegmental speech cue discrimination only. Histologic evaluation of the cochleas revealed significant sensorineural survival except in the region of the basal turn of the implanted cochlea adjacent to the implant. There was no significant pathologic condition attributable to the operation or the electrode in areas remote from the basal turn of the cochlea.

Audiometry, Pure-Tone↗

High-resolution CT investigation of nonchromaffin paragangliomas of the temporal bone.

Twenty-six cases of surgically verified nonchromaffin paragangliomas (NCPs) of the temporal bone were investigated by contrast-enhanced, thin-section, multiplanar high-resolution computed tomography (CT). Based on the high-resolution CT findings the tumors were classified according to a recently introduced surgical classification of NCP into four main types (A, B, C1-C3, and D1-D3). With high-resolution CT tumors were correctly classified in all cases, as was shown with intraoperative correlation. On the basis of these findings, high-resolution CT should replace conventional tomography and should be regarded as complementary to selective angiography in the preoperative evaluation of NCP.

Ear Neoplasms↗

Temporal bone histopathology of a patient with a nucleus 22-channel cochlear implant.

The temporal bone histopathology of a patient with profound sensorineural hearing loss attributable to cochlear otosclerosis is presented. The patient had a Nucleus 22-channel cochlear prosthesis implanted in the right ear prior to his demise. Unintentional scala media insertion of the electrode array resulted from labyrinthitis ossificans obliteration of the scala tympani. Inadvertent facial nerve stimulation necessitated program exclusion of electrodes 11 to 16 located in proximity to the labyrinthine and geniculate segments of the facial nerve. The patient received significant benefit from use of the device. The histopathologic findings are correlated with psychophysical and speech perception results.

Cochlear Diseases↗