Radiography of the petromastoid portion of the temporal bones.
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We present the case of a scuba diver who experienced acute ear pain during ascent from a dive. CT imaging was performed because of severe unrelenting headache. Blood and gas was identified within the epidural space of the middle fossa and over the petrous bone, as well as hemorrhage within the adjacent temporal lobe. To the best of our knowledge, this is the first case of CT-documented barotrauma affecting the brain as a result of middle-ear gas rupturing through the tegmen tympani.
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To visualize the three-dimensional (3-D) shapes of structures in the temporal bone from histologic sections, we developed computer software to create computer-generated 3-D images from two-dimensional (2-D) materials. Using those images, we have been able to measure these structures in three dimensions. This means that quantitative 3-D measurements can be performed regardless of the angle at which the specimen was cut. This report describes this method for 3-D reconstruction and measurement and discusses its implications. For instance, in addition to showing the 3-D shape of the cochlea from different angles, we have been able to measure the length of the cochlea and have shown that measurements made by use of the conventional 2-D graphic reconstruction method can be distorted considerably by variations in cutting angle of the specimen.
This paper compares the size of the bony labyrinth in infants to that in adults. Fusible metal was injected in dried temporal bones and after the overlying bone was removed by dissolving in weak acid, the semicircular canals and cochlea were measured and compared. A summary of the method of preparation is also included.
Brain tissue with or without its dural covering may protrude into the temporal bone through a defect in the tegmen tympani. Infection or granulation tissue, with or without cholesteatoma may make diagnosis difficult. While computed tomography (CT) may demonstrate a bony defect, it is difficult to distinguish between herniated brain, cholesteatoma or granulation tissue. Magnetic resonance imaging (MRI) clearly demonstrates healthy herniated brain tissue, but ischaemic or necrotic elements may mimic other lesions. We present a series of five patients with brain hernia, highlighting the spectrum of preoperative radiological appearances, and some of the difficulties encountered in interpreting these images. MRI demonstrated herniation of healthy brain in two patients but in three, showed irregular soft tissue with signal characteristics consistent with cholesteatoma. Surgery in these three patients demonstrated necrotic brain with coexisting cholesteatoma in two. Brain hernias are often necrotic and may have morphological and signal characteristics similar to cholesteatoma with which they may coexist.
Mechanical vibrations of Hensen cells were measured with a laser-heterodyne interferometer in the guinea-pig temporal-bone preparation without the application of an external acoustic stimulus. Smoothed periodograms (spectral-density estimates v. frequency) were constructed from the velocity v. time waveforms recorded from individual cells. Several peaks were seen in the periodograms at levels as high as 10 dB above the noise floor, indicating the presence of spontaneous vibrations. The frequencies at which the peaks were located differed in different preparations, indicating that the observed peaks were not caused by the presence of ambient noise or ambient vibrations. Furthermore, vibrations were seen only in fresh preparations. The tuning curves of cells from which spontaneous vibrations were measured (determined by applying an external stimulus to the ear) had single principal peaks. Several peaks in the periodogram were found to be located within the principal-peak region of the tuning curve. The spontaneous response does not arise from noise filtered through the tuning curve which would have a single peak. We propose that these spontaneous vibrations originate at the outer hair cells and are the source of spontaneous otoacoustic emissions in the ear.
The findings of thin-section high-resolution CT of the temporal bone in two children with Johanson-Blizzard syndrome are reported. In both cases an anomaly of the inner ear was found, consisting of bilateral cystic dilatation of the cochlea and the vestibulum. The possible etiologic basis for the hearing loss in this syndrome is discussed and the literature is reviewed.
We have developed a technique for sectioning temporal bones and have studied non-decalcified frozen guinea pig cochleas to localize succinic dehydrogenases. The technique is simple and practicable. The 6-microns sections used preserve both fine cochlear structure and satisfactory histochemical localization for identifying the succinic dehydrogenases. The technique can also be extended to immunological test, detecting transmitters and investigating enzymes in the cochlea.
A 49-year-old white female patient was referred to the ENT Department, Zentralkrankenhaus, Bremen, because of conductive hearing loss. Widespread tumor formation was found in the left temporal bone and was identified by biopsy to be an osteoclastoma. The tumor was extirpated surgically and reconstruction was performed. Periodic clinical follow-ups during a 36-month period after surgery have included control computed tomographic scans and have shown no evidence for recurrent disease. The specific pathology of the osteoclastoma is presented and different ways for treatment are discussed.
OBJECTIVES: To describe the clinical and radiological features of the vascular anomaly aberrant internal carotid artery (ICA) in the temporal bone and to discuss management strategies. DESIGN: Retrospective study. PATIENTS: Sixteen cases of aberrant ICA were diagnosed between 1982 and 2003. RESULTS: Of 16 cases, 11 were recognized by imaging assessment, 4 were recognized during middle ear surgery, and 1 was recognized clinically. Among the 11 cases, 8 malformations were diagnosed because of otologic symptoms related to the abnormal ICA or chronic otitis, while the other 3 were identified incidentally because of an underlying accompanying disease. In 4 cases, the diagnosis was made during surgery related to chronic otitis media (n = 2) or conductive hearing loss (n = 2). In these 4 cases, massive bleeding resulted from surgical injury to the vessel. Packing the external auditory canal and the middle ear first controlled the bleeding. Endovascular procedure was required in 2 cases to exclude an aneurysm or to control bleeding but was followed by anterior cerebral stroke in 1 case. The aberrant ICA could be identified on computed tomographic scan by the following features: intratympanic mass, enlarged inferior tympanic canaliculus, absence of the vertical segment of the ICA canal, and absence of bone covering the tympanic portion of the ICA. Conventional angiography was mandatory when intervention was planned to control bleeding or aneurysm. CONCLUSIONS: This study highlights that aberrant ICA has to be identified before any middle ear surgery because misdiagnosis may lead to dramatic surgical complications, whereas diagnosis with computed tomographic scan is easy. Bleeding is a minor complication compared with the putative neurologic deficit due to endovascular occlusion.
Vibration modes of the ossicles and the lever function were studied in human cadaver temporal bones with an intact cochlea. After placing tiny steel spheres on the ossicles, ossicular vibration to a sound stimulus was measured by observing the displacements of the spheres under a microscope with strobe illumination by means of a video measuring system. The lever ratio varied from 1.9 at 0.6 kHz (minimum) to a peak of 6 near 2 kHz. This relatively high lever ratio at higher frequencies was considered to be caused by a shift of the malleus-incus rotation axis secondary to the loading of the cochlear fluid on the ossicular system. Dependence of the lever ratio on frequency indicated that the rotation axis of the ossicles was not fixed, but variable according to frequency due to a relative increase in the translational movements of the rotation axis of the malleus and incus with frequency.