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Sample records for cholesteatoma

  1. Cholesteatoma

    DEFF Research Database (Denmark)

    Svane-Knudsen, V; Halkier-Sørensen, L; Rasmussen, G; Ottosen, P D

    2001-01-01

    Two different lipid-retaining fixation techniques permitted electron microscopic visualization of both intra- and extracellular lipids in cholesteatoma epithelium obtained from 25 patients. An increased number of intracellular lipid-containing Odland bodies was demonstrated, with a maximum in the...

  2. MR imaging of cholesteatoma

    Energy Technology Data Exchange (ETDEWEB)

    Ban, Shigeyuki [Teikyo Univ., Tokyo (Japan). Faculty of Medicine

    2000-01-01

    CT has been used for the diagnosis of cholesteatoma. CT shows a cholesteatoma as a soft tissue mass with characteristic ossicular displacement and bony erosion, but, it is unable to distinguish between cholesteatoma and granulation tissue or other pathologic soft tissues with similar radiologic density. We compared the MR image findings of 46 cholesteatomas, 32 pars flaccida type lesions and 14 pars tensa type lesions, with the operative records. All of the patients underwent both CT and MR preoperatively. MR studies were done with a surface coil on a high field (1.5 T) unit. The intrinsic signal intensity of the cholesteatoma was hypointense or isointense on T1-weighted images and hyperintense on T2-weighted images compared with the gray matter of the cerebellum in most of the cases. The central part of the cholesteatomas showed no enhancement after intravenous injection of Gd-DTPA on T1-weighted images in any of the cases. These findings were characteristic of cholesteatoma in contrast with other inflammatory tissues. The extent of cholesteatoma on MRI was consistent with surgical findings in most of the cases. MRI is useful for the diagnosis and localization of cholesteatoma. (author)

  3. Etiopathology of acquired cholesteatoma

    Directory of Open Access Journals (Sweden)

    Prabodh Karnik

    2011-01-01

    Full Text Available The etiopathology of acquired cholesteatoma has undergone numerous changes over the past 150 years. However, certain facts stand out with clarity. The presence of cytokeratins in acquired cholesteatoma, which are akin to those found in the tympanic membrane and external auditory canal, shows that these are probably the site of origin of acquired cholesteatoma. The cholesteatoma sac also shows its greatest growth at its tympanic membrane attachment into the middle ear. Implantations of squamous epithelium due to trauma or surgery could be another originating factor. The basic pathology is the formation of papillary cones from the tympanic membrane or external auditory canal, which progress from microcholesteatoma to frank cholesteatoma with keratin collections. There is an altered matrix metalloproteinase pathway. Tumor necrosis factor activation with altered wound healing process contributes to the collateral destruction of bone. Trisomy and aneuploidy of chromosome 8 predispose to cholesteatoma formation in affected individuals. In this article, we present the etiopathology of acquired cholesteatoma as it stands today.

  4. Etiopathogenesis of cholesteatoma.

    Science.gov (United States)

    Olszewska, Ewa; Wagner, Mathias; Bernal-Sprekelsen, Manuel; Ebmeyer, Jörg; Dazert, Stefan; Hildmann, Henning; Sudhoff, Holger

    2004-01-01

    Cholesteatoma is a destructive lesion of the temporal bone that gradually expands and causes complications by erosion of the adjacent bony structures. Bone resorption can result in destruction of the ossicular chain and otic capsule with consecutive hearing loss, vestibular dysfunction, facial paralysis and intracranial complications. Surgery is the only treatment of choice. The etiopathogenesis of cholesteatoma, however, is still controversial. This review was designed to understand the reasons for these disparities and to reduce or eliminate them. Future studies focused on developmental, epidemiological, hormonal and genetic factors as well as on treatment are likely to contribute to further understanding of cholesteatoma pathogenesis. PMID:12835944

  5. Ear canal cholesteatoma.

    Science.gov (United States)

    Holt, J J

    1992-06-01

    Although cholesteatomas are more commonly found in the middle ear and the mastoid, the disease can occur in the external ear canal. All cases of ear canal cholesteatoma treated by the author were reviewed. There were nine ears in seven patients, who had an average age of 62 years. The lesions ranged in size from a few millimeters to extensive mastoid destruction. Smaller lesions can be managed by frequent cleaning as an office procedure. Larger lesions require surgery, either canaloplasty or mastoidectomy. The otolaryngologist should suspect this disease in the elderly. Microscopic examination of the ear with meticulous cleaning of all wax, especially in elderly patients, is most useful in detecting early disease. Frequent applications of mineral oil to the canal should be used in the management of the disease and to prevent recurrence. PMID:1376388

  6. Pediatric middle ear cholesteatoma: the comparative study of congenital cholesteatoma and acquired cholesteatoma.

    Science.gov (United States)

    Morita, Yuka; Yamamoto, Yutaka; Oshima, Shinsuke; Takahashi, Kuniyuki; Takahashi, Sugata

    2016-05-01

    This study examined the differences between congenital cholesteatoma (CC) and acquired cholesteatomas (AC) in children by comparing clinical features and treatment courses. This was a retrospective study which retrospectively evaluated 127 children with middle ear cholesteatomas using medical records from January 1999 to December 2012 in the Department of Otolaryngology, Niigata University Hospital. The study comprised 69 and 58 cases of CC and AC, respectively. The main outcome measures include patient backgrounds, the opportunities for consultations, mastoid cell development, intraoperative finding of stapes, surgical procedure and number of surgeries. The average age at operation was 6.4 and 9.8 years in CC and AC, respectively. AC was more prevalent in boys. Mastoid development was better in CC than in AC. We adopted a two-stage operation in 17 cases (25 %) of CC and in 22 cases (38 %) of AC. The repeat surgery rate was 11.6 % in CC and 27.6 % in AC. Three times as many operations were required for three cases (4.3 %) of CC and 10 cases (17.2 %) of AC. The lesions in AC were more difficult to control. In the treatment of pediatric middle ear cholesteatoma, we had to keep the outcome in mind. PMID:26044405

  7. Complications of atticoantral cholesteatoma: MR manifestations

    International Nuclear Information System (INIS)

    Cholesteatoma of the temporal bone usually occurs in the attic (epitympanic cavity) and extends easily into the mastoid antrum through the aditus as antrum. Since atticoantral cholesteatoma can lead to clinically serious complications, successful patient management requires an accurate knowledge of the extent of the condition. All complications of cholesteatoma are in fact related to bony erosion and may be classified as labyrinthitis, extracranial complication, meningitis, dural sinus obstruction, or parenchymal inflammation. This paper describes the diverse MR manifestations of the complications arising from atticoantral cholesteatoma. (author)

  8. Complications of atticoantral cholesteatoma: MR manifestations

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Jeong Hyun; Lee, Ho Kyu; Lim, Soo Mi; Shin, Ji Hoon; Choi, Choong Gon; Suh, Dae Chul; Lee, Kwang Sun [Asan Medical Center, College of Medicine, University of Ulsan, Ulsan (Korea, Republic of)

    2000-02-01

    Cholesteatoma of the temporal bone usually occurs in the attic (epitympanic cavity) and extends easily into the mastoid antrum through the aditus as antrum. Since atticoantral cholesteatoma can lead to clinically serious complications, successful patient management requires an accurate knowledge of the extent of the condition. All complications of cholesteatoma are in fact related to bony erosion and may be classified as labyrinthitis, extracranial complication, meningitis, dural sinus obstruction, or parenchymal inflammation. This paper describes the diverse MR manifestations of the complications arising from atticoantral cholesteatoma. (author)

  9. Animal Models of Middle Ear Cholesteatoma

    OpenAIRE

    Tomomi Yamamoto-Fukuda; Haruo Takahashi; Takehiko Koji

    2011-01-01

    Middle ear acquired cholesteatoma is a pathological condition associated with otitis media, which may be associated with temporal bone resorption, otorrhea and hearing loss, and occasionally various other complications. Cholesteatoma is characterized by the enhanced proliferation of epithelial cells with aberrant morphologic characteristics. Unfortunately, our understanding of the mechanism underlying its pathogenesis is limited. To investigate its pathogenesis, different animal models have b...

  10. Altered permeability barrier structure in cholesteatoma matrix

    DEFF Research Database (Denmark)

    Svane-Knudsen, Viggo; Halkier-Sørensen, Lars; Rasmussen, Gurli;

    2002-01-01

    The stratum corneum of the cholesteatoma epithelium comprises the greater part of the cholesteatoma matrix. The permeability barrier that militates against diffusion and penetration of infectious and toxic agents into and through the epithelium is situated here. The multiple long sheets of lamellar...

  11. Congenital cholesteatoma: delayed diagnosis and its consequences.

    Science.gov (United States)

    Goh, B S; Faizah, A R; Salina, H; Asma, A; Saim, L

    2010-09-01

    This is a retrospective review of congenital cholesteatoma cases that were managed surgically. There were 5 cases. The age of presentation ranged from 5 to 18 year old. Three patients presented with complication of the disease. Three patients had intact tympanic membrane, two had perforation at the anterior superior quadrant. All patients had cholesteatoma medial to tympanic membrane. Four cases had extensive ossicular erosion with preoperative hearing worse than 40 dB. Four cases underwent canal wall down mastoid surgery and one underwent canal wall up surgery. One patient had recurrence which required revision surgery. In conclusion, congenital cholesteatoma presented late due to the silent nature of disease in its early stage. Extensive disease, ossicular destruction with risk of complication at presentation were marked in our study. Hence, more aggressive surgical intervention is recommended in the management of congenital cholesteatoma. PMID:21939167

  12. Cholesteatoma of the temporal bone. MR findings

    Energy Technology Data Exchange (ETDEWEB)

    Park, Yoon Ok; Youn, Eun Kyung; Chung, Eun Chul; Lee, Young Uk; Kim, Dong Ju; Chin, Seung Byum; Keum, Joo Seob [Sungkyunkwan Univ. Colledge of Medicine. Kangbuk Samsung Hospital, Seoul (Korea, Republic of)

    1998-07-01

    The purpose of this study is to evaluate the diagnostic capability of MR imaging for distinguishing cholesteatoma from other causes of inflammation. Materials and Methods : We prospectively evaluated the MR images of 17 patients with a fully opacified middle ear in whom CT of the temporal bone suggested cholesteatoma. All patients underwent middle ear surgery and cholesteatoma was verified in 15 cases, granulation tissue in 15,cholesterol granuloma in four and hemotympanium in one. For each lesion, MR and pathologic findings were correlated. Results : All cases of cholesteatoma showed low to intermediate signal intensity on T1-weighted images. On T2-weighted images, 11 cases showed high signal intensity, while seven were less than CSF and four were the same. Four cases revealed central low signal intensity with peripheral rim of high signal intensity. On GdDTPA-enhanced images, peripheral or marginal enhancement due to surrounding granulation tissue was noted in 12 cases. Two appeared to be totally enhanced. One case of congenital cholesteatoma showed no enhancement. OnT2-weighted images, all cases of granulation tissue showed high signal intensity, and on neither T1- nor T2-weighted images could these be distinguished from cholesteatoma. On Gd DTPA-enhanced study, all cases of granulation tissue were enhanced, and on T1WI, all cases of cholesterol granuloma showed homogeneous bright signal intensity on T1WI. One case of cholesterol granuloma in the mastoid showed bright signal intensity mixed with irregular areas of dark signal intensity. A further comparison of MR imaging with CT is that two case of labyrinthitis and one of meningitis were diagnosed on Gd- enhanced T1-weighted images. Conclusion : To differentiate cholesteatoma from granulation tissue and cholesterol granuloma by the evaluation of their signal intensities and enhancement patterns, MR imaging is superior to CT. When there are cholesteatoma-associated complications such as labyrinthitis or

  13. Quantitative analysis of cholesteatoma using high resolution computed tomography

    International Nuclear Information System (INIS)

    Seventy-three cases of adult cholesteatoma, including 52 cases of pars flaccida type cholesteatoma and 21 of pars tensa type cholesteatoma, were examined using high resolution computed tomography, in both axial (lateral semicircular canal plane) and coronal sections (cochlear, vestibular and antral plane). These cases were classified into two subtypes according to the presence of extension of cholesteatoma into the antrum. Sixty cases of chronic otitis media with central perforation (COM) were also examined as controls. Various locations of the middle ear cavity were measured in terms of size in comparison with pars flaccida type cholesteatoma, pars tensa type cholesteatoma and COM. The width of the attic was significantly larger in both pars flaccida type and pars tensa type cholesteatoma than in COM. With pars flaccida type cholesteatoma there was a significantly larger distance between the malleus and lateral wall of the attic than with COM. In contrast, the distance between the malleus and medial wall of the attic was significantly larger with pars tensa type cholesteatoma than with COM. With cholesteatoma extending into the antrum, regardless of the type of cholesteatoma, there were significantly larger distances than with COM at the following sites: the width and height of the aditus ad antrum, and the width, height and anterior-posterior diameter of the antrum. However, these distances were not significantly different between cholesteatoma without extension into the antrum and COM. The hitherto demonstrated qualitative impressions of bone destruction in cholesteatoma were quantitatively verified in detail using high resolution computed tomography. (author)

  14. Differential Protein Expression in Congenital and Acquired Cholesteatomas.

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    Seung-Ho Shin

    Full Text Available Congenital cholesteatomas are epithelial lesions that present as an epithelial pearl behind an intact eardrum. Congenital and acquired cholesteatomas progress quite differently from each other and progress patterns can provide clues about the unique origin and pathogenesis of the abnormality. However, the exact pathogenic mechanisms by which cholesteatomas develop remain unknown. In this study, key proteins that directly affect cholesteatoma pathogenesis are investigated with proteomics and immunohistochemistry. Congenital cholesteatoma matrices and retroauricular skin were harvested during surgery in 4 patients diagnosed with a congenital cholesteatoma. Tissue was also harvested from the retraction pocket in an additional 2 patients during middle ear surgery. We performed 2-dimensional (2D electrophoresis to detect and analyze spots that are expressed only in congenital cholesteatoma and matrix-assisted laser desorption/ionization time of flight mass spectrometry (MALDI-TOF/MS to separate proteins by molecular weight. Protein expression was confirmed by immunohistochemical staining. The image analysis of 2D electrophoresis showed that 4 congenital cholesteatoma samples had very similar protein expression patterns and that 127 spots were exclusively expressed in congenital cholesteatomas. Of these 127 spots, 10 major spots revealed the presence of titin, forkhead transcription activator homolog (FKH 5-3, plectin 1, keratin 10, and leucine zipper protein 5 by MALDI-TOF/MS analysis. Immunohistochemical staining showed that FKH 5-3 and titin were expressed in congenital cholesteatoma matrices, but not in acquired cholesteatomas. Our study shows that protein expression patterns are completely different in congenital cholesteatomas, acquired cholesteatomas, and skin. Moreover, non-epithelial proteins, including FKH 5-3 and titin, were unexpectedly expressed in congenital cholesteatoma tissue. Our data indicates that congenital cholesteatoma origins

  15. Cholesteatoma

    Science.gov (United States)

    ... vertigo) Erosion into the facial nerve (causing facial paralysis ) Labyrinthitis Meningitis Persistent ear drainage Spread of the cyst into the brain When to Contact a Medical Professional Call your ...

  16. Biochemical and Bioimaging Evidence of Cholesterol in Acquired Cholesteatoma

    DEFF Research Database (Denmark)

    Thorsted, Bjarne; Bloksgaard, Maria; Groza, Alexandra;

    2016-01-01

    results show that the total lipid content of the cholesteatoma matrix is similar to that of stratum corneum from skin and that the cholesteatoma matrix unquestionably contains cholesterol. The cholesterol content in the cholesteatoma matrix is increased by over 30% (w/w dry weight) compared to the control....... The cholesterol sulfate content is below 1% of the total lipids in both the cholesteatoma and the control. Cholesterol ester was reduced by over 30% when compared to the control. CONCLUSIONS: The content of cholesterol in the cholesteatoma matrix is significantly different from that in stratum corneum...

  17. Imaging of postoperative middle ear cholesteatoma

    International Nuclear Information System (INIS)

    Cholesteatoma is often treated surgically using canal wall-preserving techniques. Clinical and otoscopic diagnosis of residual or recurrent disease after this form of surgery is unreliable and thus radiological imaging is often used prior to mandatory 'second-look' surgery. Imaging needs to be able to differentiate residual or recurrent disease from granulation tissue, inflammatory tissue or fluid within the middle ear cavity and mastoid cavity. High-resolution computed tomography (HRCT), conventional magnetic resonance imaging (MRI), and delayed contrast MRI have all been used in detecting postoperative cholesteatoma. Although delayed contrast MRI performs better than HRCT and conventional MRI, the sensitivities and specificities of these different imaging methods are relatively poor. Diffusion-weighted MRI (DWI and, in particular, non-echo planar DWI) has been shown to have a high sensitivity and specificity for detecting recurrent cholesteatoma. In this review we provide examples of postoperative imaging appearances following cholesteatoma surgery and we review the relevant literature with an emphasis on studies evaluating the diagnostic accuracy of DWI.

  18. ISOLATED CONGENITAL CHOLESTEATOMA OF THE MASTOID PROCESS: A CASE REPORT

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    Shankar

    2014-11-01

    Full Text Available Congenital Cholesteatomas have historically been considered a rare disorder, an incidence ranging from 4 to 24%. The most common sites of presentation on physical examination are Anterior superior and posterior superior quadrants of the tympanic membrane; conductive hearing loss is the most common presenting symptom. There is a lack of uniformity of reporting and classifying congenital cholesteatomas. Recidivism of the lesion appears more commonly with posterior superior congenital cholesteatomas. Treatment of Congenital Cholesteatoma is still surgical. We are here presenting a case of isolated congenital cholesteatoma in Mastoid process treated with modified radical mastoidectomy and tympanoplasty, patient followed up to one year no recurrent was found, hearing also improved, heightened awareness and early diagnosis of congenital cholesteatoma is imperative, early treatment decreases the extent of the disease and reduces the risk of recidivism and complications.

  19. The c-MYC Protooncogene Expression in Cholesteatoma

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    Enikő Palkó

    2014-01-01

    Full Text Available Cholesteatoma is an epidermoid cyst, which is most frequently found in the middle ear. The matrix of cholesteatoma is histologically similar to the matrix of the epidermoid cyst of the skin (atheroma; their epithelium is characterized by hyperproliferation. The c-MYC protooncogene located on chromosome 8q24 encodes a transcription factor involved in the regulation of cell proliferation and differentiation. Previous studies have found aneuploidy of chromosome 8, copy number variation of c-MYC gene, and the presence of elevated level c-MYC protein in cholesteatoma. In this study we have compared the expression of c-MYC gene in samples taken from the matrix of 26 acquired cholesteatomas (15 children and 11 adults, 15 epidermoid cysts of the skin (atheromas; head and neck region and 5 normal skin samples (retroauricular region using RT-qPCR, providing the first precise measurement of the expression of c-MYC gene in cholesteatoma. We have found significantly elevated c-MYC gene expression in cholesteatoma compared to atheroma and to normal skin samples. There was no significant difference, however, in c-MYC gene expression between cholesteatoma samples of children and adults. The significant difference in c-MYC gene expression level in cholesteatoma compared to that of atheroma implies a more prominent hyperproliferative phenotype which may explain the clinical behavior typical of cholesteatoma.

  20. Stratum corneum barrier lipids in cholesteatoma

    DEFF Research Database (Denmark)

    Svane-Knudsen, V; Halkier-Sørensen, L; Rasmussen, G; Ottosen, P

    2000-01-01

    emerged. When the corneocyte reaches the transitional stage to the stratum corneum, the Odland bodies accumulate near the cell membrane and discharge their contents of lipid and enzymes. The lipids are reorganized into multiple long sheets of lamellar structures that embrace the keratinized corneocytes...... structures in the intercellular space. In theory, the failure to desquamate seen in cholesteatomas could be caused by partial or total failure of Odland body delivery to the intercellular region, or to local breakdown of the permeability barrier....

  1. Imaging evaluation of middle ear cholesteatoma: iconographic essay

    Energy Technology Data Exchange (ETDEWEB)

    Avila, Ana Flavia Assis de; Aburjeli, Bruna de Oliveira Melim; Moreira, Wanderval; Motta, Emilia Guerra Pinto Coelho; Ribeiro, Marcelo Almeida; Diniz, Renata Lopes Furletti Caldeira, E-mail: fauassis@hotmail.com [Hospital Mater Dei, Belo Horizonte, MG (Brazil)

    2013-06-15

    Middle ear cholesteatoma is a relevant and relatively common disease that may have severe consequences. In the present pictorial essay, the authors have selected illustrative examples of multislice computed tomography and magnetic resonance imaging depicting the main presentations of cholesteatomas, and describing their characteristics, locations, and major complications. (author)

  2. Imaging evaluation of middle ear cholesteatoma: iconographic essay

    International Nuclear Information System (INIS)

    Middle ear cholesteatoma is a relevant and relatively common disease that may have severe consequences. In the present pictorial essay, the authors have selected illustrative examples of multislice computed tomography and magnetic resonance imaging depicting the main presentations of cholesteatomas, and describing their characteristics, locations, and major complications. (author)

  3. Cholesteatoma must be considered in case of recurrent ear discharge

    DEFF Research Database (Denmark)

    Fjaeldstad, Alexander; Ovesen, Therese; Britze, Anders

    2014-01-01

    This case report describes delayed cholesteatoma detection in a six-year-old boy with recurrent ear discharge since the age of two with no history of vertigo. Removal of the cholesteatoma disclosed facial nerve dehiscence, exposure of the sigmoid sinus and the dura covering the posterior fossa, as...

  4. Cholesteatoma in children, predictors and calculation of recurrence rates.

    Science.gov (United States)

    Stangerup, S E; Drozdziewicz, D; Tos, M

    1999-10-01

    The aim of the study was to evaluate the long-term recurrence rate after surgery for acquired cholesteatoma in children, to search for predictors of recurrency and to analyse the impact of the applied statistical method on the outcome of the results. During a 15-year period, 114 children underwent first-time surgery for acquired cholesteatoma. The patients were re-evaluated with a median observation time of 5.8 years, range 1-16 years. Recurrence of cholesteatoma developed in 27 ears. The cumulated total recurrence rate was 24% using standard incidence rate calculation, applying Kaplan-Meier survival analysis the recurrence rate was 33%. Recurrent disease occurred significantly more frequent in children ossicular resorption and with large cholesteatomas. In conclusion, young children with poor Eustachian tube function, large cholesteatoma and erosion of the ossicular chain, are at special risk of recurrence and should be observed several years after surgery. PMID:10577779

  5. Computed tomography of middle ear cholesteatomas without tympanic membrane perforation

    International Nuclear Information System (INIS)

    The growth of a middle ear cholesteatoma behind a normal tympanic membrane is a rate though possible event. In such cases, CT may provide useful information for diagnosis. The results are presented of a CT study carried out on 14 patients affected with unilateral conductive hearing loss and with normal tympanic membrane. CT allowed the diagnosis of meddle ear cholesteatoma to be made in all cases. All patients were treated with surgery: 8 of them underwent tympanoplasty and 6 explorative tympanotomy. While the diagnosis of cholesteatoma was confirmed in 13 patients, in 1 case tympanosclerosis was diagnosed. CT diagnosis of middle ear cholesteatoma is based on the demonstration of a low-density soft-tissue mass, in association with bone erosion or ossicular dislocation. The author emphasizes the difficulty of a CT diagnosis of cholesteatoma in the patients with middle ear soft-tissue masses in the absence of bone alterations

  6. Surgery for acquired cholesteatoma in children: long-term results and recurrence of cholesteatoma.

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    Stangerup, S E; Drozdziewicz, D; Tos, M; Trabalzini, F

    1998-08-01

    The aim of the study was to evaluate the long-term results after surgery for acquired cholesteatoma in children and to contribute to the search for predictors of recurrence. During a 15-year period, 114 children underwent surgery. The patients were re-evaluated with a median observation time of 5.8 years. At the last re-evaluation 85 per cent of the ears were dry with an intact drum. Recurrence of cholesteatoma developed in 27 ears. The cumulated total recurrence rate was 24 per cent using the incidence rate calculation, applying Kaplan-Meier survival analysis the corresponding recurrence was 33 per cent. Recurrent disease occurred significantly more frequently in children younger than eight years, with a negative pre-operative Valsalva, with ossicular resorption and with large cholesteatomas. In conclusion, young children with poor Eustachian tube function and a large cholesteatoma with erosion of the ossicular chain, are at special risk of recurrence and should be observed for several years after surgery. PMID:9850315

  7. [Clinical evaluation of congenital cholesteatoma of the middle ear].

    Science.gov (United States)

    Kikuchi, Masahiro; Yamamoto, Etsuo; Shinohara, Shogo; Shiomi, Yousaku; Fujiwara, Keizo; Shiomi, Yoshiko; Watanabe, Futoshi; Tanabe, Makito

    2003-08-01

    We conducted a retrospective study to identify the clinical features and surgical observations of congenital cholesteatoma. Sixty patients were diagnosed and underwent surgery for congenital cholesteatoma between April 1987 and May 2002. All diagnoses were made on the basis of two operative findings: 1. the tympanic membrane manifested neither retraction, perforation, nor granulation. 2. the tympanic membrane was not continuous with the cholesteatoma. In this series, congenital cholesteatoma accounted for 7% of all cholesteatomas (853 ears). The patient age ranged from 2 to 48 years. The male to female ratio was 4:1. Seventeen patients had multiple cholesteatoma. Fifty-three patients exhibited closed-type cholesteatomas, while the remaining 7 patients had open-type cholesteatomas that had formed as a flat surface of the epidermis. Patients with open-type cholesteatomas presented with a much more pronounced conductive hearing loss and ossicular erosion or malformation. Twenty-two patients with relatively small cholesteatomas were analyzed to estimate the origin of their cholesteatomas. Of the 22 patients, 13 had anterior superior quadrant (ASQ-type) and 9 had posterior superior quadrant (PSQ-type) cholesteatomas. The mean age at the time of detection was older in the PSQ-type group than in the ASQ-type group and the frequency of ossicular erosion or malformation was more prominent in the PSQ-type group than in the ASQ-type group. The primary site of origin was thought to be the portion between the tympanic ostium of the auditory canal and the semicanal for tensor tympani in the ASQ-type group and near the incudostapedial joint in the PSQ-type group. A planned staged procedure was performed in 29 patients, 15 patients (52%) had residual lesions situated mostly on the oval window, the round window, an exposed facial nerve or an exposed lateral semicircular canal. The frequency of residual lesions in patients who presented with extended, multiple cholesteatoma and

  8. Cholesteatoma after lateral bulla osteotomy in two brachycephalic dogs.

    Science.gov (United States)

    Schuenemann, Riccarda Martina; Oechtering, Gerhard

    2012-01-01

    This report describes a French bulldog and a pug that presented to the authors' hospital following total ear canal ablation (TECA) and lateral bulla osteotomy (LBO), with signs of recurring otitis media and difficulty opening their mouths. The bulldog also had unilateral facial paralysis and sensory deficits of the trigeminal nerve on the ipsilateral side. Computed tomography and MRI scans suggested cholesteatoma in the bulldog, but showed only slight enlargement of the bulla in the pug. Histopathologic examination of samples yielded cholesteatoma in both cases. The authors suspect that development of the cholesteatomas was linked to the TECA/LBO surgery in both cases. Cholesteatomas may occur more frequently than currently thought. Even if only slight changes of the bulla wall are detected on CT, early-stage cholesteatoma should be considered. The narrow anatomic conditions in brachycephalic dogs possibly predispose such breeds to develop cholesteatoma after middle ear surgery because complete removal of all inflammatory and epithelial tissue can be more difficult than in other breeds. To the authors' knowledge, this is the first report of an aural cholesteatoma causing sensory deficits of the trigeminal nerve. PMID:22611216

  9. Radiation-induced external ear canal cholesteatoma-like disease

    International Nuclear Information System (INIS)

    Three cases of cholesteatoma-like disease in the ear canals after radiation therapy for head and neck tumor were reported. Effect of irradiation on bone and soft tissue including skin brings about pathological reaction to the external ear canal as well. Two types of disease resembling cholesteatomas have been recognized: keratosis obturans (KO) and external auditory canal cholesteatoma (EACC). KO appears to be derived from disease of canal skin involved with keratinization, creating a widning of the canal. EACC, on the other hand, seems to develop in the disease of bony canal where a localized absorption of its bone with invasion of squamous epithelium takes place. (author)

  10. [Experiment study on solubilization of cholesteatoma debris].

    Science.gov (United States)

    Gyo, K; Sasaki, Y; Kobayashi, T

    1991-01-01

    A variety of solutions were tested in vitro to find a suitable solvent of cholesteatoma debris for use in clinical practice. The specimens were taken during surgery from the patients of otitis media with cholesteatoma. They were divided in pieces and put in test tubes. Each tube was then admixed with one of the test solutions and incubated at 37 degrees C for 48 hours. Hydrochloric acid (1N) and sodium hydroxide (1N) had no substantial effect to solve the debris. Urea (10N), acetylcysteine (20%) and chymotrypsin (1%) had a weak such effect. Proteolytic agents such as diiodosalitylic acid (0.1N), sodium dodecyl sulfate (0.1N) and cholic acid (0.1N) showed a stronger effect but not enough for clinical use. In contrast, a detergent which contains interfacial active agents and a proteolytic enzyme (alkaline cellulase), such as Attack and Hi-Top, proved to be more effective to solve the debris. However, biological effect of such detergent on the ear is not clear. Further study will be necessary before actual application in the patients. PMID:2019913

  11. Cholesteatomas of the temporal bone: role of computed tomography

    Energy Technology Data Exchange (ETDEWEB)

    Johnson, D.W.; Voorhees, R.L.; Lufkin, R.B.; Canalis, R.

    1983-09-01

    Computed tomography (CT) of the temporal bone was performed in 64 patients thought to have a cholesteatoma of the middle ear. Twenty had not had surgery before, while 44 had been operated on; special consideration was given to 21 patients who were scanned immediately before a second operation and had confirmation of the CT findings. Inflammatory disease without cholesteatoma was characterized by absence of erosion of the otic capsule or ossicular chain. Sharply circumscribed cholesteatomas were easily diagnosed by CT. When they were combined with scarring, granulation tissue, or postsurgical changes, the resulting soft-tissue masses were indistinguishable, although cholesteatoma may be suspected if there is evidence of progressive bone erosion about the middle ear. CT can play a major role in postoperative follow-up by confirming that the ear is normal and demonstrating displacement of ossicular grafts or prostheses.

  12. School performance in cholesteatoma-operated children in Denmark

    DEFF Research Database (Denmark)

    Djurhuus, B D; Hansen, Tom Giedsing; Pedersen, Jacob Krabbe;

    2016-01-01

    Cholesteatoma in childhood had no long-term effect on school performance for the majority who completed lower secondary school. Aim To investigate whether individuals operated on for cholesteatoma in childhood have impaired school performance in adolescence. Methods All children born in Denmark...... between 1986-1991 with cholesteatoma surgery performed before the age of 15 years were included (cholestetaoma group). A control group consisting of a 5% random sample of all children born in Denmark during the same period was used for comparison. Final marks (average, mathematics, Danish, and English......) achieved upon completion of lower secondary school (9th grade; age 15 or 16 years) were compared between groups. Results A total of 549 individuals met the inclusion criteria for the cholesteatoma group and 15 106 for the control group. High parental education and female sex were strongly associated with...

  13. Aggressiveness of pediatric cholesteatoma. Do we have an evidence?

    Science.gov (United States)

    Lynrah, Zareen A; Bakshi, Jaimanti; Panda, Naresh K; Khandelwal, N K

    2013-07-01

    To compare pediatric and adult patients, affected by cholesteatoma for the clinical presentation, disease extent and final outcome. This is a prospective study in which 60 cases of unsafe chronic suppurative otitis media with cholesteatoma were included. These cases were divided into two groups of 30 cases each on the basis of age. All patients were subjected to detailed clinical examination. A high resolution computed tomography of the temporal bone was done in all the cases. An innovative grading system was devised to grade the disease. The patients were subjected to canal wall down mastoidectomy and were evaluated postoperatively for resolution of the symptoms, hearing and cavity problems. Granulation tissue along with cholesteatoma was more common among children (p granulation tissue along with cholesteatoma in children causes more aggressive disease with higher recidivism rate. PMID:24427579

  14. Ossicular Erosion in Patients Requiring Surgery for Cholesteatoma

    OpenAIRE

    Ghodrat Mohammadi; Masoud Naderpour; Mehrnoosh Mousaviagdas

    2012-01-01

    Introduction: The aim of this study was to evaluate the condition of the ossicular chain in patients requiring surgery for cholesteatoma.  Materials and Methods: In a retrospective analysis, the destruction of the individual and combined bony structures of the ear was described in 166 patients with cholesteatoma who went through surgery in our Otology Center between 2003 and 2009.  Results: Total (55.4%) or partial (30.7%) erosion of the incus was the most common pathology. In...

  15. Petrous Apex Cholesteatoma: Exteriorization vs. Subtotal Petrosectomy with Obliteration

    OpenAIRE

    Pyle, G. Mark; Wiet, Richard J.

    1991-01-01

    True cholesteatomas developing medial to the labyrinth and facial nerve with extension into the petrous apex are uncommon lesions. More recent techniques of total matrix removal and obliteration require the otoneurosurgeon to be knowledgeable of intratemporal facial nerve mobilization techniques. Total cholesteatoma matrix removal and obliteration may obviate the need for frequent care of the exteriorized cavity. However, these procedures can be associated with extensive recurrence from resid...

  16. Posttraumatic Cholesteatoma Complicated by a Facial Paralysis: A Case Report

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    M. Chihani

    2012-01-01

    Full Text Available The posttraumatic cholesteatoma is a rare complication of different types of the temporal bone damage. Its diagnosis is often done after several years of evolution, sometimes even at the stage of complications. A case of posttraumatic cholesteatoma is presented that was revealed by a facial nerve paralysis 23 years after a crash of the external auditory canal underlining the importance of the otoscopic and radiological regular monitoring of the patients with a traumatism of the temporal bone.

  17. The c-MYC Protooncogene Expression in Cholesteatoma

    OpenAIRE

    2014-01-01

    Cholesteatoma is an epidermoid cyst, which is most frequently found in the middle ear. The matrix of cholesteatoma is histologically similar to the matrix of the epidermoid cyst of the skin (atheroma); their epithelium is characterized by hyperproliferation. The c-MYC protooncogene located on chromosome 8q24 encodes a transcription factor involved in the regulation of cell proliferation and differentiation. Previous studies have found aneuploidy of chromosome 8, copy number variation of c-MYC...

  18. Endoscopic Management of Attic Cholesteatoma: Long-Term Results.

    Science.gov (United States)

    Alicandri-Ciufelli, Matteo; Marchioni, Daniele; Kakehata, Seiji; Presutti, Livio; Villari, Domenico

    2016-10-01

    The main application of endoscopic surgery relies on the middle ear cholesteatoma surgical treatment, although for a definitive validation and acceptance by scientific community, long-term results are needed about recurrent and residual rates of the pathology. The aim of the present paper was to analyze the single institution experience with the long-term results of surgical treatment of attic cholesteatoma. PMID:27565391

  19. Radiologic evaluation of the ear anatomy in pediatric cholesteatoma.

    Science.gov (United States)

    Manolis, Evangelos N; Filippou, Dimitrios K; Tsoumakas, Constantinos; Diomidous, Marianna; Cunningham, Michael J; Katostaras, Theophanis; Weber, Alfred L; Eavey, Roland D

    2009-05-01

    The aim of the study was to describe computed tomography (CT) findings in middle ear cholesteatoma in pediatric patients. A cohort of 32 children with cholesteatoma (3-14 years old) entered the study. From them, 30 presented acquired cholesteatoma (AC), and 2 presented congenital cholesteatoma. All of the children were investigated using CT before surgery of the middle ear and mastoid. Computed tomography was performed with 1- or 2-mm axial and coronal sections of both temporal bones. Nineteen children with AC (63.3%) revealed a diffuse soft-tissue density isodense with muscle, whereas in 6 of them, the mass mimicked inflammation. The remaining revealed localized soft-tissue mass with partially lobulated contour. In AC, ossicular erosion was detected in 23 cases (76.7%), abnormal pneumatization in 19 cases (63.3%), and erosion-blunting of spur and enlargement of middle ear or mastoid in 8 cases (26.7%). The 2 congenital cholesteatomas revealed soft-tissue mass with polypoid densities, while a semicircular canal fistula was detected in one of them. High-resolution CT facilitates early diagnosis and appropriate treatment of pediatric cholesteatoma by assessing the anatomic abnormalities and the extent of disease, which are crucial in middle ear and mastoid surgery. PMID:19390457

  20. Cholesteatoma risk in 8,593 orofacial cleft cases and 6,989 siblings

    DEFF Research Database (Denmark)

    Djurhuus, Bjarki Ditlev; Skytthe, Axel; Faber, Christian Emil;

    2015-01-01

    increase in the risk of cholesteatoma was found in individuals with cleft palate, whereas cleft lip did not pose a risk of cholesteatoma. Furthermore, the study indicates an increased risk of cholesteatoma in unaffected siblings of individuals with cleft palate. LEVEL OF EVIDENCE: 2b Laryngoscope, 2014....

  1. Middle-ear cholesteatoma surgery. The need of individualized therapy

    International Nuclear Information System (INIS)

    The goal of middle-ear cholesteatoma surgery is two-fold- a safe, dry, trouble-free ear and good hearing. No single surgical strategy is optimal in all cases, however, necessitating an individualized approach- and a standard for surgical selection. We reviewed middle-ear ventilation and tympanoplasty techniques. Cholesteatoma recurrence is a major problem following closed tympanoplasty, requiring ventilation created from the mesotympanum to the mastoid cavity and promoting mastoid reaeration. If a ventilation route cannot be constructed postoperatively, open tympanoplasty should be considered. In attic and antrum aeration in preoperative computed tomography (CT), we selected closed tympanoplasty. For such cases without attic and antrum aeration, planned tympanoplasty was selected. In those older than 60 years or with poor Eustachian tube function, open tympanoplasty with or without soft-wall external ear canal reconstruction was selected rather than planned staged tympanoplasty. Postoperative residual cholesteatoma was seen in 19 of 185 ears (10.3%), but no recurrent cholesteatoma. Individual hospital staffs should thus prepare and review a standard individualizing cholesteatoma surgery. (author)

  2. Wholly Endoscopic Permeatal Removal of a Petrous Apex Cholesteatoma

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    Todd Kanzara

    2014-01-01

    Full Text Available We report a case of a petrous apex cholesteatoma which was managed with a wholly endoscopic permeatal approach. A 63-year-old Caucasian male presented with a 10-year history of right-sided facial palsy and profound deafness. On examination in our clinic, the patient had a grade VI House-Brackmann paresis, otoscopic evidence of attic cholesteatoma behind an intact drum, and extensive scarring of the face from previous facial reanimation surgery. Imaging review was suggestive of petrous apex cholesteatoma. An initial decision to manage the patient conservatively was later reviewed on account of the patient suffering recurrent epileptic seizures. A wholly endoscopic permeatal approach was used with successful outcomes. In addition to the case report we also provide a brief description of the technique and a review of the relevant literature.

  3. External ear canal cholesteatoma after ventilation tube insertion and mastoidectomy

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    Đerić Dragoslava

    2012-01-01

    Full Text Available Introduction. Etiopathogenetically, there are two types of chollesteatomas: congenital, and acquired. Numerous theories in the literature try to explain the nature of the disease, however, the question about cholesteatomas remain still unanswered. The aim of the study was to present a case of external ear canal cholesteatoma (EEC developed following microsurgery (ventilation tube insertion and mastoidectomy, as well as to point ant possible mechanisms if its development. Case report. A 16-yearold boy presented a 4-month sense of fullness in the ear and otalgia on the left side. A year before, mastoidectomy and posterior atticotomy were performed with ventilation tube placement due to acute purulent mastoiditis. Diagnosis was based on otoscopy examination, audiology and computed tomography (CT findings. CT showed an obliterative soft-tissue mass completely filled the external ear canal with associated erosion of subjacent the bone. There were squamous epithelial links between the canal cholesteatoma and lateral tympanic membrane surface. They originated from the margins of tympanic membrane incision made for a ventilation tube (VT insertion. The position of VT was good as well as the aeration of the middle ear cavity. The tympanic membrane was intact and of normal appearance without middle ear extension or mastoid involvement of cholesteatoma. Cholesteatoma and ventilation tube were both removed. The patient recovered without complications and shortly audiology revealed hearing improving. Follow-up 2 years later, however, showed no signs of the disease. Conclusion. There could be more than one potential delicate mechanism of developing EEC in the ear with VT insertion and mastoidectomy. It is necessary to perform routine otologic surveillance in all patients with tubes. Affected ear CT scan is very helpful in showing the extent of cholesteatoma and bony defects, which could not be assessed by otoscopic examination alone.

  4. Evaluation of cholesteatoma frequency in patients with chronic otitis media

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    Amad Meimaneh Jahromi

    2010-04-01

    Full Text Available ntroduction: Chronic otitis media (COM is regarded as one of the disabling diseases which have a great influence on the quality of life. Because of the surgical approach of cholesteatoma, timely diagnosis is very important in management of patients with COM. The purpose of this study was to assess the frequency of cholesteatoma in patients with COM, demographic factors and disease related factors. Materials and Methods: In this retrospective study, medical records of 100 patients with COM who had surgery since 2005 to 2009 in Imam Reza Hospital were selected. Patients’ age, gender, duration of COM, clinical manifestations, location of perforation of tympanic membrane and presence or absence of cholesteatoma were analyzed by SPSS statistical software and some tables and graphs were planned. Results: patients   included 70 males and 30 females with an average age of 23.08 ± 11.35. Mean of COM duration was 8.04 ± 7.14 years. The most common manifestations of the disease were otorrhea (92% and hearing loss (80%. The most frequent type of tympanic perforation was total perforation. Frequency of cholesteatoma was 42% and it was more common in males than females (42.9% and 40%. Presence of choleasteatoma was related to gender, age, location of tympanic perforation, presence of otorrhea and hearing loss. Conclusion: Prevalence of cholesteatoma in patients  with COM  in  Mashhad  is more than  other  cites of Iran and  also other  countries, but it is less than prevalence of non cholesteatomatos COM. It is very important to pay more attention to patients with COM who are evaluated about presence of cholesteatoma, specially those with otorrhea, hearing loss, total perforation of tympanic membrane or male gender.

  5. Evidence of residual disease in ossicles of patients undergoing cholesteatoma removal.

    Science.gov (United States)

    Dornhoffer, J L; Colvin, G B; North, P

    1999-01-01

    For the past several years there has been much debate regarding the advisability of reusing the incus for ossicular reconstruction in cases involving cholesteatoma. There appears to be some evidence that microscopic foci of cholesteatoma in the incus could lead to reimplantation of the cholesteatoma should the incus be used in the reconstruction phase. In an effort to elucidate the incidence of microscopic residual cholesteatoma, the incudes of patients with cholesteatoma were examined both grossly in the operating room and microscopically in the laboratory for erosion and residual cholesteatoma. Our examination showed that a number of specimens apparently free of cholesteatoma after macroscopic examination had microscopic evidence of cholesteatoma. Likewise, microscopic examination of an incus that appeared to be free of residual cholesteatoma revealed epithelial cells deeply invading the bone. Macroscopic examination consistently underestimated the amount of erosion that was clearly evident upon histologic examination. In light of these findings, gross examination of the incus after removal of cholesteatoma is not reliably predictive of invasive microscopic disease. Reusing the ossicles in this situation creates the potential of reimplanting the disease. PMID:10219392

  6. Giant cholesteatoma: case and literature review' report

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    Nunes, Leonardo Mendes Acatauassú

    2010-03-01

    Full Text Available Introduction: Cholesteatomas are cystic lesions encased by stratified squamous epithelium, filled for keratin. They are classified in congenital, about of 2-5% and acquired, which are subdivided in primary formed from a tympanic retraction and secondary, originated from epithelium migration through a tympanic perforation. They are tumeurs with an expansive capacity and of bone lysis being able to invade adjacent structures. Case Report: This work reports the case of ONV, 23 years old from Macapá/Amapá. In august 2007, he/she appeared to attendance with a case history of right chronic otorrhea, he/she also reported meningitis and progressive right peripherica facial paralysis. The mastoid tomography demonstrated an hypodense image with density of soft tissues filling the middle ear, destructing the ossicular chain, semicircular canals, cochlea and extending until next to the proximal portion of the internal auditory meatus. He/she was referred to surgery. During the trans-operative it is evidenced an extensive destruction of the cortical layer of the mastoid, which was obstructed by a mass of an yellow coloration, fetid and of the consistent aspect. After the lesion is removed it is verified the presence of fistulae of high debit with posterior fossa. It was proceeded with the fistulae closing with a bone wax and temporal muscle shred. The patient remained confined during 15 days in use wide antimicrobial schema. Currently, it is find in regular accompaniment and in a good general state. Final Comments: This work aims to call attention to the rigorous complications of these pathologies , which despite to be common and to be a benign tumoral lesion can bring severe sequelae to the patient, in the event of the diagnosis and treatment not to be prematurely performed.

  7. Canine aural cholesteatoma: a histological and immunohistochemical study.

    Science.gov (United States)

    Banco, Barbara; Grieco, Valeria; Di Giancamillo, Mauro; Greci, Valentina; Travetti, Olga; Martino, Pieranna; Mortellaro, Carlo M; Giudice, Chiara

    2014-06-01

    Canine aural cholesteatoma is an epidermoid cyst that forms in the middle ear cavity as a rare complication of otitis media but the aetiopathogenesis remains controversial. In the present study, 13 cases of canine aural cholesteatoma were investigated histologically and immunohistochemically and compared with cases of chronic otitis. The immunohistochemical investigation was performed using the following monoclonal antibodies: anti-cytokeratins (CK) 14, 16, 8/18, and 19, and anti-Ki67. The proliferative indexes (PIs) of cholesteatomata and otitis epithelium were calculated as the percentage of Ki67 positive nuclei/total nuclei. Histologically, the cholesteatomata were composed of a hyperplastic, hyperkeratotic epithelium (matrix) resting on a fibrous perimatrix, infiltrated by inflammatory cells and devoid of cutaneous adnexa. Immunohistochemically, the cholesteatoma epithelium was CK14- and CK16-positive, and CK8/18- and CK19-negative. A similar pattern of CK expression was found in otitis externa. In otitis media, ciliated epithelium stained CK8/18- and CK19-positive in all layers, CK14-positive in the basal layers, and CK16-negative. The mean PIs in cholesteatomata and otitides were 18.8 and 17.8, respectively. The immunohistochemical pattern of CK expression in cholesteatomata, when compared with chronic otitis, was suggestive of hyperproliferative epithelium, but its origin could not be demonstrated. Comparable PI values were obtained in cholesteatoma and in chronic otitis, which confirmed that Ki67 is a valuable indicator of a hyperproliferative state, but not a predictor of aggressiveness. PMID:24775276

  8. Lateral semicircular canal fistula in cholesteatoma: diagnosis and management.

    Science.gov (United States)

    Meyer, Anais; Bouchetemblé, Pierre; Costentin, Bertrand; Dehesdin, Danièle; Lerosey, Yannick; Marie, Jean-Paul

    2016-08-01

    The objective of this retrospective study was to present the authors' experience on the management of labyrinthine fistula secondary to cholesteatoma. 695 patients, who underwent tympanoplasty for cholesteatoma, in a University Hospital between 1993 and 2013 were reviewed, to select only those with labyrinthine fistulas. 42 patients (6%) had cholesteatoma complicated by fistula of the lateral semicircular canal (LSCC). The following data points were collected: symptoms, pre- and postoperative clinical signs, surgeon, CT scan diagnosis, fistula type, surgical technique, preoperative vestibular function and audiometric outcomes. Most frequent symptoms were unspecific, such as otorrhea, hearing loss and dizziness. However, preoperative high-resolution computed tomography predicted fistula in 88 %. Using the Dornhoffer and Milewski classification, 16 cases (38 %) were identified as stage 1, 22 (52 %) as stage II, and 4 (10 %) as stage III. The choice between open or closed surgical procedure was independent of the type of fistulae. The cholesteatoma matrix was completely removed from the fistula and immediately covered by autogenous material. In eight patients (19 %), the canal was drilled with a diamond burr before sealing with autologous tissue. After surgery, hearing was preserved or improved in 76 % of the patients. There was no statistically significant relationship between the extent of the labyrinthine fistula and the hearing outcome. In conclusion, a complete and nontraumatic removal of the matrix cholesteatoma over the fistula in a one-staged procedure and its sealing with bone dust and fascia temporalis, with sometimes exclusion of the LSCC, is a safe and effective procedure to treat labyrinthine fistula. PMID:26351038

  9. Bacterial Infections and Osteoclastogenesis Regulators in Men and Women with Cholesteatoma.

    Science.gov (United States)

    Likus, Wirginia; Siemianowicz, Krzysztof; Markowski, Jarosław; Wiaderkiewicz, Jan; Kostrząb-Zdebel, Anna; Jura-Szołtys, Edyta; Dziubdziela, Włodzimierz; Wiaderkiewicz, Ryszard; Łos, Marek J

    2016-06-01

    One of the most distinct features of middle ear cholesteatoma is bone destruction. Aetiology of cholesteatoma is thought to be multifactorial. Endotoxins produced by bacteria are thought to initiate the inflammation process in the middle ear leading to cholesteatoma. There are physiological differences in bone metabolism between men and women. The aim of our study was the immunohistochemical evaluation of the contents of two key components of the OPG/RANK/RANKL triad-RANKL and OPG in cholesteatoma, to analyse if there are any differences between the sexes and to evaluate the bacteria species isolated from cholesteatoma just before surgical treatment and to evaluate their plausible influence on the expression of OPG and RANKL in cholesteatoma. Twenty-one adult patients with acquired cholesteatoma who underwent surgery were analysed. There were no statistically significant differences in the expression of both regulators of osteoclastogenesis between the sexes. In 38.1 % patients cholesteatoma was not infected, whereas in 61.9 % patients various bacterial infections or mycosis were found. The most frequently isolated species was Pseudomonas aeruginosa (14.29 % infections) followed by Staphylococcus aureus (9.52 % infections). There were no statistically significant differences in expression of both OPG and RANKL between uninfected and infected cholesteatomas. PMID:26584851

  10. UNILATERAL MEMBRANOUS ATRESIA WITH OSSICULAR MALROTATION AND CONGENITAL CHOLESTEATOMA

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    Sibhithran

    2016-03-01

    Full Text Available INTRODUCTION Congenital cholesteatoma is a rare entity, arising from aberrant epithelial remnants left at the time of closure of the neural groove between the third and fifth week of fetal life with incidence ranging from 4 to 24%. Congenital membranous atresia is more common on right side and unilateral presentation is a rarity in females which is seen in our case. Here we report a rare case of 44 year old female with bilateral hard of hearing which is more on right side with ear discharge and was diagnosed by CT scan to have congenital unilateral membranous atresia with rare finding of ossicular malrotation associated with congenital cholesteatoma which are extremely rare combination of findings in a single patient. Knowing such rarity may help in appropriate surgical approach when confronted with such cases in clinical practice.

  11. Tomography and xerotomography after reconstructive middle ear surgery for cholesteatoma

    International Nuclear Information System (INIS)

    In order to adequately visualize the ossicles and other fine structures in the middle ear, sophisticated radiological methods are essential. The temporal bone has been studied with hypocycloidal tomography using conventional films and xerotomography in 60 patients with cholesteatoma. In 53 of the patients xerotomography gave good results while conventional tomography gave good results in only 38 patients. The superiority of xerotomography to conventional radiological methods is stressed. The only drawback is the high radiation dose to the patient. (orig.)

  12. Ossicular Erosion in Patients Requiring Surgery for Cholesteatoma

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    Ghodrat Mohammadi

    2012-03-01

    Full Text Available Introduction: The aim of this study was to evaluate the condition of the ossicular chain in patients requiring surgery for cholesteatoma.  Materials and Methods: In a retrospective analysis, the destruction of the individual and combined bony structures of the ear was described in 166 patients with cholesteatoma who went through surgery in our Otology Center between 2003 and 2009.  Results: Total (55.4% or partial (30.7% erosion of the incus was the most common pathology. In some cases, the long process (25.9% and the body of incus (4.8% were also involved. Erosion of the stapes superstructure occurred more commonly than a total loss of the bone (40.9% vs. 25.9%. Erosion of the malleus was least common. Completely intact ossicles were present in 5.5% of cases. Total ossicular erosion with an intact footplate (18.7% and incudostapedial erosion (18% was the most common combination of ossicular erosion. All patients with incudostapedial erosion had advanced disease (85% with multiple site involvement.  Conclusion: Widespread cholesteatoma results in greater ossicular erosion and poor hearing outcomes.

  13. Bone destruction mechanisms in chronic otitis media with cholesteatoma: specific production by cholesteatoma tissue in culture of bone-resorbing activity attributable to interleukin-1 alpha.

    Science.gov (United States)

    Kurihara, A; Toshima, M; Yuasa, R; Takasaka, T

    1991-12-01

    To clarify specific mechanisms underlying cholesteatoma-induced bone destruction, surgical specimens of middle ear inflammatory granulation tissue with or without cholesteatoma were maintained in vitro and the bone-resorbing activity in their culture supernatants was analyzed by means of calcium release from mouse calvaria. Almost the same levels of bone-resorbing activity and prostaglandin (PG) E2 were found in the supernatants of both types of tissue. By contrast, aural polyp tissue yielded hardly any such activity or PGE2. Under the influence of indomethacin, however, only tissue with cholesteatoma produced considerable bone resorption activity, whereas PGE2 production was suppressed completely. Such activity in the cholesteatoma culture supernatant was not due to contamination of endotoxin and proved to be blocked by the introduction of anti-interleukin (IL)-1 alpha antibody into the calvarial assay system. Anti-IL-1 beta antibody had no effect on such activity. Interleukin-1 alpha was detected only in cholesteatoma tissue culture supernatants by means of enzyme-linked immunosorbent assay and by bioassay. These data suggest that the bone destruction in otitis media with cholesteatoma may be attributed to IL-1 alpha in addition to PGE2. PMID:1746847

  14. Colesteatoma causando paralisia facial Cholesteatoma causing facial paralysis

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    José Ricardo Gurgel Testa

    2003-10-01

    Full Text Available A paralisia facial causada pelo colesteatoma é pouco freqüente. As porções do nervo mais acometidas são a timpânica e a região do 2º joelho. Nos casos de disseminação da lesão colesteatomatosa para o epitímpano anterior, o gânglio geniculado é o segmento do nervo facial mais sujeito à injúria. A etiopatogenia pode estar ligada à compressão do nervo pelo colesteatoma seguida de diminuição do seu suprimento vascular como também pela possível ação de substâncias neurotóxicas produzidas pela matriz do tumor ou pelas bactérias nele contidas. OBJETIVO: Avaliar a incidência, as características clínicas e o tratamento da paralisia facial decorrente da lesão colesteatomatosa. FORMA DE ESTUDO: Clínico retrospectivo. MATERIAL E MÉTODO: Estudo retrospectivo envolvendo dez casos de paralisia facial por colesteatoma selecionados através de levantamento de 206 descompressões do nervo facial com diferentes etiologias, realizadas na UNIFESP-EPM nos últimos dez anos. RESULTADOS: A incidência de paralisia facial por colesteatoma neste estudo foi de 4,85%,com predominância do sexo feminino (60%. A idade média dos pacientes foi de 39 anos. A duração e o grau da paralisia (inicial juntamente com a extensão da lesão foram importantes em relação à recuperação funcional do nervo facial. CONCLUSÃO: O tratamento cirúrgico precoce é fundamental para que ocorra um resultado funcional mais adequado. Nos casos de ruptura ou intensa fibrose do tecido nervoso, o enxerto de nervo (auricular magno/sural e/ou a anastomose hipoglosso-facial podem ser sugeridas.Facial paralysis caused by cholesteatoma is uncommon. The portions most frequently involved are horizontal (tympanic and second genu segments. When cholesteatomas extend over the anterior epitympanic space, the facial nerve is placed in jeopardy in the region of the geniculate ganglion. The aetiology can be related to compression of the nerve followed by impairment of its

  15. Should we use ossicular remnants in ossicular reconstruction following cholesteatoma removal?

    Science.gov (United States)

    Ferekidis, E; Nikolopoulos, T P; Yiotakis, J; Ferekidou, E; Korres, S; Manolopoulos, L; Kandiloros, D

    2006-01-01

    The remnants of the acoustic ossicles have been used in ossicular reconstruction during mastoid surgery for many decades. The present study assessed the status of the acoustic ossicles in 114 patients (57 with cholesteatoma and 57 without) during surgery for chronic otitis media using the operating microscope. In 52 cases, the ossicles (malleus and/or incus) were assessed using both the surgical and scanning electron microscope in order to reveal any erosions and compare the findings. From the 57 operated ears with cholesteatoma, 45 (79%) had ossicular erosion whereas 12 (21%) did not. In the group of 57 operated ears with chronic otitis media without cholesteatoma, 33 (58%) had ossicular erosion whereas 24 (42%) did not. This difference was statistically significant (p = 0.02). With regard to the 52 operated cases who were studied with both microscopes, in the cholesteatoma patients the surgical microscope was not able to reveal any ossicular erosions in 39% of the cases, whereas the scanning electron microscope revealed moderate or severe erosions in the same ears. This suggests that the operating microscope is not reliable enough to determine if ossicular remnants can be used in ossicular reconstruction following cholesteatoma surgery. There is a considerable risk that epithelia or other cholesteatoma particles remain in the areas of erosions that cannot be seen with the operating microscope. The use of such ossicular remnants may lead to cholesteatoma recurrence and failures in mastoid surgery. Therefore, autoclaving or alternative prosthesis may be considered in such cases. PMID:16567949

  16. TLR4 drives the pathogenesis of acquired cholesteatoma by promoting local inflammation and bone destruction.

    Science.gov (United States)

    Si, Yu; Chen, Yu Bin; Chen, Sui Jun; Zheng, Yi Qing; Liu, Xiang; Liu, Yi; Jiang, Huai Li; Xu, Guo; Li, Zhuo Hao; Huang, Qiu Hong; Xiong, Hao; Zhang, Zhi Gang

    2015-01-01

    Acquired cholesteatoma is a chronic inflammatory disease characterized by both hyperkeratinized squamous epithelial overgrowth and bone destruction. Toll-like receptor (TLR) activation and subsequent inflammatory cytokine production are closely associated with inflammatory bone disease. However, the expression and function of TLRs in cholesteatoma remain unclear.We observed inflammatory cell infiltration of the matrix and prematrix of human acquired cholesteatoma, as well as dramatically increased expression of TLR4 and the pro-inflammatory cytokines TNF-α and IL-1β. TLR2 exhibited an up-regulation that was not statistically significant. TLR4 expression in human acquired cholesteatoma correlated with disease severity; the number of TLR4-positive cells increased with an increased degree of cholesteatoma, invasion, bone destruction, and hearing loss. Moreover, TLR4 deficiency was protective against experimental acquired cholesteatoma-driven bone destruction and hearing loss, as it reduced local TNF-α and IL-1β expression and impaired osteoclast formation by decreasing expression of the osteoclast effectors receptor activator of nuclear factor (NF)-κB ligand (RANKL) and tartrate-resistant acid phosphatase (TRAP). TLR2 deficiency did not relieve disease severity, inflammatory responses, or osteoclast formation. Moreover, neither TLR2 nor TLR4 deficiency had an effect on antimicrobial peptides, inducible iNOS,BD-2 expression or bacterial clearance. Therefore, TLR4 may promote cholesteatoma-induced bone destruction and deafness by enhancing inflammatory responses and osteoclastogenesis. PMID:26639190

  17. Cholesteatoma: computed tomography and radiography in a dog

    International Nuclear Information System (INIS)

    Cholesteatoma, a rare and/or misdiagnosed disease, results of a serious complication in dogs with chronic otitis. This article describes a case of a dachshund sent to the veterinary hospital presenting signs of cognitive dysfunction associated to peripheral neuropathy of the facial nerve on the right side. At radiography, an enlargement and thickness of the contours associated with loss of anatomical definition of the right tympanic bulla compared to the left was seen. At tomography, this enlargement and thickness were seen with better definition, besides the fulfilling by hyperdense calcified content, bullae osteolysis and temporal bone sclerosis at the same side. (author)

  18. Cholesteatoma associated with squamous cell carcinoma of the external auditory canal: Case report and literature review

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    Olfa Ben Gamra

    2015-11-01

    Conclusion: SCC of the external auditory canal can mimic cholesteatoma. A precise diagnosis of the disease is important to predict the treatment outcome. Optimal management relies on early surgery and postoperative radiotherapy, thus offering the greatest chance of cure.

  19. Identification of novel cholesteatoma-related gene expression signatures using full-genome microarrays.

    Directory of Open Access Journals (Sweden)

    Christin Klenke

    Full Text Available BACKGROUND: Cholesteatoma is a gradually expanding destructive epithelial lesion within the middle ear. It can cause extensive local tissue destruction in the temporal bone and can initially lead to the development of conductive hearing loss via ossicular erosion. As the disease progresses, sensorineural hearing loss, vertigo or facial palsy may occur. Cholesteatoma may promote the spread of infection through the tegmen of the middle ear and cause meningitis or intracranial infections with abscess formation. It must, therefore, be considered as a potentially life-threatening middle ear disease. METHODS AND FINDINGS: In this study, we investigated differentially expressed genes in human cholesteatomas in comparison to regular auditory canal skin using Whole Human Genome Microarrays containing 19,596 human genes. In addition to already described up-regulated mRNAs in cholesteatoma, such as MMP9, DEFB2 and KRT19, we identified 3558 new cholesteatoma-related transcripts. 811 genes appear to be significantly differentially up-regulated in cholesteatoma. 334 genes were down-regulated more than 2-fold. Significantly regulated genes with protein metabolism activity include matrix metalloproteinases as well as PI3, SERPINB3 and SERPINB4. Genes like SPP1, KRT6B, PRPH, SPRR1B and LAMC2 are known as genes with cell growth and/or maintenance activity. Transport activity genes and signal transduction genes are LCN2, GJB2 and CEACAM6. Three cell communication genes were identified; one CDH19 and two from the S100 family. CONCLUSIONS: This study demonstrates that the expression profile of cholesteatoma is similar to a metastatic tumour and chronically inflamed tissue. Based on the investigated profiles we present novel protein-protein interaction and signal transduction networks, which include cholesteatoma-regulated transcripts and may be of great value for drug targeting and therapy development.

  20. Is Cholesteatoma a Risk Factor for Graft Success Rate in Chronic Otitis Media Surgery?

    OpenAIRE

    Faramarzi, Mohammad; Dehbozorgi, Mohammad Mehdi; Heydari, Seyed Taghi

    2015-01-01

    Introduction: In developing countries, chronic otitis media (COM) and cholesteatoma are relatively prevalent. Within the field of otology, COM surgery remains one of the most common surgical treatments. Most recent studies evaluating the potential prognostic factors in COM surgery have addressed graft success rate and types of middle ear and mastoid pathology. There has been much controversy about this issue until the present time. This study evaluated the effect of cholesteatoma on the GSR i...

  1. Spontaneous external auditory canal cholesteatoma in a young male: Imaging findings and differential diagnoses

    Science.gov (United States)

    Aswani, Yashant; Varma, Ravi; Achuthan, Gayathri

    2016-01-01

    A cholesteatoma is a non-neoplastic lesion of the petrous temporal bone commonly described as “skin in the wrong place.” It typically arises within the middle ear cavity, may drain externally via tympanic membrane (mural type), or may originate in the external auditory canal (EAC). The latter type is rarely encountered and typically affects the elderly. EAC cholesteatoma poses diagnostic challenges because it has numerous differential diagnoses. The present case describes a 19-year-old male who presented with gradually progressive diminution of hearing in a previously naïve right ear since 8 months. A soft tissue attenuation lesion confined to the right EAC with erosion of the canal on computed tomography prompted magnetic resonance imaging (MRI). The lesion showed restricted diffusion on MRI. Thus, a diagnosis of spontaneous EAC cholesteatoma was established. The case elucidates the rarity of spontaneous EAC cholesteatoma in a young male. In addition, it describes the role of imaging to detect, delineate the extent, and characterize lesions of petrous temporal bone. The case also discusses common differential diagnoses of EAC cholesteatoma, as well as the importance of diffusion weighted imaging in EAC cholesteatoma similar to its middle ear counterpart.

  2. Congenital cholesteatoma of the infratemporal fossa with congenital aural atresia and mastoiditis: a case report

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    Abdel-Aziz Mosaad

    2012-06-01

    Full Text Available Abstract Background Congenital cholesteatoma may be expected in abnormally developed ear, it may cause bony erosion of the middle ear cleft and extend to the infratemporal fossa. We present the first case of congenital cholesteatoma of the infratemporal fossa in a patient with congenital aural atresia that has been complicated with acute mastoiditis. Case presentation A sixteen year old Egyptian male patient presented with congenital cholesteatoma of the infratemporal fossa with congenital aural atresia complicated with acute mastoiditis. Two weeks earlier, the patient suffered pain necessitating hospital admission, magnetic resonance imaging revealed a soft tissue mass in the right infratemporal fossa. On presentation to our institute, Computerized tomography was done as a routine, it proved the diagnosis of mastoiditis, pure tone audiometry showed an air-bone gap of 60 dB. Cortical mastoidectomy was done for treatment of mastoiditis, removal of congenital cholesteatoma was carried out with reconstruction of external auditory canal. Follow-up of the patient for 2 years and 3 months showed a patent, infection free external auditory canal with an air-bone gap has been reduced to 35db. One year after the operation; MRI was done and it showed no residual or recurrent cholesteatoma. Conclusions Congenital cholesteatoma of the infratemporal fossa in cases of congenital aural atresia can be managed safely even if it was associated with mastoiditis. It is an original case report of interest to the speciality of otolaryngology.

  3. SUCCESSFUL OUTCOME IN MULTIPLE INTRACRANIAL COMPLICATIONS OF CHOLESTEATOMA

    Directory of Open Access Journals (Sweden)

    Praveen Kumar

    2014-02-01

    Full Text Available twenty two year old male presented with left sided otorrhea , otalgia , fever and headache. On examination patient was febrile , conscious , and irritable with neck rigidity. Mastoid tenderness was present. A granulation tissue polyp was seen occupying the entire ear canal. Imaging revealed an extradural abscess in the left posterior cranial fossa adjacent to the mastoid . Computed Tomography revealed Delta sign. Cerebrospinal fluid examination revealed features of meningitis. Before surgery the patient sudde nly deteriorated neurologically. Immediate mastoid exploration was done and the extradural abscess was drained through the transmastoid route. Cholesteatoma in the middle ear and mastoid was completely excised. A Cerebellar dura fistula was present through which a cerebrospinal fluid leak occurred which was sealed with a muscle plug. A modified radical mastoidectomy was done . On the sixth postoperative day , patient again complained of headache . A Computed Tomography scan revealed three extradural abscesses in the left parietal region which was drained by neurosurgical colleagues. The patient recovered completely

  4. Congenital cholesteatoma of mastoid origin: A multicenter case series

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    Čvorović Ljiljana

    2014-01-01

    Full Text Available Background/Aim. The mastoid is the rarest site for the onset of congenital cholesteatoma (CC. The symptoms are atypical and minimal. The aim of this multicenter retrospective descriptive study was to define this extremely rare condition and its clinical presentation, diagnosis and management. Methods. We analyzed data files for a 15- year period in 4 tertiary otology centers and discovered 6 patients with the diagnosis of CC of the mastoid. Results. The clinical presentation of CC varied from incidental findings in patient to patient with otogenic meningitis. The most common findings during surgical procedures were mastoid cortex erosion, sigmoid plate dehiscence, dural exposure and external canal wall destruction. Conclusion. CC of mastoid origin tends to occur in adult patients probably because of minimal symptoms and the delayed diagnosis. It can exist for years in a nonaggressive state and develop to giant sizes. In children it is almost incidentally diagnosed. Early imaging is necessary in order to prevent serious complication.

  5. Management of cholesteatoma complications: Our experience in 145 cases

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    Aziz Mustafa

    2014-01-01

    Full Text Available Objectives: To assess the incidence, clinical features, diagnosis and treatm ent of complications of cholesteatomatous chronic otitis media (CCOM seen in the ENT/Head and Neck Surgery Clinic, University Clinical Center of Kosova, Prishtina. Materials and Methods: This is a retrospective study of the medical records of patients with complications of CCOM who had undergone surgical treatment at the ENT Clinic of the University Clinical Center of Kosovo for the period time of 1994 to 2011. Results: From a total of 2765 patients suffering from COM, 502 (18.08% had cholesteatoma. From this group, in 145 patients had complications. The mean age was 30 years. Eighty-two (56.55% cases had extracranial complications (ECC and 49 patients (33.79% intracranial complications (ICC. For the ECC cases, we found that subperiostal mastoid abscess occurred in 25%, facial nerve palsy was seen in 13% and labyrinthine fistula in 9.6 %. For the ICC cases, meningitis (12% and perisinusal abscess (11% were the most common complications. The most frequent radiological diagnostic procedures were mastoid X-rays, which were performed in 70% of the patients, and computed tomography in 20%. Patients with ECC were treated in the ENT Clinic, whereas patients with ICC, after otologgic surgical procedures, were transferred to the Neurosurgery Clinic. In this series, 5 patients (3.4% died as a result of complications. Conclusions: The incidence of cholesteatoma and its complications in our country still poses a challenge that requires higher dedication. Application of sophisticated diagnostic methods, CT and MRI is going to assist in choosing the adequate surgical approach, especially in cases with intracranial complications

  6. [Middle ear cholesteatoma in children. Criteria for surgical procedure in 57 cases].

    Science.gov (United States)

    Lerosey, Y; Andrieu-Guitrancourt, J; Marie, J P; Dehesdin, D

    1998-10-01

    Fifty five children with 57 cholesteatomas (2 bilateral cholesteatomas) were operated on by the same surgeon. The median period of follow-up was 87 months. Fifteen cases were lost to follow-up (26%). An ossicular erosion was present in 76% of cases. In the first stage, an "intact canal wall technique" (ICWT) was carried out in 44% and a "canal wall down technique" (CWDT) in 56%. A planned second stage was carried out in 76% of ICWT and 56% of CWDT. The incidence of residual cholesteatoma was 29% and the incidence of recurrent cholesteatoma was 11%. A third stage was carried out in 6 cases (11%) without residual or recurrent cholesteatoma. Finally a CWDT was performed in 65% and a ICWT in 35%. The hearing results were significantly better with ICWT but this was due to a better preoperative hearing level. Whatever the surgical technique, the hearing results were better in the presence of an intact stapes. The surgery was individualized. Although ICWT is our priority technique, it was feasible, in our experience, only in a minority of cases because of difficult ablation, insufficient eustachian tube function and very advanced sigmoid sinus or very low lying tegmen plate. Minimal postoperative cavity problems were encountered, even in children where in our experience the mastoidal pneumatisation is limited. PMID:9827188

  7. First Branchial Cleft Fistula Associated with External Auditory Canal Stenosis and Middle Ear Cholesteatoma

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    shahin abdollahi fakhim

    2014-10-01

    Full Text Available Introduction: First branchial cleft anomalies manifest with duplication of the external auditory canal.   Case Report: This report features a rare case of microtia and congenital middle ear and canal cholesteatoma with first branchial fistula. External auditory canal stenosis was complicated by middle ear and external canal cholesteatoma, but branchial fistula, opening in the zygomatic root and a sinus in the helical root, may explain this feature. A canal wall down mastoidectomy with canaloplasty and wide meatoplasty was performed. The branchial cleft was excised through parotidectomy and facial nerve dissection.   Conclusion:  It should be considered that canal stenosis in such cases can induce cholesteatoma formation in the auditory canal and middle ear.

  8. Comparison of Preoperative Temporal Bone CT with Intraoperative Findings in Patients with Cholesteatoma

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    Mehrdad Rogha

    2014-01-01

    Full Text Available Introduction: Cholesteatoma is traditionally diagnosed by otoscopic examination and treated by surgery. The necessity for imaging in an uncomplicated case is controversial. This study was planned to investigate the usefulness of a preoperative high-resolution computed tomography (HRCT scan in depicting the status of middle ear structures in the presence of cholesteatoma and also to compare the correspondence between pre- and intraoperative CT findings in patients with cholesteatoma.   Materials and Methods: This prospective descriptive study was performed from January 2009 to May 2011 in 36 patients with cholesteatoma who were referred to the Kashani and Al-Zahra Clinics of Otolaryngology. Preoperative high-resolution temporal bone CT scans (axial and coronal views were carried out and compared with intraoperative findings.   Results: Evaluation of 36 patients and their CT scans revealed excellent correlation for sigmoid plate erosion, widening of aditus, and erosion of scutum; good correlation for erosion of malleus and tegmen; moderate correlation for lateral canal fistula (LCF and erosion of mastoid air cells; and poor correlation for facial nerve dehiscence (FND, incus, and stapes erosion.    Conclusion:  A preoperative CT scan may be helpful in relation to diagnosis and decision making for surgery in cases of cholesteatoma and ossicular erosion. The CT scan can accurately predict the extent of disease and is helpful for detection of lateral canal fistula, erosions of dural plate, and ossicular erosions. However it is not able to distinguish between cholesteatoma and mucosal disease, facial nerve dehiscency, incus, and stapes erosion. 

  9. A retrospective study on cholesteatoma otitis media coexisting with cholesterol granuloma.

    Science.gov (United States)

    Luo, Linghui; Gong, Shusheng; Bai, Guangping; Wang, Jibao

    2002-01-01

    To investigate the etiology and pathogenesis of cholesteatoma otitis media accompanied by cholesterol granuloma and the relationship between cholesteatoma and cholesterol granuloma, 63 cases of middle ear cholesterol granuloma treated in our hospital during the period from March 1988 to May 2000 were retrospectively reviewed. All cases were surgically and pathologically verified. 15 cases of cholesteatoma coexisting with cholesterol granuloma were found among the 63 patients. All 15 cases had a long-term history of otitis media, such as otorrhea (sanguine purulent otorrhea and bloody otorrhea in 8 cases) and perforation of the eardrum (perforation of pars flaccida in 8 cases). Temporal bone CT scans showed cholesteatoma in 11 cases. All patients were treated surgically, and cholesteatoma and cholesterol granuloma were found coexisting alternately, the latter lying mainly in the tympanic antrum, attic and mastoid air cells. Chocolate-colored mucus was accumulated in well-developed mastoid air cells, and glistening dotty cholesterol crystals were also found. In most cases, enlarged aditus, destruction of lateral attic wall, erosion of ossicular chain, exposure of horizontal segment of facial nerve and tegmen of attic were observed. Occlusion of Eustachian tube was noted in 6 cases, and occlusion of tympanic isthmus was revealed in all cases. A post-operative dry ear was achieved in all patients, and hearing improvement was achieved in all 12 cases following tympanoplasty. Cholesteatoma and cholesterol granuloma in middle ear may share a common pathophysiological etiology: occlusion of ventilation and disturbance of drainage. The diagnosis should be considered when patients presented with chronic otitis media with bloody otorrhea. CT and magnetic resonance imaging are useful for the diagnosis before operation. The surgical approach depends on the location, extension and severity of the lesion. The purpose of surgery is to remove the lesion and create an adequate

  10. Is endoscopic ear surgery an alternative to the modified Bondy technique for limited epitympanic cholesteatoma?

    Science.gov (United States)

    Prasad, Sampath Chandra; Giannuzzi, Annalisa; Nahleh, Eyad Abu; Donato, Giuseppe De; Russo, Alessandra; Sanna, Mario

    2016-09-01

    The objective of this study is to evaluate the outcomes of the modified Bondy's technique performed at our center and for limited epitympanic cholesteatomas and to debate the purported benefits of endoscopic surgery for the same indication. This is a retrospective study. 269 ears of 258 patients with a minimum of 5-year follow-up that were operated for limited epitympanic cholesteatoma using the modified Bondy's technique were included in the study. All patients had primary acquired cholesteatoma with good preoperative hearing in the affected ear and an intact ossicular chain. The outcomes of were analyzed and the results were compared with a literature review of outcomes of endoscopic ear surgery for the same indication. The mean follow-up was 81.63 months. The mean preoperative air-bone gap was 13.6 ± 7 dB. Intraoperatively, the ossicular chain was preserved in all patients. Postoperatively, there was no significant change from preoperative levels in mean air conduction, mean bone conduction and the air-bone gap. There were no recurrent cholesteatomas in our series. A residual pearl-like cholesteatoma was found lateral to the tympanic membrane in 8.1 % of ears, which was removed in the outpatient clinic. Three patients (1.2 %) developed stenosis of the meatoplasty. Eight (3.1 %) ears exhibited retraction pockets involving the attic. Postoperative ear discharge was observed in 1.5 % cases. The modified Bondy technique, which provides excellent postoperative outcomes, is the surgery of choice for limited epitympanic cholesteatomas. The endoscope, despite its better visualization of hidden areas does not provide a distinct overall technical advantage or better results over the microscope. PMID:26742905

  11. A Retrospective Study on Cholesteatoma Otitis Media Coexisting with Cholesterol Granuloma

    Institute of Scientific and Technical Information of China (English)

    罗凌惠; 龚树生; 白广平; 汪吉宝

    2002-01-01

    Summary: To investigate the etiology and pathogenesis of cholesteatoma otitis media accompanied by cholesterol granuloma and the relationship between cholesteatoma and cholesterol granuloma, 63 cas-es of middle ear cholesterol granuloma treated in our hospital during the period from March 1988 to May 2000 were retrospectively reviewed. All cases were surgically and pathologically verified. 15 cas-es of cholesteatoma coexisting with cholesterol granuloma were found among the 63 patients. All 15 cases had a long-term history of otitis media, such as otorrhea (sanguine purulent otorrhea and blood-y otorrhea in 8 cases) and perforation of the eardrum (perforation of pars flaccida in 8 cases). Tem poral bone CT scans showed cholesteatoma in 11 cases. All patients were treated surgically, and cholesteatoma and cholesterol granuloma were found coexisting alternately, the latter lying mainly in the tympanic antrum, attic and mastoid air cells. Chocolate-colored mucus was accumulated in well developed mastoid air cells, and glistening dotty cholesterol crystals were also found. In most cases,enlarged aditus, destruction of lateral attic wall, erosion of ossicular chain, exposure of horizontal segment of facial nerve and tegmen of attic were observed. Occlusion of Eustachian tube was noted in 6 cases, and occlusion of tympanic isthmus was revealed in all cases. A post-operative dry ear was achieved in all patients, and hearing improvement was achieved in all 12 cases following tympanoplas-ty. Cholesteatoma and cholesterol granuloma in middle ear may share a common pathophysiological e-tiology: occlusion of ventilation and disturbance of drainage. The diagnosis should be considered when patients presented with chronic otitis media with bloody otorrhea. CT and magnetic resonance imaging are useful for the diagnosis before operation. The surgical approach depends on the location,extension and severity of the lesion, The purpose of surgery is to remove the lesion and create an

  12. School performance in cholesteatoma-operated children in Denmark: a nationwide population-based register-study.

    Science.gov (United States)

    Djurhuus, B D; Hansen, T G; Pedersen, J K; Faber, C E; Christensen, K

    2016-07-01

    Conclusion Cholesteatoma in childhood had no long-term effect on school performance for the majority who completed lower secondary school. Aim To investigate whether individuals operated on for cholesteatoma in childhood have impaired school performance in adolescence. Methods All children born in Denmark between 1986-1991 with cholesteatoma surgery performed before the age of 15 years were included (cholestetaoma group). A control group consisting of a 5% random sample of all children born in Denmark during the same period was used for comparison. Final marks (average, mathematics, Danish, and English) achieved upon completion of lower secondary school (9th grade; age 15 or 16 years) were compared between groups. Results A total of 549 individuals met the inclusion criteria for the cholesteatoma group and 15 106 for the control group. High parental education and female sex were strongly associated with high 9th grade marks. The cholesteatoma group did equally as well as the control group in all outcome-measures except from in English (1st foreign language), where children with ≥2 cholesteatoma surgeries scored 0.26 marks lower (95% confidence interval = 0.03-0.48). In the cholesteatoma group, though, the odds ratio for not attaining a 9th grade exam was 1.33 (95% confidence interval = 1.03-1.72%) when compared with the control group. PMID:26924562

  13. Interleukin-1 alpha, interleukin-1 beta and interleukin-8 gene expression in human aural cholesteatomas.

    Science.gov (United States)

    Kim, C S; Lee, C H; Chung, J W; Kim, C D

    1996-03-01

    Bone destruction is a common characteristic feature of chronic otitis media, especially aural cholesteatoma. A number of immunohistochemical studies have suggested that interleukin-1 (IL-1) may be responsible for cholesteatomatous bone destruction. We designed this study to present the mRNA expression patterns of IL-1 alpha, IL-1 beta, and IL-8, which can induce and activate the leukocyte, the major reservoir of potent proteolytic enzymes. Total RNAs were extracted from aural cholesteatomas, external auditory canal skin (EACS), postauricular skin (PAS), and granulation tissues and transcribed into cDNAs. cDNAs were amplified by using PCR technique with primers for IL-1 alpha, IL-1 beta, IL-8, and beta-actin. Amplified products were hybridized with each internal probe and the relative density was measured. In granulation tissues, the relative density of IL-1 alpha was greater than that of other tissues. The ratio of IL-1 beta and IL-8 of aural cholesteatoma was significantly higher than that of EACS and PAS. We suggest that both of IL-1 alpha and IL-1 beta may play a role in the pathological changes, and that IL-8, which is mainly produced from cholesteatomatous epithelium, may have an important role in the pathological changes of cholesteatomas. PMID:8725537

  14. TNF-R2 expression in acquired middle ear cholesteatoma Expressão do TNF-R2 no colesteatoma adquirido da orelha média

    OpenAIRE

    Rodrigo Faller Vitale; Celina Siqueira Barbosa Pereira; Adriana Leal Alves; Jose Humberto Tavares Guerreiro Fregnani; Fernando Quintanilha Ribeiro

    2011-01-01

    Acquired middle ear cholesteatoma is a disease which promotes bone erosion resulting in potentially serious complications. The tumor necrosis factor alpha (TNF-α) is present in cholesteatoma and it is related to bone erosion, as shown by different authors. To understand the aggressiveness characteristics of cholesteatoma is necessary, however, to better address the presence and distribution of their receptors. OBJECTIVE: To evaluate the expression of type 2 TNF-α receptor (TNF-R2) i...

  15. Expression of the epidermal growth factor system in human middle ear cholesteatoma

    DEFF Research Database (Denmark)

    Thorup, Mette Bendixen; Munk, Mathias; Poulsen, Steen Seier; Gaihede, Michael; Nexo, Ebba; Sorensen, Boe Sandahl; Ovesen, Therese

    2014-01-01

    -binding EGF-like growth factor (HB-EGF), and epiregulin (EPI) of the EGF system is presented. At the mRNA level, the study demonstrates an up-regulation of mRNA encoding EPI and AR. In contrast HER1 and EGF were down-regulated. HER4 mRNA could be detected in 50% of cholesteatoma and 20% of reference tissues...

  16. FRONTAL SINUS CHOLESTEATOMA: A RARE BUT IMPORTANT CLINICAL ENTITY TO REMEMBER

    OpenAIRE

    Muhammad Shakeel; Siew Keh; Andrea Chapman; Bhaskar Ram

    2014-01-01

    We aim to discuss the clinical presentation, investigations and successful management of frontal sinus cholesteatoma. A 26 year old Caucasian female, otherwise fit and healthy, presented with a 4 month history of swollen right eye and sudden visual impairment. The ophthalmological examination revealed right sided proptosis, diplopia and reduced visual acuity. The colour vision was normal and there was no afferent papillary defect. On nasendoscopy, the nasal cavity was unremarkable apart from ...

  17. Congenital cholesteatoma of petrous apex: Rare case report: Diagnostic and management challenge

    Directory of Open Access Journals (Sweden)

    Arun Dehadaray

    2013-01-01

    Full Text Available A rare case of congenital cholesteatoma of petrous apex with facial nerve palsy and its successful management is reported. 49 year old female presented with progressive vertigo since 2 years. Patient developed tinnitus and hearing loss in the right ear since 7 months and right sided complete facial asymmetry since 6 months. She had normal right tympanic membrane and complete right lower motor neuron facial nerve palsy. She also had profound sensorineural hearing loss with positive Cerebellar signs. Magnetic resonance imaging and High resolution computed tomography with contrast temporal bone showed extensive bony destruction and petrous apex lesion. Facial nerve and vestibular cochlear nerve was compressed by abnormal soft-tissue present in the internal auditory meatus. Transmastoid translabyrinthine exploration was carried out for petrous apex lesion. Intra-operative extensive bony erosion was noted in the temporal bone. Erosion was extending upto Internal Acoustic Meatus compressing VII and VIII nerve bundle. Post-operatively patient was relieved of vertigo and tinnitus. Though hearing didn′t improve, but there was an improvement in facial palsy. Congenital petrous apex cholesteatoma is very rare case. With no specific radiological signs congenital cholesteatoma is difficult to diagnose pre-operatively. It was a challenge to treat surgically such a rare case with extensive neurosurgical presentation without any neurological deficit. Patient showed improvement official nerve after the 1΍ year of surgery.

  18. Surgical management of cholesteatoma: the two main options and the third way--atticotomy/limited mastoidectomy.

    Science.gov (United States)

    Nikolopoulos, T P; Gerbesiotis, P

    2009-09-01

    Chronic otitis media with cholesteatoma is considered an "unsafe" ear and generally requires surgical management. This is particularly challenging in children due to anatomical, pathophysiological and social reasons. There are different approaches for this objective. The two main options are the canal wall up and canal wall down mastoidectomy. The aim of this article is to compare the advantages and disadvantages of canal wall up and canal wall down method and present the third way of surgical management: the inside-outside approach through an endaural incision. This technique includes atticotomy, atticoantrostomy or mastoidectomy (mostly very limited) according to the size and location of the cholesteatoma. This technique contributes to the successful surgical management of cholesteatoma, eradicating the disease with the creation of small, dry, self-cleaning cavities and no pinna protrusion. Moreover, there is no need for meatoplasty or obliteration. However, we should never forget that in ear surgery the choice of the operative procedure should take into account the needs of the patient, the extent of the disease, and the surgeon's experience. PMID:19545913

  19. Diffusion Weighted MR Imaging of Primary and Recurrent Middle Ear Cholesteatoma: An Assessment by Readers with Different Expertise

    Directory of Open Access Journals (Sweden)

    A. Elefante

    2015-01-01

    Full Text Available Introduction and Purpose. Diffusion weighted imaging (DWI has been proven to be valuable in the diagnosis of middle ear cholesteatoma. The aims of our study were to evaluate the advantage of multi-shot turbo spin echo (MSh TSE DWI compared to single-shot echo-planar (SSh EPI DWI for the diagnosis of cholesteatoma. Material and Methods. Thirty-two patients with clinical suspicion of unilateral cholesteatoma underwent preoperative MRI (1.5T with SSh EPI and MSh TSE. Images were separately analyzed by 4 readers with different expertise to confirm the presence of cholesteatoma. Sensitivity, specificity, diagnostic accuracy, and positive (PPV and negative predictive values (NPV were assessed for each observer and interrater agreement was assessed using kappa statistics. Diagnosis was obtained at surgery. Results. Overall MSh TSE showed higher diagnostic accuracy and lower negative predictive value (NPV compared to conventional SSh EPI. Interreader agreement between the observers revealed the superiority of MSh TSE compared to SSh EPI. Interrater agreement among all the four observers was higher by using MSh TSE compared to SSh EPI. Conclusion. Our findings suggest that MSh TSE DWI has higher sensitivity for detection of cholesteatoma and lower probability of misdiagnosis. MSh TSE DWI is useful in guiding less experienced observers to the diagnosis.

  20. Diagnostic accuracy of non-echo-planar diffusion-weighted MRI versus other MRI sequences in cholesteatoma

    International Nuclear Information System (INIS)

    Non-echo-planar imaging (EPI) MRI has been recently introduced to improve the detection of small-sized cholesteatoma and decrease different artefacts occurring in the EPI-diffusion-weighted (DW) technique. This technique is also time saving in comparison to delayed post-contrast imaging. We prospectively assessed the diagnostic accuracy of MRI including delayed post-contrast standard MRI, EPI and non-EPI-DW sequences in the detection of middle ear cholesteatoma. We evaluated 35 patients suspected of having cholesteatoma who underwent MRI including delayed post-contrast MRI, EPI and non-EPI-DW sequences prior to their planned surgery, and the MR findings were compared with surgical findings. Two experienced radiologists reported the images. Sensitivity, specificity and predictive values of MRI were estimated. We detected 26 cases of cholesteatoma at surgery. Sensitivity and specificity of delayed post-contrast MRI, EPI DW and non-EPI DW were 73.1 and 77.8%, 61.5 and 88.9%, and 96.2 and 100%, respectively, as interpreted by the first radiologist. Sensitivity and specificity of delayed post-contrast MRI, EPI-DW sequence and non-EPI-DW sequence were 84.6 and 88.9%, 50 and 88.9%, and 92.3 and 100%, respectively, as interpreted by the second radiologist. The non-EPI MRI technique is a more accurate method in detecting middle ear cholesteatoma in comparison to other conventional sequences.

  1. Cholesteatoma in Danish children - A national study of changes in the incidence rate over 34 years

    DEFF Research Database (Denmark)

    Djurhuus, Bjarki Ditlev; Skytthe, Axel; Christensen, Kaare; Faber, Christian Emil

    2015-01-01

    was examined using Poisson regression analysis, while the cumulative incidence proportion was estimated using life-tables. RESULTS: A total of 5850 cases of surgically treated middle ear cholesteatoma distributed among 3874 children aged 0-15 years were identified. From 1977 to 2002 the age...... of 5.4% (95% CI 3.2-7.5%). Age-specific incidence rates were at maximum around the age of 9 years during the whole period. The estimated cumulative incidence proportion at age 16 years based on the 2010 age-specific incidence rates was 0.16% (95% CI 0.09-0.32%) compared with 0.20% (95% CI 0...

  2. FRONTAL SINUS CHOLESTEATOMA: A RARE BUT IMPORTANT CLINICAL ENTITY TO REMEMBER

    Directory of Open Access Journals (Sweden)

    Muhammad Shakeel

    2014-10-01

    Full Text Available We aim to discuss the clinical presentation, investigations and successful management of frontal sinus cholesteatoma. A 26 year old Caucasian female, otherwise fit and healthy, presented with a 4 month history of swollen right eye and sudden visual impairment. The ophthalmological examination revealed right sided proptosis, diplopia and reduced visual acuity. The colour vision was normal and there was no afferent papillary defect. On nasendoscopy, the nasal cavity was unremarkable apart from some fullness at the area of the right uncinate process. Computerized tomography scan identified a space occupying lesion in the right frontal sinus eroding through the orbital roof and displacing the right globe. There was also extensive bony erosion through the posterior table. The patient underwent right sided endoscopic sinus surgery and fronto-ethmoidectomy via an external approach. Intra-operatively, the right frontal sinus was found to be full of keratin. The histological examination showed sheets of keratinous debris. She made a good post-operative recovery and remained disease free at 3 years follow-up. The frontal sinus cholesteatoma is a rare condition but should be included in the differential diagnosis of a slowly expanding lesion occurring in the frontal sinus.

  3. Differential diagnosis between chronic otitis media with and without cholesteatoma by temporal bone CT: focus on bone change and mass effect

    International Nuclear Information System (INIS)

    In order to determine specific differences, we compared the temporal bone CT findings of chronic otitis media (COM) with and without cholesteatoma, focusing on bone change. Between 1997 and 1998, 82 patients (84 cases) underwent temporal bone CT and were shown to have COM, with or without cholesteatoma after mastoidectomy and tympanoplasty. There were 36 cases of COM with cholesteatoma (26 patients, M:F =3D 11:15; age range, 16-61 (mean, 36,2) years), and 58 cases without chlesteatoma (56 patients, M:F =3D 25:31, age range, 15-61 (mean, 36.2) years). The findings of temporal bone CT were analysed at the point of bony changes including erosion and medial displacement of ossicles (malleus, incus, and stapes), erosion or destruction of the scutum, tegmen, facial canal, and lateral semicircular canal, and ballooning of the tympanic cavity and mastoid antrum. In addition, the soft tissue changes seen on temporal bone CT were analyzed at the site of lateral bulging of soft tissue in Prussak's space, perforation of the pars flaccida, tympanic membrane retraction, and tympanosclerosis. We retrospectively compared the findings of temporal bone CT with the surgical findings, and to assess statistical significance, the Chi-square test was used. Bone erosion or destruction was seen in 36.2% of COM cases without cholesteatoma, and in 96.2% of cases with cholesteatoma. Comparing COM with and without cholesteatoma, the erosion of ossicles including the malleus (81%, 24%), incus (88%, 14%), stapes (58%, 10%), scutum (88%, 10%), facial canal (8%, 0%), and lateral semicircular canal (8%, 0%), was more common in COM with cholesteatoma (p-value less than 0.05), with the exception of erosion of the tegmen (8%, 3%). Other bony changes including medial displacement of ossicles (27%, 3%), ballooning of tympanic cavity and mastoid antrum (96%, 16%), and the soft tissue changes including lateral bulging of soft tissue in Prussak's space (58%, 14%) and perforation of the pars flaccida (35

  4. Matriz Metaloproteinase 2: um importante marcador genético para colesteatomas Matrix Metalloproteinase 2: an important genetic marker for cholesteatomas

    Directory of Open Access Journals (Sweden)

    Douglas Salmazo Rocha Morales

    2007-02-01

    Full Text Available Este estudo foi desenvolvido para determinar a presença de MMP2 em colesteatomas humanos e observar se colesteatomas que complicam (invasivos apresentam uma maior expressão imunohistoquímica de Matriz Metaloproteinase 2 (MMP2. Colesteatomas produzem enzimas que causam erosão óssea, como a MMP2. MATERIAL E MÉTODO: Analisamos a expressão imunohistoquímica de MMP2 em colesteatomas invasivos, comparando-os aos latentes. Um estudo de corte transversal com dezenove lâminas e blocos parafinados de colesteatoma, derivados de mastoidectomias, foram desparafinados e submetidos à técnica imunohistoquímica com anticorpos anti-MMP2. RESULTADOS: Os resultados foram expressos em 0 (tênue, + (leve, ++ (moderado e +++ (intenso, de acordo com a intensidade da expressão de MMP2. As expressões 0 e + foram denominadas Fraca e as expressões ++ e +++, Forte. Dos 8 colesteatomas invasivos, 7 apresentaram Forte expressão de MMP2 (87,5%. Com relação aos colesteatomas latentes (11, apenas 3 apresentaram Forte expressão de MMP2 (27,3%, com um teste exato de Fisher significante (p= 0,015. CONCLUSÃO: Colesteatomas expressam MMP2 e colesteatomas invasivos expressam MMP2 com maior intensidade, em relação aos latentes.AIM: This study is to determine the MMP2’s presence in cholesteatomas and whether complicating cholesteatomas show a higher immunohistochemical expression of matrix metalloproteinase 2. Cholesteatoma produces enzymesthat cause bone erosion like Matrixmetalloproteinase 2 (MMP2. MATERIAL AND METHODS: We analyzed the expression of MMP2 in invasive (causing complications compared to latent cholesteatomas (not causing complications. A crosssectional study with nineteen slides and paraffin blocks of cholesteatomas derived from mastoidectomies were located and processed, including 8 invasive and 11 latent cholesteatomas. Immunohistochemical thecnique was empregated to MMP2. RESULTS: The results are expressed as 0, + (to low, ++ and +++(high

  5. TYMPANOPLASTY WITH SEPTAL CARTILAGE AND CORTICAL MASTOID BONE IN CHOLESTEATOMA PATIENTS

    Directory of Open Access Journals (Sweden)

    Biram Singh

    2015-12-01

    Full Text Available OBJECTIVE This study was conducted to find out the ideal graft between septal cartilage and cortical mastoid bone in Farrior’s type 3 tympanoplasty in cholesteatoma patients in terms of hearing improvement, graft status and recurrence rate of the disease after canal wall down mastoidectomy. METHODS This randomized controlled trial was conducted in a tertiary care centre and the procedure and data collections were carried out for one and a half calendar year with effect from September 2007 and each case was followed up for 6 months. The data were entered and calculated statistically using SPSS16 for windows. RESULTS The study shows significant hearing improvement in both the groups. The tympanoplasty type 3 with cortical mastoid bone had air bone gap less than 20dB in 40% of patients. In septal cartilage, tympanoplasty group air bone gap less than 20dB was observed in 36.4%. Retraction of graft developed in 1(2.4% out of 20 patients among cortical mastoid bone tympanoplasty group. Among 22 patients of septal cartilage tympanoplasty type 3, 2(4.8% patients had cartilage resorption and 3(7.1% had graft displacement. Of the total 42 patients, 2(4.8% developed recurrence of the disease. CONCLUSION Cholesteatoma management is controversial. Canal wall down mastoidectomy can reduce the recurrence of disease. The cortical mastoid bone and septal cartilage grafts can provide hearing improvement after tympanoplasty type 3. There is no significant difference in hearing improvement between the two grafts.

  6. Intercellular Communication between Keratinocytes and Fibroblasts Induces Local Osteoclast Differentiation: a Mechanism Underlying Cholesteatoma-Induced Bone Destruction.

    Science.gov (United States)

    Iwamoto, Yoriko; Nishikawa, Keizo; Imai, Ryusuke; Furuya, Masayuki; Uenaka, Maki; Ohta, Yumi; Morihana, Tetsuo; Itoi-Ochi, Saori; Penninger, Josef M; Katayama, Ichiro; Inohara, Hidenori; Ishii, Masaru

    2016-06-01

    Bone homeostasis is maintained by a balance in activity between bone-resorbing osteoclasts and bone-forming osteoblasts. Shifting the balance toward bone resorption causes osteolytic bone diseases such as rheumatoid arthritis and periodontitis. Osteoclast differentiation is regulated by receptor activator of nuclear factor κB ligand (RANKL), which, under some pathological conditions, is produced by T and B lymphocytes and synoviocytes. However, the mechanism underlying bone destruction in other diseases is little understood. Bone destruction caused by cholesteatoma, an epidermal cyst in the middle ear resulting from hyperproliferation of keratinizing squamous epithelium, can lead to lethal complications. In this study, we succeeded in generating a model for cholesteatoma, epidermal cyst-like tissue, which has the potential for inducing osteoclastogenesis in mice. Furthermore, an in vitro coculture system composed of keratinocytes, fibroblasts, and osteoclast precursors was used to demonstrate that keratinocytes stimulate osteoclast differentiation through the induction of RANKL in fibroblasts. Thus, this study demonstrates that intercellular communication between keratinocytes and fibroblasts is involved in the differentiation and function of osteoclasts, which may provide the molecular basis of a new therapeutic strategy for cholesteatoma-induced bone destruction. PMID:27001307

  7. Cholesteatoma: computed tomography and radiography in a dog; Colesteatoma: tomografia computadorizada e radiografia em cao com otite cronica

    Energy Technology Data Exchange (ETDEWEB)

    Belotta, Alexandra Frey; Babicsak, Viviam Rocco; Mamprim, Maria Jaqueline; Vulcano, Luiz Carlos, E-mail: a_fbelotta@yahoo.com.br [Universidade Estadual Paulista Julio de Mesquita Filho (FMVZ/UNESP), Botucatu, SP (Brazil). Faculdade de Medicina Veterinaria e Zootecnia . Dept. de Reproducao Animal e Radiologia Veterinaria; Arruda, Vanesa Kutz de; Amorim, Rogerio Martins [Universidade Estadual Paulista Julio de Mesquita Filho (FMVZ/UNESP), Botucatu, SP (Brazil). Faculdade de Medicina Veterinaria e Zootecnia. Dept. de Clinica Veterinaria

    2012-07-01

    Cholesteatoma, a rare and/or misdiagnosed disease, results of a serious complication in dogs with chronic otitis. This article describes a case of a dachshund sent to the veterinary hospital presenting signs of cognitive dysfunction associated to peripheral neuropathy of the facial nerve on the right side. At radiography, an enlargement and thickness of the contours associated with loss of anatomical definition of the right tympanic bulla compared to the left was seen. At tomography, this enlargement and thickness were seen with better definition, besides the fulfilling by hyperdense calcified content, bullae osteolysis and temporal bone sclerosis at the same side. (author)

  8. Non-echoplanar diffusion-weighted MRI in children and adolescents with cholesteatoma: reliability and pitfalls in comparison to middle ear surgery

    International Nuclear Information System (INIS)

    Currently, there is only limited and contradictory evidence of the role of diffusion-weighted MRI (DW-MRI) in the management of children with cholesteatoma. To provide surgically controlled data that may allow to replace second-look surgery by non-echoplanar DW-MRI in children. Fifty-five children and adolescents with a median age of 8.6 years (2.2-17.7 years) underwent 61 preoperative half-Fourier acquisition single-shot turbo spin-echo (HASTE) DW-MRI of their petrous bone. Surgical interventions followed within 24 h (79%), within 5 months (20%) or at 18 months (1 case). Surgery detected a cholesteatoma or retraction pocket in 41 of 61 cases (67%). In 49 cases (80%), the MR result was confirmed by surgical findings. Two MR findings were false-positive and 10 false-negative (including cholesteatomas <4 mm). HASTE DW-MRI alone had a sensitivity of 76% and a specificity of 90%. The positive predictive value was 94%, the negative predictive value 64%. In combination with preoperative otoscopy, sensitivity was 90% and negative predictive value 82%. DW-MRI correctly detected the majority of lesions but could not reliably exclude small cholesteatomas and empty retraction pockets. We would therefore not generally recommend MR as a substitute for second-look surgery. (orig.)

  9. Non-echoplanar diffusion-weighted MRI in children and adolescents with cholesteatoma: reliability and pitfalls in comparison to middle ear surgery

    Energy Technology Data Exchange (ETDEWEB)

    Kalle, Thekla von [Olgahospital Klinikum Stuttgart, Pediatric Radiology, Radiologisches Institut, Stuttgart (Germany); Amrhein, Peter; Koitschev, Assen [Olgahospital Klinikum Stuttgart, Division of Pediatric Otorhinolaryngology and Otology, Department of Otorhinolaryngology, Stuttgart (Germany)

    2015-07-15

    Currently, there is only limited and contradictory evidence of the role of diffusion-weighted MRI (DW-MRI) in the management of children with cholesteatoma. To provide surgically controlled data that may allow to replace second-look surgery by non-echoplanar DW-MRI in children. Fifty-five children and adolescents with a median age of 8.6 years (2.2-17.7 years) underwent 61 preoperative half-Fourier acquisition single-shot turbo spin-echo (HASTE) DW-MRI of their petrous bone. Surgical interventions followed within 24 h (79%), within 5 months (20%) or at 18 months (1 case). Surgery detected a cholesteatoma or retraction pocket in 41 of 61 cases (67%). In 49 cases (80%), the MR result was confirmed by surgical findings. Two MR findings were false-positive and 10 false-negative (including cholesteatomas <4 mm). HASTE DW-MRI alone had a sensitivity of 76% and a specificity of 90%. The positive predictive value was 94%, the negative predictive value 64%. In combination with preoperative otoscopy, sensitivity was 90% and negative predictive value 82%. DW-MRI correctly detected the majority of lesions but could not reliably exclude small cholesteatomas and empty retraction pockets. We would therefore not generally recommend MR as a substitute for second-look surgery. (orig.)

  10. CT of petrou bone. Utility to cholesteatoma location. Study of 28 cases. TC de peasco. Utilidad para la localizacion preoperativa del colesteatoma. Estudio de 28 casos

    Energy Technology Data Exchange (ETDEWEB)

    Ferrer, M.D.; Espinos, M.A.; Molina, A.; Martinez-Rodrigo, J.; Galant, J. (Hospital Dr. Peset. Servicio de Diagnostico por la imagen. Valencia (Spain))

    1993-01-01

    Twenty-eight patients with cholesteatoma were studied preoperatively by means of CT petrous bone to determine the localization and extension of their lesion. All the patients underwent survey and the intraoperative findings were compared with those resulting from CT. The reading was carried out with no knowledge of the intraoperative data. The following results were obtained: localization of cholesteatoma in attic, antrum and posterior tympanic cavity had a sensitivity of 0.91 and a specificity of 0.57, with a Fisher's p value less than 0.0005. When the erosion produced by the cholesteatoma was studied in the different structures, the accuracy was greatest with the stape, the septum and prussak's space; the highest number of false negatives corresponded to the tympanic membrane. The false positives were produced in the assessment of the facial canal, tegmen tympani and the labyrinthine fistula. The reliability of CT was very high for the diagnosis of ossicular destruction and displacement of the small bones, as well as for the state of the mastoid cells and congenital variations. In conclusion, we point out the importance of performing a CT study prior to surgery for cholesteatoma due to its elevated sensitivity in locating the lesion, and we stress the value of the knowledge of the erosion of the different structures since it constitutes a guide for intraoperative exploration and assessment. (Author)

  11. Cholesteatoma of the external ear canal: etiological factors, symptoms and clinical findings in a series of 48 cases

    DEFF Research Database (Denmark)

    Gaihede, Michael Lyhne

    2006-01-01

    ABSTRACT: BACKGROUND: To evaluate symptoms, clinical findings, and etiological factors in external ear canal cholesteatoma (EECC). METHOD: Retrospective evaluation of clinical records of all consecutive patients with EECC in the period 1979 to 2005 in a tertiary referral centre. Main outcome...... measures were incidence rates, classification according to causes, symptoms, extensions in the ear canal including adjacent structures, and possible etiological factors. RESULTS: Forty-five patients were identified with 48 EECC. Overall incidence rate was 0.30 cases per year per 100,000 inhabitants. Twenty......-five cases were primary, while 23 cases were secondary: postoperative (n = 9), postinflammatory (n = 5), postirradiatory (n = 7), and posttraumatic (n = 2). Primary EECC showed a right/left ratio of 12/13 and presented with otalgia (n = 15), itching (n = 5), occlusion (n = 4), hearing loss (n = 3), fullness...

  12. Ten-year results of cartilage palisades versus fascia in eardrum reconstruction after surgery for sinus or tensa retraction cholesteatoma in children

    DEFF Research Database (Denmark)

    Cayé-Thomasen, Per; Andersen, Janne; Uzun, Cem;

    2009-01-01

    threshold, and pure tone air-bone gap). RESULTS: All but two patients in both groups attended the 10-year follow-up examination (94% attendance). The mean overall follow-up period was 119 months (115 months in the palisade and 125 months in the fascia group). Total number of retractions during follow-up and....... METHODS: A total of 64 children underwent surgery for either sinus or tensa retraction cholesteatoma during the period 1995 to 2000 (mean age 9 years, range 5-15). The eardrum was reconstructed using cartilage palisades in 32 children (32 ears) and fascia or perichondrium in 32 children (33 ears). The...... patients were followed for at least one year postoperatively and re-evaluated 4 years after surgery, and again recently at a mean of 10 years. The main outcome measures were postoperative drum retraction and perforation, cholesteatoma recurrence, and hearing acuity (pure tone average, speech reception...

  13. Toll-like receptors 2, 3 and 4 (TLR-2, TLR-3 and TLR-4) are expressed in the microenvironment of human acquired cholesteatoma.

    Science.gov (United States)

    Szczepański, Mirosław; Szyfter, Witold; Jenek, Renata; Wróbel, Maciej; Lisewska, Iwona Mozer; Zeromski, Jan

    2006-07-01

    Human toll-like receptors (TLR 1-10) are crucial in the induction and activation of innate immunity in the course of an infection. They are expressed mainly on the cells of the immune system, and also on some epithelia and endothelia. Their ligands so called pathogen associated molecular patterns are abundant on invading microbes. TLR-ligand binding results in cell signal transduction and subsequent production of various proinflammatory cytokines such as IL-1 and TNF-alpha. Acquired cholesteatoma is formed during chronic otitis media in the proportion of cases. It has adverse effects on ear structures, resulting in osteolysis and bone resorption. Its formation and pathogenesis are not fully understood. The current study attempted to search the possible role of TLRs in this somewhat awkward pathological condition. Surgical specimens of human acquired cholesteatoma (n=15) and normal external auditory canal skin (n=5, control tissues) were tested by immunohistochemistry for the presence of TLRs. Three TLRs were examined: TLR-2, TLR-3 and TLR-4. All TLRs tested were demonstrated in matrix (layer of keratinizing epithelium) and perimatrix (granulation tissue) of this inflammatory tumour. Expression of particular TLRs within the keratinizing epithelium was distinct and uneven. In the perimatrix, numerous T (CD3+) cells were seen and relatively few macrophages (CD11c+, HLA-DR+). There was a weak expression of all TLRs on normal (non-inflammatory) skin. Expression of TLR-3 both on the epithelium and some cells within the perimatrix and the presence of T cells may suggest that apart from innate immune responses, mechanisms of adaptive immunity also operate in cholesteatoma. Weak expression of these receptors on normal skin may also suggest the important role of TLRs in the etiopathogenesis of cholesteatoma. PMID:16538507

  14. Algumas considerações sobre colesteatomas adquiridos pediátricos e adultos Some considerations about acquired adult and pediatric cholesteatomas

    Directory of Open Access Journals (Sweden)

    Cristina Dornelles

    2005-08-01

    Full Text Available Neste artigo, os autores dissertam sobre o tema colesteatoma, desde a primeira vez em que foi utilizada a palavra por Mueller (1838, até informações atuais. Fazem uma abordagem de sua definição, passam pela etiopatogênese e apresentam noções básicas sobre sua biologia. Ainda realizam uma ampla revisão sobre colesteatoma pediátrico, apresentam dados clínicos epidemiológicos e biológicos e mostram um paralelo com o colesteatoma em adultos. Para finalizar, descrevem alguns trabalhos sobre erosão da cadeia ossicular correlacionando-a com dados sobre a perimatriz, colágeno e colagenase.Authors debate about cholesteatomas, from the first time this word was employed, by Muller, in 1838, until the recent updates. They dissert about its definition, etiology and pathology and present basic concepts about its biology. They also make a wide review about pediatric cholesteathoma, its epidemiology and biology, and compare it with adult cholesteatoma. Finally, they describe some articles about ossicle chain erosion and its correlation with cholesteatoma perimatrix, collagen and collagenase.

  15. Estudo comparativo de aspectos histológicos e imunohistoquímicos entre o colesteatoma espontâneo do meato acústico externo e o colesteatoma adquirido da orelha média Comparative study of the histological and immunohisochemical aspects of the spontaneous cholesteatomas of the external ear canal and the acquired cholesteatoma of the middle ear

    Directory of Open Access Journals (Sweden)

    Fernando de Andrade Quintanilha Ribeiro

    2004-10-01

    Full Text Available OBJETIVO: Neste trabalho foram avaliadas as características histológicas e imunohistoquímicas (Ki-67 e CK-16 do colesteatoma espontâneo do meato acústico externo comparando-as com as do colesteatoma adquirido da orelha média. FORMA DE ESTUDO: Caso controle. MATERIAL E MÉTODO: Fragmentos de colesteatoma do meato acústico externo foram submetidos a estudo histológico e imunohistoquímico com o intuito de verificar a expressão da CK16 e do antígeno nuclear Ki-67 nas células de sua matriz, e os resultados foram comparados com os encontrados no colesteatoma adquirido da orelha média. RESULTADOS: Os aspectos histológico e imunohistoquímico quanto à presença da CK16 e do antígeno nuclear Ki-67 na matriz do colesteatoma do meato acústico externo foram idênticos àqueles encontrados no colesteatoma adquirido da orelha média. DISCUSSÃO: Acreditamos que a ocorrência do colesteatoma do meato acústico externo seja devido ao comportamento anormal de células com potencial hiperproliferativo no epitélio do meato. Este potencial estaria relacionado com a presença da CK16 em uma região onde estes marcadores não são usualmente encontrados. Esta característica hiperproliferativa do colesteatoma do meato fica patente pela presença do antígeno nuclear Ki-67 nas células suprabasais de sua epiderme. Possivelmente esta doença deve ser desencadeada pela interação desta citoqueratina (CK16 com citocinas presentes no tecido conjuntivo subepitelial inflamado, como a TGF-µ. CONCLUSÃO: As características histológicas (presença de cones epiteliais e histoquímicas (expressão da CK16 e do antígeno nuclear KI-67 são idênticas no colesteatoma adquirido da orelha média e no colesteatoma espontâneo do meato acústico externo.AIM: A comparative analysis between the histological and the immuno histochemical (Ki-67 and CK-16 characteristics of spontaneous cholesteatomas of the external ear canal and acquired cholesteatomas of the middle

  16. The impact of ventilation tubes in otitis media on the risk of cholesteatoma on a national level

    DEFF Research Database (Denmark)

    Djurhuus, Bjarki Ditlev; Christensen, Kaare; Skytthe, Axel; Faber, Christian Emil

    2015-01-01

    OBJECTIVE: To estimate the impact of treatment with middle ear ventilation tube insertion (VTI) in children with otitis media (OM) on the risk of cholesteatoma on a national level. METHODS: Data were obtained from the Danish National Patient Register, the National Health Service Register and...... with STMEC1 at 12 years of age for children with 0, 1, 2, 3, and ≥4 VTI's was 0.04% (95% confidence interval 0.02-0.12%), 0.21% (0.18-0.26%), 0.35% (0.28-0.43%), 0.40% (0.30-0.54%), and 0.55% (0.44-0.70%), respectively. In the regression model each additional year of age before the first VTI increased...... underlying indication for VTI. In short the present study suggests that treatment with VTI in children with OM reduces the risk of STMEC1 on a population level. However, for the individual child the absolute risk reduction is very small, and the decision of treatment with VTI must always rely on the symptoms...

  17. TNF-R2 expression in acquired middle ear cholesteatoma Expressão do TNF-R2 no colesteatoma adquirido da orelha média

    Directory of Open Access Journals (Sweden)

    Rodrigo Faller Vitale

    2011-08-01

    Full Text Available Acquired middle ear cholesteatoma is a disease which promotes bone erosion resulting in potentially serious complications. The tumor necrosis factor alpha (TNF-α is present in cholesteatoma and it is related to bone erosion, as shown by different authors. To understand the aggressiveness characteristics of cholesteatoma is necessary, however, to better address the presence and distribution of their receptors. OBJECTIVE: To evaluate the expression of type 2 TNF-α receptor (TNF-R2 in fragments of cholesteatoma and correlate it to the degree of inflammation present. MATERIAL AND METHODS: observational cross-sectional study, which analyzed 33 fragments of cholesteatomas through histological analysis and immunohistochemistry (using as primary antibody to TNF-R2 LabVision® brand. The evaluation was performed by means of a qualitative and semi-quantitative agreement with the observed intensity. For statistical analysis we used the Fisher exact test and Spearman´s correlation coefficient (considered statistically significant when p O colesteatoma adquirido da orelha média promove erosão óssea, ocasionando complicações potencialmente graves. O fator de necrose tumoral alfa (TNF-α está presente no colesteatoma adquirido da orelha média e relaciona-se com a erosão óssea, como demonstraram diferentes autores. Para que se compreenda as características de agressividade do colesteatoma, é necessário que se estude a presença e a distribuição seus receptores. OBJETIVO: Avaliar a expressão do receptor tipo dois do TNF-α (TNF-R2 em fragmentos de colesteatoma e relacioná-lo com o grau de inflamação. MATERIAL E MÉTODOS: Estudo observacional do tipo transversal. Foram analisados 33 fragmentos de colesteatomas, submetidos à análise histológica e imunoistoquímica (utilizando o TNF-R2 da marca Labvision®. A avaliação foi realizada de forma qualitativa e semiquantitativa, de acordo com a intensidade observada. Para a análise estat

  18. O papel das citocinas no colesteatoma adquirido da orelha média: revisão da literatura The role of cytokines in acquired middle ear cholesteatoma: literature review

    Directory of Open Access Journals (Sweden)

    Adriana Leal Alves

    2004-12-01

    Full Text Available Este estudo visa a analisar de modo crítico a literatura pertinente a respeito do papel das citocinas no colesteatoma adquirido. O colesteatoma da orelha média é caracterizado pela presença de epitélio escamoso estratificado queratinizado neste local, com alto poder invasivo, causando destruição óssea e podendo levar a complicações. As citocinas são glicoproteínas de baixo peso molecular que atuam na intercomunicação celular. São importantes na estimulação e supressão dos eventos da resposta imune, desencadeando e coordenando a resposta inflamatória, assim como os processos de cicatrização e remodelação tecidual. No colesteatoma já foram observadas as seguintes citocinas e fatores de crescimento: IL-1, IL-6, IL-8, TNF-±, TGF- ±,TGF-², EGF e KGF. Ocorre um sinergismo entre as diferentes citocinas para resultar nas características agressivas do colesteatoma.The present study conducted a critical analysis of the literature regarding the role of cytokines in acquired cholesteatomas. Middle ear cholesteatomas are characterized by the presence of stratified squamous epithelium in this cavity revealing highly invasive properties evolving bone destruction and subsequent complications. Cytokines are low molecular weight-glycoproteins able to act in cellular intercommunication. They are important to stimulation and suppression of immune response-related events, triggering and coordinating inflammatory response, as well as wound healing and tissue remodeling. In cholesteatoma, reported cytokines and growth factors were as follows: IL-1, IL-6, IL-8, TNF-a, TGF-alpha, TGF-beta, EGF and KGF. A synergism among different cytokines should occur to generate the aggressive characteristics of cholesteatoma.

  19. Correlação da cadeia ossicular no transoperatório com achados histológicos de colesteatomas Hystology findings' correlation between the ossicular chain in the transoperative and cholesteatomas

    Directory of Open Access Journals (Sweden)

    Cristina Dornelles

    2007-12-01

    Full Text Available A Otite Média Crônica é definida pela presença de alterações teciduais inflamatórias irreversíveis na fenda auditiva. As lesões ossiculares são as mais prevalentes. OBJETIVO: Correlacionar o grau de comprometimento da cadeia ossicular, visualizada no transoperatório, com o grau histológico de inflamação e com a espessura da perimatriz de colesteatomas. TIPO DE ESTUDO: Estudo transversal. MÉTODOS: Descrições cirúrgicas de 71 pacientes foram revisadas. Colesteatomas coletados e fixados em formol 10% e preparadas uma lâmina em Hematoxilina-Eosina e outra em Picrossírios. A leitura foi "cega", através de imagens digitais, no ImageProPlus. A análise estatística foi realizada através do coeficiente de Spearman, sendo considerados como estatisticamente significativos os valores de PChronic otitis media is hystopathologycaly defined as the presence of irreversible inflammatory tissue changes in the middle ear. Ossicular lesions represent the most prevalent change. AIM: to correlate the degree of ossicular chain changes seen during surgery with the inflammatory histological degree and the thickness of the cholesteatoma perimatrix. STUDY DESGN: Cross-sectional study. METHODS: Seventy-one descriptions of surgeries done in patients submitted to tympanomastoydectomy were reviewed. Cholesteatoma were collected and fixed in 10% formaldehyde. Two slides were made for each cholesteatoma, one stained with HE and another with picrossirius. Images were obtained from light microscopy and digitally processed and "blindly" analyzed using Image Pro-Plus Software. For statistical analysis we used Spearman's coefficient. Differences were considered statistically significant if P≤0.05. RESULTS: the ossicular chain was involved in 65 cases. The incus was the most frequently affected bone, followed by the stapes and the malleus. When the Spearman's coefficient was employed considering ossicular chain change degree with patient's age by the time of

  20. Efeito do ácido trans-retinóico na inibição de colesteatoma em cobaias Effect of trans-retinoic acid in the inhibition of cholesteatoma in guinea pigs

    Directory of Open Access Journals (Sweden)

    Marcos Luiz Antunes

    2008-02-01

    Full Text Available O colesteatoma de orelha média atingia mais de 5 milhões de pessoas até a década de 80. Vários modelos animais já foram utilizados para alternativas de tratamento do colesteatoma sem sucesso. OBJETIVO: Estudar os efeitos do ácido trans-retinóico, uso tópico na orelha externa em cobaias, na inibição da formação do colesteatoma de orelha média induzido pelo propilenoglicol. Estudo experimental prospectivo. MATERIAL E MÉTODOS: 25 cobaias foram submetidas à aplicação de propilenoglicol a 100% na bula timpânica bilateralmente e uma solução de ácido trans-retinóico foi aplicada topicamente (total de 5 aplicações na orelha externa, região justa-timpânica, na orelha direita, enquanto na orelha esquerda aplicou-se solução fisiológica (orelha controle. As cobaias foram sacrificadas após 6 semanas do procedimento inicial e os ossos temporais foram separados, fixados e descalcificados, para análise macroscópica e histológica. RESULTADOS: Os achados macroscópicos evidenciaram a presença e suspeita de colesteatoma em 25% das orelhas direitas e 85% das orelhas esquerdas (P=0,0003*. Os achados histológicos dos 40 ossos temporais evidenciaram a presença de colesteatoma em 30% das orelhas direitas e 75% das orelhas esquerdas (P=0,0104*. CONCLUSÃO: O uso tópico do ácido trans-retinóico é efetivo na inibição da formação de colesteatoma induzido pelo propilenoglicol em cobaias.Middle ear cholesteatoma affected more than 5 million people until the 80`s. Many animal models were used, unsuccessfully, to study an alternative therapy to cholesteatoma. AIM: observe the effect of the trans-retinoic acid in the inhibition of middle ear cholesteatomas induced by propylene glycol. STUDY DESIGN: Clinical and Experimental. METHODS: 25 guinea pigs were submitted to the application of a 100% propylene glycol solution in their bulla bilaterally and a solution of trans-retinoic acid was applied locally in the external right ear, while

  1. The role of high-resolution computed tomography (HRCT) and magnetic resonance imaging (MRI) in the diagnosis of preoperative and postoperative complications caused by acquired cholesteatomas; CT und MRT des erworbenen Cholesteatoms: Prae- und postoperative Bildgebung

    Energy Technology Data Exchange (ETDEWEB)

    Krestan, C.; Czerny, C. [Abteilung fuer Osteologie, Univ.-Klinik fuer Radiodiagnostik, Wien (Austria); Gstoettner, W. [Univ.-Klinik fuer Hals-Nasen-Ohren-Heilkunde, Frankfurt (Germany); Franz, P. [Univ.-Klinik fuer Hals-Nasen-Ohren-Heilkunde, Wien (Austria)

    2003-03-01

    The role of high-resolution computed tomography (HRCT) and magnetic resonance imaging (MRI) in the diagnosis of preoperative and postoperative complications caused by acquired cholesteatomas will be described in this paper. The pre- and postoperative imaging of the temporal bone was performed with HRCT and MRI. HRCT and MRI were performed in the axial and coronal plane. MRI was done with T2 weighted and T1 weighted sequences both before and after the intravenous application of contrast material. All imaging findings were confirmed clinically or surgically. The preoperative cholesteatoma-caused complications depicted by HRCT included bony erosions of the ossicles, scutum, facial canal in the middle ear, tympanic walls including the tegmen tympani, and of the labyrinth. The preoperative cholesteatoma-caused complications depicted by MRI included signs indicative for labyrinthitis, and brain abscess. Postoperative HRCT depicted bony erosions caused by recurrent cholesteatoma, bony defects of the facial nerve and of the labyrinth, and a defect of the tegmen tympani with a soft tissue mass in the middle ear. Postoperative MRI delineated neuritis of the facial nerve, labyrinthitis, and a meningo-encephalocele protruding into the middle ear. HRCT and MRI are excellent imaging tools to depict either bony or soft tissue complications or both if caused by acquired cholesteatomas. According to our findings and to the literature HRCT and MRI are complementary imaging methods to depict pre- or postoperative complications of acquired cholesteatomas if these are suspected by clinical examination. (orig.) [German] In dieser Arbeit wird die Rolle der hochaufloesenden Computertomographie (HRCT) und der Magnetresonanztomographie (MRT) zur Abklaerung prae- und postoperativ bedingter Komplikationen erworbener Cholesteatome beschrieben. Die Bildgebung wurde sowohl mit der HRCT als auch mit der MRT durchgefuehrt. Die HRCT und die MRT wurden in axialer und koronaler Ebene (auch

  2. [5 cases of epidermoid cyst (or primary cholesteatoma) of the petrous pyramid. Clinical, radiologic, pathogenic and therapeutic aspects. Value of nuclear magnetic resonance in the diagnosis and postoperative monitoring].

    Science.gov (United States)

    Tran Ba Huy, P; Lévy, C; Bensimon, J L; Cophignon, J

    1986-01-01

    Five cases of epidermoid cyst (or primary cholesteatoma) of petrous bone are described and the criteria necessary to consider these tumors as truly primary outlined. The most plausible theories appear to be either congenital: embryonic inclusions or, to a lesser degree, acquired: papillary proliferation. Emphasis is placed on facial signs, even minimal, associated with progressive perception or mixed unilateral deafness. Advantages and indications for different surgical approaches are discussed and the value of NMR imaging emphasized, both for diagnosis and postoperative follow up review, especially when a closed technique had been selected. PMID:3789583

  3. Análise dos padrões histopatológicos do colesteatoma adquirido da orelha média Analysis of histopathological aspects in acquired middle ear cholesteatoma

    Directory of Open Access Journals (Sweden)

    Adriana Leal Alves

    2008-12-01

    Full Text Available O colesteatoma da orelha média é caracterizado pela presença de epitélio estratificado pavimentoso queratinizado neste local, com alto poder invasivo, causando destruição óssea e podendo levar a complicações. OBJETIVO: Estudar os padrões histopatológicos no colesteatoma adquirido da orelha média. Correlacionar esses dados com a idade do paciente. FORMA DE ESTUDO: Clínico e experimental do tipo transversal. MATERIAL E MÉTODO: Foram colhidas amostras de colesteatoma de 50 pacientes submetidos à cirurgia otológica, sendo 34 adultos e 16 crianças, no período de 2006 a 2007. Essas amostras foram submetidas à análise histológica. RESULTADOS: A presença de atrofia foi encontrada em 78% dos casos, acantose em 88%, hiperplasia da camada basal em 88% e cones epiteliais em 62%. As correlações entre acantose e hiperplasia da camada basal, acantose e formação de cones epiteliais, hiperplasia da camada basal foram positivas e significativas. Não houve diferença estatisticamente significativa em relação aos padrões histopatológicos entre os dois grupos etários (p>0,05. CONCLUSÃO: O colesteatoma tem características hiperproliferativas, com acantose, hiperplasia da camada basal e presença de cones epiteliais na sua matriz.Middle ear cholesteatomas are characterized by the presence of stratified squamous epithelium in this cavity with highly invasive properties causing bone destruction and it may lead to complications. AIM: To study the histopathological features in acquired cholesteatomas of the middle ear, correlating this data with patient age. Study design:clinical and experimental cross-sectional study. MATERIAL AND METHODS: Samples were obtained from 50 patients submitted to otologic surgery for the removal of middle ear cholesteatomas from 2006 to 2007. Thirty four patients were adults and 16 were children. Samples were studied by histological analysis. RESULTS: we found the presence of epithelial atrophy (78

  4. High-resolution three-dimensional diffusion-weighted imaging of middle ear cholesteatoma at 3.0 T MRI: Usefulness of 3D turbo field-echo with diffusion-sensitized driven-equilibrium preparation (TFE–DSDE) compared to single-shot echo-planar imaging

    International Nuclear Information System (INIS)

    Objective: To prospectively evaluate the usefulness of a newly developed high-resolution three-dimensional diffusion-weighted imaging method, turbo field-echo with diffusion-sensitized driven-equilibrium (TFE–DSDE) in diagnosing middle-ear cholesteatoma by comparing it to conventional single-shot echo-planar diffusion-weighted imaging (SS-EP DWI). Materials and methods: Institutional review board approval and informed consent from all participants were obtained. We studied 30 patients with preoperatively suspected acquired cholesteatoma. Each patient underwent an MR examination including both SS-EP DWI and DSDE-TFE using a 3.0 T MR scanner. Images of the 30 patients (60 temporal bones including 30 with and 30 without cholesteatoma) were reviewed by two independent neuroradiologists. The confidence level for the presence of cholesteatoma was graded on a scale of 0–2 (0 = definite absence, 1 = equivocal, 2 = definite presence). Interobserver agreement as well as sensitivity, specificity, and accuracy for detection were assessed for the two reviewers. Results: Excellent interobserver agreement was shown for TFE–DSDE (κ = 0.821) whereas fair agreement was obtained for SS-EP DWI (κ = 0.416). TFE–DSDE was associated with significantly higher sensitivity (83.3%) and accuracy (90.0%) compared to SS-EP DWI (sensitivity = 35.0%, accuracy = 66.7%; p < 0.05). No significant difference was found in specificity (96.7% for TFE–DSDE, 98.3% for SS-EP DWI) Conclusion: With increased spatial resolution and reduced susceptibility artifacts, TFE–DSDE improves the accuracy in diagnosing acquired middle ear cholesteatomas compared to SS-EP DWI

  5. CT Diagnosis of Chronic Otitis Media with Cholesteatoma%胆脂瘤型慢性中耳炎的CT诊断

    Institute of Scientific and Technical Information of China (English)

    余红胜; 吉六舟

    2011-01-01

    目的:探讨胆脂瘤型慢性中耳炎(CMC)的CT影像表现特征,以提高对该病的诊断及鉴别诊断水平.方法:收集医院经手术病理证实的CMC病例34例,所有病例术前均行HRCT扫描,阅片时重点观察瘤体软组织形态及分布、邻近骨质改变等.结果:34例患者中,单侧31例,双侧3例,合计37耳;上鼓室28耳,中鼓室2耳,鼓窦及入口7耳,表现为软组织团块状影.骨质改变:鼓室盾板破坏27耳,合并上鼓室外侧壁破坏扩大14耳;听小骨移位31耳,伴有骨质破坏23耳;岩鳞板破坏5耳,乳突多呈硬化型及板障型.结论:鼓室、乳突窦及入口软组织影(占位征)、邻近骨质破坏是诊断中耳胆脂瘤的主要影像学依据.%Objective To explore the CT performance characteristics of chronic otitis media with cholestealoma(CMC) to raise the level of diagnosis and differential diagnosis. Methods 34 CMC cases proven by pathological examination underwent pre-operative HRCT scanning, and the soft tissue morphology, distribution and ambient bone change of the tumor body were paid attention to. Results Of the 34 cases, 31 ones had unilateral CMC, and the remained 3 ones had bilateral CMC. Of the 37 nodular shadows, there were 28 ones at the upper tympanum, 2 ones at the mesotympanum, and the remained 7 ones at the tympanic anlmm and aditus ad antrum. There were 27 ones of tympanic scute destruction, of which, 14 ones were accompanied by lateral wall destruction of the tympanum. 31 ones suffered from auditory ossicles transport, with 23 ones of bone destruction. There were 5 ones of petrosquamous lamina destruction. Conclusion The soft tissue shadows at the tympanum, mastoid sinuses and aditus ad antrum as well as ambient bone destruction can be the imaging diagnosis bases for the cholesteatoma.

  6. 胆脂瘤型中耳炎合并胆固醇肉芽肿的诊断和外科治疗%Diagnosis and surgical treatment on cholesteatoma otitis media coexisted with cholesterol granuloma

    Institute of Scientific and Technical Information of China (English)

    吕萍; 冯勃

    2012-01-01

    Objective To study the pathogenesis, clinical manifestations, diagnosis and treatment of cholesteatoma otitis media accompanying cholesterol granuloma and their relations. Methods Clinical data about 12 patients (12 ears) with cholesteatoma otitis media accompanying cholesterol granuloma diagnosed by surgery and pathology were retrospectively analyzed, including their clinical manifestations, CT scan of temporal bone, operation and follow-up. Results Of the 12 patients with recurrent otorpyorrhea, 4 had jam-like secretion, 3 had sanguine secretion, 1 had bloody secretion, and 4 had purulent secretion. Hearing disability was manifested as mild-severe conductive hearing loss or mixed deafness. Mastoid CT scanning showed destruction of bone and bone resorption, which underwent mastoidectomy or modified radical mastoidectomy plus hearing reconstruction. The patients were followed up for 1-2 years, during which no recurrence was observed. Conclusion Jam-like or bloody otopyorrhea is one of the key characteristics of cholesteatoma otitis media accompanying cholesterol granuloma and surgery is the chief choice of its treatment. Hearing is reconstructed depending on the condition of patients.%目的 探讨胆脂瘤型中耳炎合并胆固醇肉芽肿的病因、临床表现、诊治方法及二者的关系.方法 回顾性分析12 例(12耳) 经手术和病理诊断为胆脂瘤型中耳炎合并胆固醇肉芽肿患者的临床表现、颞骨CT 扫描、手术及随访资料.结果 12 例均有反复耳流脓,其中果酱样分泌物4 耳,脓血性分泌物3 耳,血性分泌物1 耳,脓性分泌物4 耳.听力损失为轻到重度传导性或混合性耳聋,乳突CT 扫描均有骨质破坏吸收,分别采用乳突根治术或改良乳突根治+ 听力重建术治疗,术后随访1-2 年无复发.结论 果酱样或脓血性耳溢液是胆脂瘤型中耳炎合并胆固醇肉芽肿的主要临床特征之一,治疗以手术为主,根据病变情况行听力重建.

  7. 中耳胆脂瘤听骨链破坏与传导性听力损失的关系%The relationship between ossicular status and conductive hearing loss in cholesteatoma

    Institute of Scientific and Technical Information of China (English)

    叶放蕾; 赵堃; 陈蓓; 高佩; 王晓东

    2013-01-01

    Objective:To investigate and analyze the characteristic of destructive ossicular chain and it's impact on air-bone gap(ABG) among patients with cholesteatoma.Method:Data from 204 cases(213 ears) undergoing an initial surgery for cholesteatoma were retrospectively reviewed to evaluate the relationships between preoperative pure tone audiometry data and intraoperative assessment of individual ossicular destruction.Result:Incus was the most significantly affected ossicle.Furthermore,the destruction of malleus and stapes was often accompanied by the destruction of incus.A partially eroded incus caused significantly increase in ABG from that of an intact incus with cholesteatom aabutting(P<0.05).A partially eroded incus and a partially eroded stapes caused significantly increase in ABG compared to a partially eroded incus(P<0.05).A completely eroded incus caused significantly increase in ABG compared to a partially eroded incus(P<0.05).False fibre-connected would significantly influence on ABG in some ossicular chain erosion patterns(P<0.05).Cholesteatoma abutting an intact ossicle significantly altered average ABG compared to a normal ossicle(P<0.01).Conclusion:Different ossicular chain erosion pattern caused different degrees of ABG.%目的:探讨中耳胆脂瘤患者听骨链病变特点及其与传导性听力损失的关系.方法:回顾性分析204例(213耳)中耳胆脂瘤患者的临床资料,分析术中显微镜下听骨病变特点及其与术前纯音听阈测定结果的关系.结果:中耳胆脂瘤患者砧骨破坏最常见,锤骨、镫骨的破坏往往伴随着砧骨的破坏,砧骨破坏较听骨仅接触胆脂瘤的气骨导差更大(P<0.05),砧镫骨均有破坏较仅有砧骨破坏的气骨导差更大(P<0.05),砧骨完全缺失较仅有部分破坏气骨导差更大(P<0.05).软连接可在部分听骨链破坏类型中发挥传导声能的作用(P<0.05).胆脂瘤接触听骨将影响听力(P<0.01).结论:听骨链不同的

  8. Surgical management of the external auditory canal cholesteatoma invading the tympanic cavity and mastoid%外耳道胆脂瘤侵及鼓室及乳突的的手术治疗

    Institute of Scientific and Technical Information of China (English)

    王胜军

    2012-01-01

    Objective To investigate and evaluate the effects of the surgical management in treating external auditory canal cholesteatoma invading the tympanic cavity and mastoid. Methods A retrospective review was performed in 16 cases of external auditory canal cholesteatoma invading the tympanic cavity and mastoid during the time interval from 2005 to 2010. Results All 16 cases showed different bone erosion in the four walls of external auditory canal with extention to the mastoid and tympanic cavity. Pars flaccida perforation were found in 6 cases with invasion of the cholesteatoma into the tympanic cavity,and the ossicular chains were destroyed. The bony mastoid segment of facial canal was destroyed in 3 cases. According to the extent of disease, intact - bridge tympanomastoidectomy was performed in 8 cases and canal wall - down tympanoplasty with ossiculoplasty in a single stage in 6 cases, meatoplasty in 2 cases. The postoperative hearing of 10 cases with intact ossicular chains were normal. The hearing threshold of the air condition in 6 cases got 15 to 20dB of improvement among the language frequency after reconstruction of ossicular chain with PORP. The 16 cases were followed - up at least 12 months and no recurrences were found. Conclusion Diagnosis of the external auditory canal cholesteatoma invading the tympanic cavity and mastoid should be made early. If it can be treated by preoperative temporal bone CT scannings and intraoperative clinical findings properly, not only the removing of the primary lesion, but also the proper choice of surgical approach and improvement of the hearing of the diseased ear can be obtained.%目的 探讨并评价通过开放式和完桥式鼓室成形术治疗累及乳突和鼓室腔的外耳道胆脂瘤的临床效果.方法 该文回顾性分析2005-2010年间手术、随访至少12月的通过手术治疗16例累及乳突和鼓室腔的外耳道胆脂瘤的病例,并对其临床效果进行评估.结果 16例患者病变均不同

  9. Avaliação da expressão gênica de metaloproteinases de matriz e seus inibidores em colesteatomas por amplificação de ácidos nucleicos Cholesteatoma gene expression of matrix metalloproteinases and their inhibitors by RT-PCR

    Directory of Open Access Journals (Sweden)

    Carlos Eduardo Borges Rezende

    2012-06-01

    Full Text Available O colesteatoma adquirido da orelha média é uma lesão epitelial escamosa queratinizante e hiperproliferativa benigna que pode resultar na destruição das estruturas ósseas circunvizinhas do osso temporal. Estudos recentes demonstram que alterações na produção celular de metaloproteinases de matriz (MMPs e seus inibidores específicos (TIMPs contribuem para a fisiopatologia do colesteatoma. OBJETIVO: Verificar a aplicabilidade da amplificação de RNA para avaliação da expressão de isoformas de MMPs e TIMPS em colesteatomas para correlação com a agressividade da doença. MATERIAIS E MÉTODOS: Estudo prospectivo. Dezenove casos de colesteatomas em diferentes estágios de evolução foram selecionados. RNA extraído das biópsias foi submetido à transcrição reversa - reação da polimerase em cadeia (RT-PCR para amplificação semiquantitativa de MMP2, MMP3, MMP9, MMP13 e TIMP1. Resultados: Seis colesteatomas apresentaram reação positiva para pelo menos um dos genes estudados. Quatro amostras amplificaram apenas um gene (MMP2 ou MM13 e duas amostras amplificaram três genes (MMP2, TIMP1 e MMP3 ou MMP13. Nenhuma amostra amplificou MMP9. CONCLUSÃO: A avaliação da expressão gênica de MMPs e TIMPs em colesteatomas pode ser realizada por RT-PCR, apesar de dificuldades técnicas. Não foi possível realizar associação entre o perfil de expressão gênica e a agressividade da doença.Acquired middle ear cholesteatoma is a benign keratinizing hyperproliferative squamous epithelial lesion that may result in the destruction of the bone structures surrounding the temporal bone. Recent studies show that variations in cellular production of matrix metalloproteinases (MMPs and their specific inhibitors (TIMPs contribute to the pathophysiology of cholesteatoma. OBJECTIVE: This study aims to analyze the use of RNA amplification tests to evaluate the expression of MMP and TIMP isoforms in cholesteatomas and their correlation with disease

  10. O papel do Fator de Necrose Tumoral Alfa (TNF-alfa no processo de erosão óssea presente no colesteatoma adquirido da orelha média The role of Tumor Necrosis Factor -Alpha (TNF- alpha in bone resorption present in middle ear cholesteatoma

    Directory of Open Access Journals (Sweden)

    Rodrigo Faller Vitale

    2007-02-01

    Full Text Available O colesteatoma adquirido da orelha média causa erosão óssea, com altas taxas de morbidade e mortalidade. O TNF-alfa (TNF-alfa lambda uma das principais citocinas envolvidas neste processo. OBJETIVO: Avaliar o papel do TNF-alfa na reabsorsão óssea e a ação dele no colesteatoma. MATERIAL E MÉTODOS: Foi realizado um levantamento e uma revisão crítica da literatura. RESULTADOS: Todos os autores estudados concordam com a importância do TNF-alfa no processo de reabsorção óssea presente no colesteatoma e com o grau de destruição observado. Diferentes trabalhos demonstraram que o TNF-alfa é capaz de provocar erosão óssea, através de diferentes vias de ação. Ele pode estimular a diferenciação e a maturação dos osteoclastos ou, ainda, agir na matriz óssea expondo-a à ação dos osteoclastos. Existe a possibilidade de inibir a ação do TNF-alfa, diminuindo seus efeitos e prevenindo a perda óssea em doenças como a artrite reumatóide. Não existe, entretanto, trabalhos específicos em colesteatoma. Não existe consenso sobre a sua localização. Estas diferenças, provavelmente, ocorrem devido à distribuição dos receptores. CONCLUSÃO: O TNF-alfa, presente no colesteatoma promove a reabsorsão óssea, juntamente com outras citocinas (RANKL e IL-1, estando relacionado com a presença de complicações.Cholesteatoma may cause bone erosion, with high morbidity and mortality rates. Tumor Necrosis Factor -Alpha (TNF-a is one of the main cytokines involved in this process. Our goal was to evaluate the role of TNF-a in Bone Resorption and its effect on cholesteatoma. MATERIAL AND METHODS: analysis and critical literature review. RESULTS: Different studies have demonstrated that TNF-a is capable of causing bone erosion. It may stimulate the differentiation and maturation of osteoclasts or it may act on the bone matrix, exposing it to the action of the osteoclasts. It is possible to inhibit TNF-a, reducing its effects and prevent

  11. The Analysis of the Main Pathogenic Bacteria and Drug Sensitivity in Patients with Chronic Suppurative Otitis Media and Patients with Middle Ear Cholesteatoma in Xinjiang%新疆地区慢性化脓性中耳炎及中耳胆脂瘤病原菌及药敏分析

    Institute of Scientific and Technical Information of China (English)

    顾兴智; 牛良军; 尤乐都斯·克尤木; 张华

    2014-01-01

    Objective To study the main pathogenic bacteria and drug sensitivity in patients with chronic sup-purative otitis media and patients with middle ear cholesteatoma in Xinjiang ,and to provide evidence for reasonable u-sing antibiotics for the two diseases .Methods We performed a retrospective analysis of the middle ear secretion bac-terial culture results of 409 patients with chronic suppurative otitis media and middle ear cholesteatoma at our hospi-tal from January 2008 to December 2013 .Results ①There were 361 strains of microbes isolated from 409 patients , and 16 of them were fungi ,and 245 were bacteria .There was a statistical significance of the pathogen detection rate about G+ and G- bacteria between chronic suppurative otitis media and middle ear cholesteatoma (χ2 =12 .216 ,P=0 .000) .②Staphylococcus aureus(in 78 of 254 ears ,30 .7% ) ,pseudomonas aeruginosa(in 46 of 254 ears ,18 .1% ) , coagulase-negative staphylococcus(in 42 of 254 ears ,16 .5% ) ,and proteus mirabilis(in 20 of 254 ears ,7 .87% ) were the most frequently insolated pathogens in chronic suppurative otitis media ,while staphylococcus aureus(in 26 of 107 ears ,24 .30% ) ,pseudomonas aeruginosa(in 17 of 107 ears ,15 .9% ) ,coagulase-negative staphylococcus (in 16 of 107 ears ,15 .0% ) ,and proteus mirabilis(in 14 of 107 ears ,13 .1% ) were the most frequently insolated patho-gens in middle ear cholesteatoma .③Staphylococcus aureus and coagulase -negative staphylococcus were all sensi-tive to quinoline nupu ting /dalfopristin ,teicoplanin ,vancomycin ,and moxifloxacin .The sensitivity of coagulase -negative staphylococcus to gentamicin ,trimethoprim -sulfamethoxazole ,and erythromycin in the middle ear chol-esteatoma were higher than those of in chronic suppurative otitis media .The sensitivity of pseudomonas aeruginosa to ceftazidime ,and imipenem were lower in the middle ear cholesteatoma .The drug sensitivity of pseudomonas aeruginosa ,proteus to trimethoprim/sulfamethoxazole and

  12. Imunoexpressão da citoqueratina 16 e do antígeno nuclear Ki-67 no colesteatoma adquirido da orelha média Expression patterns of cytokeratin 16 and the nuclear antigen Ki-67 in acquired middle ear cholesteatoma

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    Celina S. B. Pereira

    2002-08-01

    Full Text Available Introdução: Ocolesteatoma da orelha média é caracterizado pela presença de epitélio escamoso estratificado queratinizado nesta cavidade, causando destruição óssea e podendo levar a complicações. Algumas substâncias como a citoqueratina 16 e o Ki-67, marcadores de proliferação celular, vêm sendo utilizadas para estudar essa doença. A CK 16 é um filamento protéico, situado no citoplasma das células epiteliais, característico de epitélios hiperproliferativos. O Ki-67 é um antígeno nuclear que aparece nas células em estágio de proliferação. Objetivo: O objetivo deste trabalho foi estudar a imunoexpressão da CK 16 e do Ki-67 no colesteatoma adquirido. Forma de estudo: Clínico prospectivo. Material e Método: Foram colhidas amostras de colesteatoma de 31 pacientes submetidos à cirurgia otológica, sendo 20 adultos e 11 crianças, no período de 1998 e 2000. Essas amostras foram submetidas à análise histológica e imuno-histoquímica para estudo da expressão da CK 16 e do Ki-67 na matriz do colesteatoma. Resultado: A análise dos resultados mostrou a presença da CK 16 nas camadas suprabasais da matriz do colesteatoma e, do Ki-67, na camada basal, estendendo-se para as camadas suprabasais e, inclusive, para a camada apical da matriz. A reação aos anticorpos anti-CK 16 e Ki-67 foi heterogênea. A correlação entre a CK 16 e o Ki-67 suprabasal com variáveis morfológicas, como acantose do epitélio e hiperplasia da camada basal formando cones epiteliais em direção à perimatriz, foi positiva e significativa. Também houve relação positiva e significativa entre a CK 16 e o Ki-67 suprabasal e apical. Conclusão: Esses resultados permitem concluir que o colesteatoma tem características hiperproliferativas, expressando a CK 16 e o Ki-67 na sua matriz.Introduction: Cholesteatomas of the middle ear are characterized by the presence of stratified squamous epithelium in this cavity presenting with highly invasive

  13. 64排128层螺旋CT图像重建技术对胆脂瘤型中耳炎的术前评估价值%The Value of Preoperative Assessment about Otitis Media with Cholesteatoma by Image Reconstruction of 64-Multidetector 128-Slice Computer Tomography

    Institute of Scientific and Technical Information of China (English)

    相丽; 郑穗生

    2011-01-01

    Obiective To explore the advantages and disadvantages of post-processing techniques of MSCT to the manifestation of bone destruction in ears with otitis media with cholesteatoma. Materials and Methods fmage reconstruction of 64-multidetector 128-slice CT were performed to middle and internal ears of 42 ears with otitis media with cholesteatoma in different ways. The images were compared to intraoperative findings, and the concordance of the two underwent Kappa test. SPSS was used to deal with the results. High concordance was defined as Kappa ≥0.75. Acceptable concordance was defined as 0. 41/Ukappa"00.75. Low concordance was defined as Kappa"U0.4. Results Kappa values of head of malleus, long crus of incus, short crus of incus, body of incus body, bone destruction of meningeal board, aditus ad antrum expanding and structure defects of horizontal segment of facial nerve canal were greater than 0.75L?Kappa values of handle of malleus, incudomelleolar joints, horizontal and labyrinthin segment of facial nerve canal, semicircular canal, scutum, bone wall of sigmoid sinus and bone destruction of labyrinth were between 0.4 and 0.75, but Kappa values of incudostapedial joint, anterior crus of stapes, posterior crus of stapes and bone destruction of footplate of stapes were less than 0.4. Conclusions Images of bone destruction in middle and internal ears with otitis media with cholesteatoma have important reference value for the operation.%目的 探讨MSCT后处理技术对胆脂瘤型中耳炎骨质破坏情况显示的优劣势.材料与方法 采用64排128层螺旋CT对42耳胆脂瘤型中耳炎中耳及内耳结构进行多种方式重建,结果与术中所见对照,Kappa检验二者的一致性,采用SPSS11.0软件包处理,规定 Kappa值大于或等于0.75为两者有很高的一致程度,其值在0.4-0.75说明一致程度尚可.小于0.4则说明一致程度不够理想.结果 锤骨头、砧骨长脚、砧骨短脚、砧骨体、脑膜板骨壁骨质破坏

  14. 保留听骨链胆脂瘤手术后通气对听力改善的对比观察%Peri-operative ventilation and post-operative hearing in mastoidectomy with ossicular chain preservation for cholesteatoma

    Institute of Scientific and Technical Information of China (English)

    杨挈; 陈文文; 孙祥; 童军; 殷国华; 邓亚新

    2011-01-01

    Objective To study effects of ventilation on hearing outcomes after matoidectomy with intact canal wall and ossicular chain for cholesteatoraa. Methods Forty-one cases performed by the senior author between October 2002 and April 2010 were reviewed. Peri-operative ventilation treatment was provided in 12 cases (Group A: 3 males and 9 females, aged 28-75 years with a medium of 42 years). The mean pre-operative air-bone gap in this group was 32.42 ± 14.68 dB, No ventilation was performed in the rest 29 cases (Group B, 15 males and 14 females, aged 15-65 years with a medium of 42 years. The mean pre-operative air-bone gap was 26.79 ± 11.84 dB for this group. The pre-operation air-bone gap was not statistically different between the two groups (U test). In Group A, the mastoid was ventilated through a 2 mm silastic tube placed into the mastoid cavity once daily for 2 weeks postoperatively. All cases were followed up for at least 12 months. Results Mean air-bone GAP improved from 32.42 ± 14.68 dB to 8.58 ±11.3 dB after surgery in Group A (U = 4.46, P0.05). However, the post-operative air bone GAP was 20 dB or less in all Group A cases, whereas the GAP was over 20 dB in 4 cases (14%) in Group B, indicating a trend toward better hearing outcomes with ventilation treatment. Conclusion In patients receiving mastoidectomy for cholesteatoma with preservation of the ossicular chain, peri-operative ventilation may be associated with better hearing outcomes.%目的 观察胆脂瘤手术保留正常耳道和听骨链并辅以围手术期中耳通气机通气的听力效果.方法 回顾分析2002年10月到2010年4月间由资深术者所进行的41例采用“多种技术”完壁式并保留完整听骨链的胆脂瘤手术.充气组:术后采用充气治疗者,共12例,其中男3例,女9例;年龄28~75岁,中位年龄42岁;术前气骨导差(GAP)为(32.42±14.68) dB HL.对照组:以往手术采用同样技术但没有充气者,共29例,其中男15例,女14

  15. Curative effect of cholesteatoma by canal wall-down mastoidectomy and type Ⅲa tympanoplasty%开放式乳突根治术并Ⅲa型鼓室成形术治疗胆脂瘤中耳炎的临床研究

    Institute of Scientific and Technical Information of China (English)

    翟锦明; 马钊恩; 陈观贵; 张建国

    2013-01-01

    Objective:To explore the curative effect and auditory outcomes in canal wall -down mastoidectomy and type Ⅲa tympanoplasty. Methods; Retrospective review of 62 patients with cholesteatoma , who underwent canal wall-down mastoidectomy and type Ⅲa tympanoplasty with titanium partial ossicular replacement prosthesis in a single stage. The postoperative complication , operation and aural rehabilitation were analyzed during 2-4 years follow-up. Results: In all 62 cases, 3 patients remained tympanic perforation , 6 patients with postoperative retraction pocket, 1 reurrence of cholesteatoma and 3 (3/62, 4.8%) extrusion of ossicular replacement prosthesis. The rate of total curative effectiveness was 58. 1% , dry ear was 91. 9% , postoperative infection rate was 8. 1%. Auditory outcomes showed that preoperative average air threshold (500, 1k, 2k, 4 k Hz) was (51. 0 ±13. 5) dB, postoperative (32. 6 ±8. 8 ) dB, and average air threshold reduction was statistically significant (t =16. 549, P <0. 01). Preoperative average air-bone gap was (35.2 ±10.0) dB, postoperative was (24.4 ±7.7) dB, with statistical significance (t = 11.276, P <0. 01). Conclusion: Canal wall-down mastoidectomy and type Ⅲa tympanoplasty with titanium partial ossicular replacement prosthesis in single stage is safe and effective surgery for chol -esteatoma, with less complication and relatively satisfactory hearing improvement . Application of tragal cartilage -perichondria autograft is of unique advantages .%目的:探讨开放式乳突根治术并Ⅲa型鼓室成形术治疗胆脂瘤中耳炎的临床效果.方法:62例胆脂瘤中耳炎患者均行开放式乳突根治术并Ⅲa型鼓室成形术(钛质部分听骨植入),随访2~4年,观察手术、术后并发症及听力恢复情况.结果:62例中3例鼓膜遗留穿孔,6例鼓膜内陷,1例胆脂瘤复发,3例(3/62,4.8%)听骨赝复物脱出,手术总有效率为58.1%,术后干耳率达91.9%,术后感染率为8.1%.

  16. Facial nerve canal dehiscence in chronic otitis media without cholesteatoma

    OpenAIRE

    Nomiya, Shigenobu; Kariya, Shin; Nomiya, Rie; MORITA, NORIMASA; Nishizaki, Kazunori; Paparella, Michael M.; Cureoglu, Sebahattin

    2013-01-01

    The information on incidence of the facial nerve canal dehiscence in chronic otitis media is important for surgeons. The purpose of this study is to disclose the histopathologic findings of facial nerve canal dehiscence in human temporal bones with chronic otitis media. We divided the human temporal bones into two groups (age 4 years, and under 4 years of age). We evaluated the incidence and the area of the facial nerve canal dehiscence in chronic otitis media under light microscopy. Age-matc...

  17. Escherichia coli positive infratentorial subdural empyema secondary to mastoiditis and underlying cholesteatoma

    OpenAIRE

    Mirza, Omar; Varadarajan, Vinay; Youshani, Amir Saam; Willatt, David J

    2014-01-01

    Infratentorial subdural empyema is a neurosurgical emergency that is associated with an alarmingly high morbidity and mortality if appropriate management is delayed. It is an important differential to consider when confronted with a patient with a reduced Glasgow Coma Scale, focal neurology and symptoms of raised intracranial pressure in the presence of a head and neck infection. It is also important that the primary team managing these patients is aware of the many pathogens that may be invo...

  18. Congenital mastoid cholesteatoma presenting as a mass obstructing external auditory canal.

    Science.gov (United States)

    Khairunnisak, M; Mohd Khairi, M D

    2014-12-01

    We describe the clinical presentation, investigation and management of an eventually fatal case of hypercalcemic crisis due to primary hyperparathyridism (PHPT). A 60 year-old lady with history of urolithiasis presented with worsening generalized bone pain, spinal scoliosis and a limp. Laboratory data showed hypercalcemia and raised alkaline phosphatase. Left hip x-ray revealed a subcapital femoral neck fracture. Intact parathyroid hormone was elevated, 187.6 pmol/L (1.6 - 6.9) and ultrasound showed an enlarged right parathyroid gland. Despite initial reduction of serum calcium with saline infusion and multiple doses of intravenous pamidronate, her calcium increased to 4.14 mmol/L a week following application of Buck's traction for persistent left hip pain. She succumbed eventually with serum calcium peaking at 6.28 mmol/L despite multiple therapeutic interventions. PMID:25934960

  19. Correlation of high-resolution computed tomography temporal bone findings with intra-operative findings in patients with cholesteatoma

    Directory of Open Access Journals (Sweden)

    Sonika Kanotra

    2015-01-01

    Full Text Available Aim: To evaluate the role of high-resolution computed tomography (HRCT temporal bone in patients with active squamosal chronic otitis media (COM. Materials and Methods: Totally, 47 patients with active squamosal COM underwent preoperative HRCT temporal bone followed by surgery. Their intra-operative findings were considered as the gold standard and were compared and correlated with the radiological findings, to calculate the sensitivity, specificity, positive and negative predictive value of HRCT temporal bone. Results: According to the present study, HRCT was highly sensitive for detecting mastoid pneumatization, soft tissue extension, ossicular erosion, tegmen and sigmoid sinus erosion, and less sensitive for fallopian canal erosion and lateral sinus fistula. It was specific for all these parameters. Conclusion: The present study concludes that HRCT can be recommended not only in cases suspected with potential complications but also in all cases of COM to know the extent of disease, varied pneumatization, and the presence of anatomical variations, which should alert the clinician and guide in surgical approach and treatment plan.

  20. Estudo comparativo de aspectos histológicos e imunohistoquímicos entre o colesteatoma espontâneo do meato acústico externo e o colesteatoma adquirido da orelha média Comparative study of the histological and immunohisochemical aspects of the spontaneous cholesteatomas of the external ear canal and the acquired cholesteatoma of the middle ear

    OpenAIRE

    Fernando de Andrade Quintanilha Ribeiro; Celina Siqueira Barbosa Pereira; Renata de Almeida

    2004-01-01

    OBJETIVO: Neste trabalho foram avaliadas as características histológicas e imunohistoquímicas (Ki-67 e CK-16) do colesteatoma espontâneo do meato acústico externo comparando-as com as do colesteatoma adquirido da orelha média. FORMA DE ESTUDO: Caso controle. MATERIAL E MÉTODO: Fragmentos de colesteatoma do meato acústico externo foram submetidos a estudo histológico e imunohistoquímico com o intuito de verificar a expressão da CK16 e do antígeno nuclear Ki-67 nas células de sua matriz, e os r...

  1. Correlação da cadeia ossicular no transoperatório com achados histológicos de colesteatomas Hystology findings' correlation between the ossicular chain in the transoperative and cholesteatomas

    OpenAIRE

    Cristina Dornelles; Letícia Petersen Schmidt Rosito; Luíse Meurer; Sady Selaimen da Costa; Andréia Argenta; Sabrina Lima Alves

    2007-01-01

    A Otite Média Crônica é definida pela presença de alterações teciduais inflamatórias irreversíveis na fenda auditiva. As lesões ossiculares são as mais prevalentes. OBJETIVO: Correlacionar o grau de comprometimento da cadeia ossicular, visualizada no transoperatório, com o grau histológico de inflamação e com a espessura da perimatriz de colesteatomas. TIPO DE ESTUDO: Estudo transversal. MÉTODOS: Descrições cirúrgicas de 71 pacientes foram revisadas. Colesteatomas coletados e fixados em formo...

  2. Evaluación y terapéutica inmunológica en la otitis media supurativa crónica no colesteatomatosa Evaluation and immunological therapeutics in chronic suppurative otitis media without cholesteatoma

    OpenAIRE

    Miriam de la C Sánchez Segura; Julianis Quintero Noa; Vianed Marsán Suárez; Elisa Leyva Montero; Isabel M Torres Leyva; René M González García; Consuelo Macías Abraham

    2001-01-01

    Se estudiaron 40 pacientes con otitis media supurativa crónica no colesteatomatosa a los que se les realizó tratamiento quirúrgico (técnica cerrada). Se analizaron los resultados de las pruebas inmunológicas y la evolución clínica de 20 pacientes con tratamiento inmunológico preoperatorio por un período de 6 a 12 meses y se compararon con la de 20 pacientes operados sin dicho tratamiento. El seguimiento evolutivo se realizó durante un año posterior a la intervención quirúrgica. La alteración ...

  3. O papel das citocinas no colesteatoma adquirido da orelha média: revisão da literatura The role of cytokines in acquired middle ear cholesteatoma: literature review

    OpenAIRE

    Adriana Leal Alves; Fernando de Andrade Quintanilha Ribeiro

    2004-01-01

    Este estudo visa a analisar de modo crítico a literatura pertinente a respeito do papel das citocinas no colesteatoma adquirido. O colesteatoma da orelha média é caracterizado pela presença de epitélio escamoso estratificado queratinizado neste local, com alto poder invasivo, causando destruição óssea e podendo levar a complicações. As citocinas são glicoproteínas de baixo peso molecular que atuam na intercomunicação celular. São importantes na estimulação e supressão dos eventos da resposta ...

  4. Análise dos padrões histopatológicos do colesteatoma adquirido da orelha média Analysis of histopathological aspects in acquired middle ear cholesteatoma

    OpenAIRE

    Adriana Leal Alves; Celina Siqueira Barbosa Pereira; Fernando de Andrade Quintanilha Ribeiro; Jose Humberto Tavares Guerreiro Fregnani

    2008-01-01

    O colesteatoma da orelha média é caracterizado pela presença de epitélio estratificado pavimentoso queratinizado neste local, com alto poder invasivo, causando destruição óssea e podendo levar a complicações. OBJETIVO: Estudar os padrões histopatológicos no colesteatoma adquirido da orelha média. Correlacionar esses dados com a idade do paciente. FORMA DE ESTUDO: Clínico e experimental do tipo transversal. MATERIAL E MÉTODO: Foram colhidas amostras de colesteatoma de 50 pacientes submetidos à...

  5. [Severe forms of cholesteatomatous chronic otitis (author's transl)].

    Science.gov (United States)

    Fleury, P; Basset, J M; Aben-Moha, G; François, M; Royer, P

    1982-01-01

    Eighty further case-reports of patients, hospitalized for particularly severe forms of cholesteatomatous chronic otitis since 1977, are analyzed. -Cholesteatomas were associated with spontaneous atticotomy and atrial invasion in 37 cases, while in 8 patients the cholesteatoma was revealed by the presence of premalleal and anterior subligamental perforations. -New features were observed in 7 cases of cholesteatomatous and osteomatous chronic otitis. -Giant cholesteatoma was present in 12 cases, and unilateral tumors in 6 patients. -Four rarer types of lesion, obviously of a serious nature, were observed, including: -polypoid and hemorrhagic tumors (6 cases), -persistently highly fetid cholesteatomas (6 cases), and those that appeared to be "under pressure" (13 cases). -Finally, 7 cases were unusual and disturbing, demonstrating early extensive osteitic recurrence less than 6 months after initial excision. Widespread evidement is necessary for the majority of these cases. PMID:7103344

  6. Differential diagnosis of middle ear inflammatory diseases by MRI findings

    International Nuclear Information System (INIS)

    Although computed tomography can reveal a soft tissue mass in middle ear diseases as an area of increased density, it cannot differentiate cholesteatoma from other inflammatory tissue. We prospectively studied 30 patients with various middle ear inflammatory diseases, including inflammatory granulation tissue, cholesteatoma and cholesterin granuloma with magnetic resonance imaging (MRI) with or without Gd-DTPA enhancement. Cholesteatoma and inflammatory granulation tissue showed intensity ranging from low to high on T1-weighted images and from high to very high on T2-weighted images. However, cholesteatoma showed either no enhancement or ring enhancement on MR imagings with Gd-DTPA, and it could be differentiated from the Gd-DTPA-enhanced inflammatory granulation tissue. Cholesterin granuloma showed very high intensity on both T1 and T2-weighted images. Therefore, MRI with Gd-DTPA is considered to be useful in the differential diagnosis of these middle ear diseases. (auhtor)

  7. [Aural polyp in chronic inflammatory middle ear disease].

    Science.gov (United States)

    López Aguado, D; López Campos, D; Pérez Piñero, B; Campos Bañales, M E

    2003-03-01

    240 patients with chronic otitis media (COM) were studied: 166 ears termed as non cholesteatomatous otitis media and 74 with cholesteatoma. In 38 ears an aural polyp was found with no evidence of cholesteatoma in 19 ears (11.4%) whereas a cholesteatoma was present in the remaining 19 ears. The histology of the polyp and the characteristics of the chronic process were matched: a) The aural polyp is an infrequent complication in COM. b) After histological analysis was found to present two different pictures: The inflammatory reaction polyp, present in non cholesteatomatous COM; and the polyp with granulation tissue and foreign body reaction (keratina) usually found in cholesteatomatous COM. c) The finding of granulation tissue reaction and keratina in an aural polyp is a good predictor for the presence of a cholesteatoma. PMID:12825338

  8. Canal Wall Reconstruction Mastoidectomy

    Institute of Scientific and Technical Information of China (English)

    2007-01-01

    Objective To investigate the advantages of canal wall reconstruction (CWR) mastoidectomy, a single-stage technique for cholesteatoma removal and posterior external canal wall reconstruction, over the open and closed procedures in terms of cholesteatoma recurrence. Methods: Between June 2002 and December 2005, 38 patients (40 ears) with cholesteatoma were admited to Sun Yat-Sen Memorial Hospital and received surgical treatments. Of these patients, 25 were male with ages ranging between 11 and 60 years (mean = 31.6 years) and 13 were female with ages ranging between 20 and 65 years (mean = 38.8 years). Canal wall reconstruction (CWR)mastoidectomy was performed in 31 ears and canal wall down (CWD) mastoidectomy in 9 ears. Concha cartilage was used for ear canal wall reconstruction in 22 of the 31 CWR procedures and cortical mastoid bone was used in the remaining 9 cases. Results At 0.5 to 4 years follow up, all but one patients remained free of signs of cholesteatoma recurrence, i.e., no retraction pocket or cholesteatoma matrix. One patient, a smoker, needed revision surgery due to cholesteatoma recurrence 1.5 year after the initial operation. The recurrence rate was therefore 3.2% (1/31). Cholesteatoma recurrence was monitored using postoperative CT scans whenever possible. In the case that needed a revision procedure, a retraction pocket was identified by otoendoscopy in the pars flacida area that eventually evolved into a cholesteatoma. A pocket extending to the epitympanum filled with cholesteatoma matrix was confirmed during the revision operation, A decision to perform a modified mastoidectomy was made as the patient refused to quit smoking. The mean air-bone gap in pure tone threshold was 45 dB before surgery and 25 dB after (p < 0.05). There was no difference between using concha cartilage and cortical mastoid bone for the reconstruction regarding air-bone gap improvement, CT findings and otoendoscopic results. Conclusion CWR mastoidectomy can be used for

  9. CT findings of automastoidectomy

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Hyung Jin; Chung, Hae Gyeong; Kim, Jae Hyoung; Hwang, Eui Gee; Ma, Yong Woon; Chung, Sung Hoon [College of Medicine, Gyeongsang National University, Jinju (Korea, Republic of)

    1992-01-15

    Cholesteatoma of the middle ear and mastoid sometimes destroys the posterior wall of the external auditory canal(EAC), and this phenomenon is termed as 'automastoidectomy'. During the past two years the authors reviewed the CT features of automastoidectomy in eight patients with middle ear cholesteatoma, There was a variable amount of the cholesteatomatous mass or debris within the mastoid cavity in all patients, of whom air collection was found in four. Interestingly, the site and pattern of the erosion of the EAC were nearly identical between patients with air in the mastoid cavity and those without it. Air in the mastiod cavity was the only clue of the expulsion of the cholesteatoma. So, we think that the expulsion of the cholesteatoma might be predicted when the erosion of the EAC is present in patients with cholesteatoma in the mastoid cavity. CT clearly depicted associated complications caused by the cholesteatoma, such as ossicular destruction (n=8), the erosion of the facial nerve canal (n=2), the erosion of the lateral semicircular canal (n=2), the erosion of the tegmen (n=1), the erosion of the sigmoid sinus plate (n=1), the erosion of the superior semicircular canal (n=1), and the erosion of the vestibule (n=1). Although much of the natural history of the middle ear cholesteatoma still remains to be determined, we thick that careful evaluation of one type of possible progression of the disease will help us understand its clinical course. Moreover, our findings strongly support the use of CT for evaluation of 'automastoidectomy' seen in many cases of cholesteatoma.

  10. Removal of Selected Infralabyrinthine Lesions Without Facial Nerve Mobilization

    OpenAIRE

    Martin, CH; Prades, J.M.

    1992-01-01

    The infralabyrinthine approach can be modified for the removal of certain lesions without facial nerve mobilization. This procedure is to be used for lesions falling under the three following categories: glomus jugulare tumors, infralabyrinthine cholesteatomas, and cholesterol cysts of the temporal bone. This report includes three glomus jugulare tumors (C1 Fisch type) and five infralabyrinthine cholesteatomas operated on with such a technique. Some anatomic data concerning access to the infr...

  11. Imunoexpressão da citoqueratina 16 e do antígeno nuclear Ki-67 no colesteatoma adquirido da orelha média Expression patterns of cytokeratin 16 and the nuclear antigen Ki-67 in acquired middle ear cholesteatoma

    OpenAIRE

    Celina S. B. Pereira; Clemente I. R. Almeida; Maria Regina Vianna

    2002-01-01

    Introdução: Ocolesteatoma da orelha média é caracterizado pela presença de epitélio escamoso estratificado queratinizado nesta cavidade, causando destruição óssea e podendo levar a complicações. Algumas substâncias como a citoqueratina 16 e o Ki-67, marcadores de proliferação celular, vêm sendo utilizadas para estudar essa doença. A CK 16 é um filamento protéico, situado no citoplasma das células epiteliais, característico de epitélios hiperproliferativos. O Ki-67 é um antígeno nuclear que ap...

  12. Avaliação da expressão gênica de metaloproteinases de matriz e seus inibidores em colesteatomas por amplificação de ácidos nucleicos Cholesteatoma gene expression of matrix metalloproteinases and their inhibitors by RT-PCR

    OpenAIRE

    Carlos Eduardo Borges Rezende; Ricardo Peres do Souto; Priscila Bogar Rapoport; Laís de Campos; Marcela Bovo Generato

    2012-01-01

    O colesteatoma adquirido da orelha média é uma lesão epitelial escamosa queratinizante e hiperproliferativa benigna que pode resultar na destruição das estruturas ósseas circunvizinhas do osso temporal. Estudos recentes demonstram que alterações na produção celular de metaloproteinases de matriz (MMPs) e seus inibidores específicos (TIMPs) contribuem para a fisiopatologia do colesteatoma. OBJETIVO: Verificar a aplicabilidade da amplificação de RNA para avaliação da expressão de isoformas de M...

  13. O papel do Fator de Necrose Tumoral Alfa (TNF-alfa) no processo de erosão óssea presente no colesteatoma adquirido da orelha média The role of Tumor Necrosis Factor -Alpha (TNF- alpha) in bone resorption present in middle ear cholesteatoma

    OpenAIRE

    Rodrigo Faller Vitale; Fernando de Andrade Quintanilha Ribeiro

    2007-01-01

    O colesteatoma adquirido da orelha média causa erosão óssea, com altas taxas de morbidade e mortalidade. O TNF-alfa (TNF-alfa) lambda uma das principais citocinas envolvidas neste processo. OBJETIVO: Avaliar o papel do TNF-alfa na reabsorsão óssea e a ação dele no colesteatoma. MATERIAL E MÉTODOS: Foi realizado um levantamento e uma revisão crítica da literatura. RESULTADOS: Todos os autores estudados concordam com a importância do TNF-alfa no processo de reabsorção óssea presente no colestea...

  14. Utility and limitations of CT in otitis media

    International Nuclear Information System (INIS)

    To assess the degree of reliability of computed tomography (CT) and the agreement between the imaging studies and intraoperative findings in chronic otitis media (COM) with cholesteatoma. We studied 51 patients diagnosed clinically as having inflammatory disease of the middle ear. All the patients under-went high-resolution Ct of temporal bone in axial and coronal planes. The imaging studies were retrospectively correlated with the intraoperative findings and the sensitivity of CT in the detection of erosive cholesteatoma was determined. Open radical mastoidectomy is the surgical technique most frequently used to treat cholesteatoma in our center. The greatest radio-surgical correlation was achieved in the detection of masses presenting soft tissue attenuation in air-filled cavities in middle ear (100%) and in bone erosion (87.5%). The 20 patients (39%) who were diagnosed as having COM with cholesteatoma underwent surgical treatment in our center. CT is the technique of choice in the study of COM with cholesteatoma, providing basic and necessary information for the image-based diagnosis of this disease, the detection of masses presenting soft tissue attenuation and bone erosion. We also point out the role of CT as an intraoperative guide and discuss its low sensitivity for the detection of small areas of dura mater exposure, ossicular luxation and facial canal dehiscence. (Author) 8 refs

  15. Expression of tumor necrosis factor-α, interleukin-1α, interleukin-6 and interleukin-10 in chronic otitis media with bone osteolysis.

    Science.gov (United States)

    Kuczkowski, Jerzy; Sakowicz-Burkiewicz, Monika; Iżycka-Świeszewska, Ewa; Mikaszewski, Bogusław; Pawełczyk, Tadeusz

    2011-01-01

    The purpose of this study was to evaluate the expression of proinflammatory and immunoregulatory cytokines in chronic otitis media. The expression levels of TNF-α, IL-1α, IL-6 and IL-10 were determined by Western blot analysis of tissue samples obtained during ear surgery. The expression levels of TNF-α, IL-1α and IL-6 in cholesteatoma tissues were substantially higher compared to those determined in the granulation tissue. The highest levels of TNF-α, IL-1 and IL-6 proteins were observed in patients with bone destruction. There were no significant differences in the expression of IL-10 levels in cholesteatoma and normal skin, but in the granulation tissue its level was substantially higher. The level of IL-10 in cholesteatoma tissues inversely correlated with the expression of proinflammatory cytokines, the degree of bone destruction and cholesteatoma invasion. Increased expressions of TNF-α, IL-1α and IL-6 in chronic otitis media and a strong positive correlation between these cytokine levels and the degree of bone destruction indicate the destructive behavior of cholesteatoma or granulation tissue. PMID:21311206

  16. Clinical application of high resolution computed tomography of temporal bone diseases

    Energy Technology Data Exchange (ETDEWEB)

    Kanzaki, J.; Saito, S.; Shiga, H. (Keio Univ., Tokyo (Japan). School of Medicine)

    1981-11-01

    Using CT/T 8800 with high spatial resolution, target imaging of the various temporal bone diseases was performed. Coronal and axial scans were made. Target imaging is an effective means of studying patients with cholesteatomas, semicircular canal fistula, diseases of the internal auditory canal (acoustic neuroma, or stenosis) and inner ear anomaly (hypoplasia, or distension of the vestibulum). The results of the comparison of CT and polytomography of the temporal bone were as follows: 1. In most cases, the pathological process was demonstrated with CT scans better than or same as with polytomograms. 2. The radiation dose of CT scan is low. 3. The axial images of the temporal bone were easily obtained with CT. 4. CT is more effective than polytomography in the diagnosis and evaluation of the temporal bone involved by tumor and cholesteatoma, especially attic cholesteatoma. 5. In cases with temporal bone fracture, acoustic neuroma or other intracranial diseases, contrast-enhanced CT can be done.

  17. Evaluation of CT-scanning of the temporal bone in the diagnosis of ear diseases

    Energy Technology Data Exchange (ETDEWEB)

    Murata, Kiyotaka; Isono, Michio; Nishimae, Tadahide; Tamaki, Katsuhiko; Hosoi, Hiroshi; Ohta, Fumihiko (Kinki Univ., Higashi-Osaka, Osaka (Japan))

    1983-02-01

    CT-scanning of 96 temporal bones was carried out to reveal the extension of cholesteatoma, periossicular drainage, fracture lines, enlarged internal acoustic meatus and anomalies of labyrinthine capsules and ossicles. The clinical aspects of CT-scanning of the temporal bone (CTTB) were as follows: 1) Inner ear anomalies were observed in 17 temporal bones of unilateral deafness, high tone loss from unknown origin and fluctuant hearing loss. CTTB may explain the pathology of deafness from unknown origin; 2) Inner ear anomalies may be classified into more detailed groups than before; 3) The extension of cholesteatoma, localization and size of labyrinthine fistula can be estimated prior to surgery; 4) Cholesteatoma in a mastoidectomy cavity may be detected; 5) The malleus and incus may be visualized, although the stapes can hardly be found; 6) Fracture lines of a temporal bone, destruction of the internal acoustic meatus may be clearly detected.

  18. Evaluation of CT-scanning of the temporal bone in the diagnosis of ear diseases

    International Nuclear Information System (INIS)

    CT-scanning of 96 temporal bones was carried out to reveal the extension of cholesteatoma, periossicular drainage, fracture lines, enlarged internal acoustic meatus and anomalies of labyrinthine capsules and ossicles. The clinical aspects of CT-scanning of the temporal bone (CTTB) were as follows: 1) Inner ear anomalies were observed in 17 temporal bones of unilateral deafness, high tone loss from unknown origin and fluctuant hearing loss. CTTB may explain the pathology of deafness from unknown origin. 2) Inner ear anomalies may be classified into more detailed groups than before. 3) The extension of cholesteatoma, localization and size of labyrinthine fistula can be estimated prior to surgery. 4) Cholesteatoma in a mastoidectomy cavity may be detected. 5) The malleus and incus may be visualized, although the stapes can hardly be found. 6) Fracture lines of a temporal bone, destruction of the internal acoustic meatus may be clearly detected. (author)

  19. Primary mucocele of the petrous apex: MR appearance.

    Science.gov (United States)

    Larson, T L; Wong, M L

    1992-01-01

    Mucoceles of the petrous apex are rare. Their MR appearance varies depending on the degree of hydration or inspissation of the contents. Concise preoperative diagnosis is helpful, since mucoceles are better drained to the mastoids via an infralabyrinthine approach rather than the more risky middle cranial fossa approach used for cholesteatomas. PMID:1595444

  20. 38 CFR 4.87 - Schedule of ratings-ear.

    Science.gov (United States)

    2010-07-01

    ... 38 Pensions, Bonuses, and Veterans' Relief 1 2010-07-01 2010-07-01 false Schedule of ratings-ear...—ear. Diseases of the Ear Rating 6200Chronic suppurative otitis media, mastoiditis, or cholesteatoma... of the substance 10 6208Malignant neoplasm of the ear (other than skin only) 100 Note: A rating...

  1. The role of high-resolution CT in evaluating disease of the posterior tympanum

    International Nuclear Information System (INIS)

    The posterior tympanum consists of several irregular eminences, ridges, and sinuses. These sinuses do not communicate with the mastoid air cell system, and cholesteatoma and/or granulation tissue prefer to fill them. This area cannot be visualized with ease by the usual surgical approach, and is thus quite important for surgeons. Recent developments in high-resolution computed tomography (HRCT) allow more than ever precise identification of subtle changes in the posterior tympanum. Axial HRCT sections provide essential information for the preoperative evaluation of the posterior tympanum. The performance of surgeons has been promoted both in evaluation and treatment planning of patient with suspected posterior tympanic lesions. HRCT findings were compared with the operative findings in 52 patients (54 ears) who had the operation for chronic otitis media. Important findings by HRCT diagnosis of posterior tympanum are as follows; (1) Bone destruction in the posterosuperior part of the tympanic anulus and in the lateral wall of the facial sinus are the important findings for the diagnosis of invasion of cholesteatoma in the posterior tympanum. (2) Similarly important finding is the bone destruction of the pyramidal eminence. This was found in 6 of 9 cases with cholesteatomas extending into the sinus tympani. (3) The soft tissue density in the posterior tympanum does not necessarily indicate pathological processes. Effusion in the posterior tympanum is imaged as soft tissue density, and can not be differentiated from cholesteatoma or granulation by present HRCT. (author)

  2. The role of high-resolution CT in evaluating disease of the posterior tympanum

    Energy Technology Data Exchange (ETDEWEB)

    Funai, Hiroaki; Takubo, Masamichi (Tokyo Metropolitan Hospital of Fuchu (Japan)); Iinuma, Toshitaka; Horiuchi, Yasuharu; Ichimura, Keiichi; Oyama, Kazuyuki

    1989-08-01

    The posterior tympanum consists of several irregular eminences, ridges, and sinuses. These sinuses do not communicate with the mastoid air cell system, and cholesteatoma and/or granulation tissue prefer to fill them. This area cannot be visualized with ease by the usual surgical approach, and is thus quite important for surgeons. Recent developments in high-resolution computed tomography (HRCT) allow more than ever precise identification of subtle changes in the posterior tympanum. Axial HRCT sections provide essential information for the preoperative evaluation of the posterior tympanum. The performance of surgeons has been promoted both in evaluation and treatment planning of patient with suspected posterior tympanic lesions. HRCT findings were compared with the operative findings in 52 patients (54 ears) who had the operation for chronic otitis media. Important findings by HRCT diagnosis of posterior tympanum are as follows; (1) Bone destruction in the posterosuperior part of the tympanic anulus and in the lateral wall of the facial sinus are the important findings for the diagnosis of invasion of cholesteatoma in the posterior tympanum. (2) Similarly important finding is the bone destruction of the pyramidal eminence. This was found in 6 of 9 cases with cholesteatomas extending into the sinus tympani. (3) The soft tissue density in the posterior tympanum does not necessarily indicate pathological processes. Effusion in the posterior tympanum is imaged as soft tissue density, and can not be differentiated from cholesteatoma or granulation by present HRCT. (author).

  3. Tympanomastoidectomy: Comparison between canal wall-down and canal wall-up techniques in surgery for chronic otitis media

    Directory of Open Access Journals (Sweden)

    Azevedo, Alexandre Fernandes de

    2014-01-01

    Full Text Available Introduction: Chronic otitis media (COM is an inflammatory condition associated with otorrhea as well as large and persistent perforations of the tympanic membrane in some cases. COM can also lead to cholesteatoma. Surgical treatment with canal wall-down and canal wall-up tympanomastoidectomy is considered for both types of illness. The choice of technique is controversial and is dependent on several factors, including the extent of disease. Objective: We aimed to evaluate surgical outcomes in COM patients with and without cholesteatoma treated with canal wall-down and canal wall-up tympanomastoidectomy. Disease eradication and post-operative auditory thresholds were assessed. Method: Patient records from the otorhinolaryngology department of a tertiary hospital were assessed retrospectively. Results: Patients who underwent canal wall-up tympanomastoidectomy had a higher rate of revision surgery, especially those with cholesteatoma. However, there were no statistically significant differences in post-operative hearing thresholds between the two techniques. Conclusion: The canal wall-down technique is superior to the canal wall-up technique, especially for patients with cholesteatoma.

  4. Computed tomography study of otitis media; A tomografia computadorizada no estudo das otites medias

    Energy Technology Data Exchange (ETDEWEB)

    Bahia, Paulo Roberto Valle; Marchiori, Edson [Universidade Federal, Rio de Janeiro, RJ (Brazil). Dept. de Radiologia

    1997-03-01

    The findings of computed tomography (CT) of 89 patients clinically suspected of having otitis media were studied in this work. Such results were compared to clinical diagnosis, otoscopy, surgical findings and previous data. Among the results of our analysis, we studied seven patients with acute otitis media and 83 patients with chronic otitis media. The patients with acute otitis media have undergone CT examinations to evaluate possible spread to central nervous system. The diagnosis of cholesteatoma, its extension and complications were the main indication. for chronic otitis media study. The main findings of the cholesteatomatous otitis were the occupation of the epitympanun, the bony wall destruction and the ossicular chain erosion. The CT demonstrated a great sensibility to diagnose the cholesteatoma. (author) 25 refs., 10 figs.

  5. CT and MR imaging after middle ear surgery.

    Science.gov (United States)

    Kösling, S; Bootz, F

    2001-11-01

    This article describes the current value of imaging in patients after stapes surgery and surgery after chronic otitis media including cholesteatoma. Possibilities and limits of computed tomography (CT) and MRI are described and most important investigation parameters are mentioned. After otosclerosis surgery, CT is the method of first choice in detection of reasons for vertigo and/or recurrent hearing loss in the later postoperative phase. CT may show the position and condition of prosthesis, scarring around the prosthesis and otospongiotic foci. Sometimes, it gives indirect hints for perilymphatic fistulas and incus necrosis. MRI is able to document inner ear complications. CT has a high negative predictive value in cases with a free cavity after mastoidectomy. Localized opacities or total occlusion are difficult to distinguish by CT alone. MRI provides important additional information in the differentiation of cholesterol granuloma, cholesteatoma, effusion, granulation and scar tissue. PMID:11704358

  6. High resolution computed tomography of chronic otitis media

    International Nuclear Information System (INIS)

    Seventy six patients with chronic otitis media were examined by CT. Using 3 dried skulls, the epitympanum was impacted with a piece of paraffin containing of 2 % iodine, and studied with CT-scan (Toshiba 60A-30) to clarify whether or not the paraffin could produce a soft tissue density on CT which was similar to that of cholesteatoma in the middle ear. The results showed that computed tomography was excellent in demonstrating a soft tissue mass in the middle ear with inflammatory disease. When the middle ear infection with granulation tissue or cholesteatoma existed, the resulting soft tissue mass was indistinguishable. CT scanning was useful for accurate determination of location of bone destruction in the middle ear as well as of the ossicles. (author)

  7. CT and MR imaging after middle ear surgery

    International Nuclear Information System (INIS)

    This article describes the current value of imaging in patients after stapes surgery and surgery after chronic otitis media including cholesteatoma. Possibilities and limits of computed tomography (CT) and MRI are described and most important investigation parameters are mentioned. After otosclerosis surgery, CT is the method of first choice in detection of reasons for vertigo and/or recurrent hearing loss in the later postoperative phase. CT may show the position and condition of prosthesis, scarring around the prosthesis and otospongiotic foci. Sometimes, it gives indirect hints for perilymphatic fistulas and incus necrosis. MRI is able to document inner ear complications. CT has a high negative predictive value in cases with a free cavity after mastoidectomy. Localized opacities or total occlusion are difficult to distinguish by CT alone. MRI provides important additional information in the differentiation of cholesterol granuloma, cholesteatoma, effusion, granulation and scar tissue

  8. CT and MR imaging after middle ear surgery

    Energy Technology Data Exchange (ETDEWEB)

    Koesling, Sabrina E-mail: sabrina.koesling@medizin.uni-halle.de; Bootz, F

    2001-11-01

    This article describes the current value of imaging in patients after stapes surgery and surgery after chronic otitis media including cholesteatoma. Possibilities and limits of computed tomography (CT) and MRI are described and most important investigation parameters are mentioned. After otosclerosis surgery, CT is the method of first choice in detection of reasons for vertigo and/or recurrent hearing loss in the later postoperative phase. CT may show the position and condition of prosthesis, scarring around the prosthesis and otospongiotic foci. Sometimes, it gives indirect hints for perilymphatic fistulas and incus necrosis. MRI is able to document inner ear complications. CT has a high negative predictive value in cases with a free cavity after mastoidectomy. Localized opacities or total occlusion are difficult to distinguish by CT alone. MRI provides important additional information in the differentiation of cholesterol granuloma, cholesteatoma, effusion, granulation and scar tissue.

  9. HRCT diagnosis in the evaluation of chronic middle ear inflammation

    Energy Technology Data Exchange (ETDEWEB)

    Yu, Jung Sik; Kim, Dong Ik; Suh, Jung Ho; Chung, Tae Sub [College of Medicine, Yonsei Univ., Seoul (Korea, Republic of)

    1990-10-15

    Though the preoperative high-resolution computed tomographic (HRCT) evaluation of the patients with chronic middle ear inflammation, the nature and potential complications of the lesions can be evaluated more accurately than previous imaging modalities. We retrospectively reviewed the HRCT findings of chronic middle ear inflammation in 50 surgically proven cases during recent 2 years. We also compared findings of HRCT and otologic surgery in order to know the diagnostic ability of HRCT about the true nature and extent of soft tissue inflammatory masses within the middle ear and various complications. The results obtained were as follows : 1. HRCT demonstrated the soft tissue inflammatory lesions in the middle ear cavity in all 50 cases. Among these, 32 cases were confirmed to have cholesteatoma, and 12 cases of granulations tissue including 2 cases of cholestrol granuloma, 3 cases of thickened mucosa and 3 cases of inflammatory exude were verified respectively. 2. Among the 32 cases of cholesteatoma, HRCT showed the ossicular erosion in 87% and other complications in 38% of cases. The types of cholesteatoma can be predicted according to the site and extension of soft tissue mass except in 6 cases. 3. Among the 12 cases of granulation tissue, HRCT also showed the erosion of ossicles in 50% and facial nerve canal in 17%. 4. Pars flaccida type cholesteatomas (21 cases) were most frequently noted in atticoantral area (67%) and pars tensa type (4 cases) in mesotympanum (75%). 5. Incus body and malleus head were the most vulnerable portions of bony erosion in pars flaccida type (10/21). 6. We met some difficulty in differentiation of the soft tissue inflammatory mass in 7 cases.

  10. Endoscopic tympanomastoid exploration

    OpenAIRE

    Sanjay, Kumar; Muthukumar, Ramamoorthy; Balasubramanian, Thiagarajan

    2012-01-01

    Tympano mastoidectomy is usually performed using operating microscope. This study reports a case series of tympanomastoidectomy which was performed using an endoscope. Endoscopic Tympanomastoidectomy for atticoantral type of CSOM is an excellent technique for complete removal of cholesteatoma especially from inaccessible areas of middle ear cleft including facial recess, sinustympani Transmeatal removal of disease from mastoid antrum and even tip cells is possible with endoscopes. ...

  11. ENDOSCOPIC TYPMPANOMASTOID EXPLORATION [FUNCTIONAL ENDOSCOPIC EAR SURGERY-FEES

    OpenAIRE

    Sanjay Kumar; Muthukumar Ramamoorthy; Balasubramanian Thiagarajan

    2012-01-01

    Tympano mastoidectomy is usually performed using operating microscope. This study reports a case series of tympanomastoidectomy which was performed using an endoscope.Endoscopic Tympanomastoidectomy for atticoantral type of CSOM is an excellent technique for complete removal of cholesteatoma especially from inaccessible areas of middle ear cleft including facial recess, sinustympani Transmeatal removal of disease from mastoid antrum and even tip cells is possible with endoscopes. Preservation...

  12. Mastoid Obliteration with Autologous Bone in Mastoidectomy Canal Wall Down Surgery: a Literature Overview

    OpenAIRE

    Alves, Ricardo Dourado; Cabral Junior, Francisco; Fonseca, Anna Carolina de Oliveira; Bento, Ricardo Ferreira

    2015-01-01

    Introduction The objectives of mastoidectomy in cholesteatoma are a disease-free and dry ear, the prevention of recurrent disease, and the maintenance of hearing or the possibility to reconstruct an affected hearing mechanism. Canal wall down mastoidectomy has been traditionally used to achieve those goals with greater or lesser degrees of success. However, canal wall down is an aggressive approach, as it involves creating an open cavity and changing the anatomy and physiology of the middle e...

  13. The Petro-Occipital Trans-Sigmoid Approach for Lesions of the Jugular Foramen

    OpenAIRE

    Mazzoni, Antonio

    2009-01-01

    This study's goals were twofold: (1) to analyze the author's experience with the petro-occipital trans-sigmoid (POTS) approach for the resection of tumors arising in or adjacent to the jugular foramen, and (2) to define the anatomical sites exposed by this approach. A retrospective review was conducted of 61 patients with jugular fossa tumors that included lower cranial nerve schwannomas, paragangliomas, meningiomas, chordomas, cholesteatomas, and other benign or low-grade malignant tumors. O...

  14. Intraoperative findings in revision chronic otitis media surgery.

    Science.gov (United States)

    Faramarzi, Abolhassan; Motasaddi-Zarandy, Masoud; Khorsandi, Mohammad-Taghi

    2008-03-01

    In this study, we reviewed the surgical findings in a series of revision tympanomastoidectomy to determine the most common causes of failure in chronic otitis media surgery. The intraoperative findings at revision mastoidectomy with tympanoplasty of 116 patients were analyzed. The most common sites of pathologic tissue at revision surgery (with cholesteatoma and/ or granulation tissue) were unexenterated cells of the sinodural angle. The most common mechanical cause of retention of debris in canal wall down procedures was facial ridge. PMID:18298298

  15. The Prevalence of Labyrinthine Fistula in Chronic Otitis Media Surgery in Shiraz, Southern Iran

    OpenAIRE

    Faramarzi, A H; Heydari, S T; Rusta, M

    2011-01-01

    Background The incidence of fistulas found during the surgery for chronic otitis media with cholesteatoma has been reported in a wide range in different geographical areas. This study aims to find the prevalence of labyrinthine fistula in the south of Iran. Methods A prospective cross sectional study of 787 (504 ears belong to 462 patients) consecutive tympanoplasty with or without mastoidectomy for chronic otitis media was performed. Data on preoperative clinical and preoperative and postope...

  16. Masses and disease entities of the external auditory canal: Radiological and clinical correlation

    International Nuclear Information System (INIS)

    A wide spectrum of disease entities can affect the external auditory canal (EAC). This review describes the normal anatomy of the EAC. Congenital abnormalities, infections, neoplasms, and miscellaneous conditions, such as cholesteatoma and acquired stenosis, are shown with reference to clinical relevance and management. Cases have been histologically confirmed, where relevant. The EAC is frequently imaged — for example, on cross-sectional imaging of the brain — and this review should stimulate radiologists to include it as an important area for review.

  17. Masses and disease entities of the external auditory canal: Radiological and clinical correlation

    Energy Technology Data Exchange (ETDEWEB)

    White, R.D., E-mail: richard.white3@nhs.net [Department of Clinical Radiology, Ninewells Hospital and Medical School, Dundee (United Kingdom); Ananthakrishnan, G. [Department of Clinical Radiology, Ninewells Hospital and Medical School, Dundee (United Kingdom); McKean, S.A. [Department of Otolaryngology, Ninewells Hospital and Medical School, Dundee (United Kingdom); Brunton, J.N. [Department of Clinical Radiology, Ninewells Hospital and Medical School, Dundee (United Kingdom); Hussain, S.S.M. [Department of Otolaryngology, Ninewells Hospital and Medical School, Dundee (United Kingdom); Sudarshan, T.A. [Department of Clinical Radiology, Ninewells Hospital and Medical School, Dundee (United Kingdom)

    2012-02-15

    A wide spectrum of disease entities can affect the external auditory canal (EAC). This review describes the normal anatomy of the EAC. Congenital abnormalities, infections, neoplasms, and miscellaneous conditions, such as cholesteatoma and acquired stenosis, are shown with reference to clinical relevance and management. Cases have been histologically confirmed, where relevant. The EAC is frequently imaged - for example, on cross-sectional imaging of the brain - and this review should stimulate radiologists to include it as an important area for review.

  18. ROLE OF HIGH RESOLUTION COMPUTED TOMOGRAPHY IN THE EVALUATION OF SUPPURATIVE DISEASES OF MIDDLE EAR AND MASTOIDS AND THEIR COMPLICATIONS WITH SURGICAL CORRELATION

    Directory of Open Access Journals (Sweden)

    Deb Kr

    2016-02-01

    Full Text Available OBJECTIVE High Resolution Computed Tomography (HRCT, a modification of routine CT, provides a direct visual window in the temporal bone providing minute structural details. Purpose of the present study was to evaluate the suppurative diseases of middle ear and mastoid with their complications on HRCT and to correlate these imaging findings surgically. Our study shows good correlation of various HRCT findings in suppurative diseases of middle ear & mastoids with intra-operative findings. MATERIALS AND METHODS This retrospective study included 60 patients who were referred to the Department of Radiodiagnosis, Assam Medical College with clinically suspected temporal bone or ear pathologies. After detailed clinical examination, the patients were subjected to HRCT examination. The imaging findings of all cases were correlated with the surgical findings. RESULTS Out of 60 patients, 63.3% had unsafe CSOM with cholesteatoma. The HRCT findings with surgical correlation showed a high 91.89% sensitivity for identifying cholesteatoma. HRCT also provided good sensitivity for detecting erosion of scutum (90.32%, erosion of ossicular chain (86.96% and erosion of lateral semi-circular canal (80%. HRCT had lower sensitivity (66.67% for identifying facial canal dehiscence. CONCLUSION The HRCT findings showed a good sensitivity with intraoperative findings in identification of cholesteatoma, erosion of scutum, ossicular chain and semi-circular canal.

  19. An evaluation of preoperative computed tomography on patients with chronic otitis media.

    Science.gov (United States)

    Yildirim-Baylan, Muzeyyen; Ozmen, Cihan Akgul; Gun, Ramazan; Yorgancilar, Ediz; Akkuş, Zeki; Topcu, Ismail

    2012-03-01

    This study aimed to compare the veracity of computed tomography findings on patients undergoing surgery for chronic otitis media (COM) with the surgical findings, and to determine to what extent the preoperative computerized tomography (CT) findings are useful to the surgeon. A series of 56 patients with COM undergoing preoperative CT scanning followed by surgical exploration of the middle ear and mastoid. Operative notes were recorded and data collected on the nature of soft tissue masses, the status of the ossicles, presence or absence of facial canal dehiscence and semicircular canal (SCC) dehiscence and the presence or absence of dural plate erosion, and sigmoid sinus thrombosis. Fifty-six patients were recruited in the study, 30 males and 26 females. The age range was from 16 to 67 years with a mean of 26.51 ± 1.4 years. The preoperative CT scan imaging in cases of cholesteatoma, ossicular chain erosion and SCC dehiscence have good correlation with the intraoperative findings. The specificity of preoperative CT scan in detecting facial canal dehiscence, dural plate erosion and sigmoid sinus thrombosis in patient of COM were weak. Preoperative computed tomography evaluation is fairly useful especially in cases of cholesteatoma. According to the results of this study, CT is of value particularly in the definition of cholesteatoma, and in determining ossicular chain erosion and semicircular canal fistula. PMID:23449285

  20. The Surgical Management of Tympanic Membrane Retraction Pockets Using Cartilage Tympanoplasty.

    Science.gov (United States)

    Kasbekar, Anand V; Patel, Virjen; Rubasinghe, Mihiri; Srinivasan, Venkat

    2014-12-01

    Evaluate the surgical treatment of tympanic membrane (TM) retractions with modified cartilage augmentation tympanoplasty. Retrospective review of subjects with Charachon stage II and III TM retractions who underwent modified cartilage augmentation tympanoplasty following excision of the retracted TM segment. Pre and postoperative symptoms and air-bone gaps were recorded. Forty two ears were included in the study. Twenty six ears were of stage II and 16 were stage III retractions. 35 (83 %) ears had ossicular erosion and cholesteatoma was found in 13 (31 %) ears, all in stage III retractions. Follow-up ranged 12-102 months. The air-bone gap (ABG) improved in 29 (76 %) and worsened in seven (19 %). Ears without cholesteatoma had a greater improvement in ABG. The results of our modified cartilage tympanoplasty technique are comparable to the published literature and should provide a safe and acceptable result. The high rate of cholesteatoma found preoperatively in stage III retractions advocates early surgical intervention. PMID:26396960

  1. Comparative Study Between Radiological and Surgical Findings of Chronic Otitis Media

    Directory of Open Access Journals (Sweden)

    Prata, Anelise Abrahao Salge

    2011-01-01

    Full Text Available Introduction: The chronic otitis media (COM is a prevalent disease and the most frequent cause of indication to mastoidectomy. Many studies have evaluated the use of tomography (CT of temporal bones for preoperative evaluation of COM and its indication in the preoperative approach is still controversial nowadays. Objective: To evaluate the sensitivity of the clinical and radiological findings of COM according to the intraoperative surgical results and histopathological findings. Method: Transversal retrospective study through collection of record data of patients with COM submitted to mastoidectomy in the period from 2007 through 2008 in our service. Results: From a total of 82 ears, 40.24% had cholesteatoma. The CT presented 72.73% of sensitivity in the identification of cholesteatoma, 56.67% in the identification of changes to the ossicular chain and 100% in that of erosion of the lateral semicircular canal. Conclusion: The clinical and radiological findings showed a high level sensitivity with intraoperative findings as regards to the presence of cholesteatoma, large changes of the ossicular chain and erosion of the lateral semicircular canal. For minor changes to the ossicular chain, the facial nerve canal and the tympanic tegmen they described low sensitivity.

  2. CT and MRI of the middle ear

    International Nuclear Information System (INIS)

    High-resolution computed tomography (HRCT) provides excellent contrast between osseous structures, air and soft tissue in conjunction with high spatial resolution. Therefore, thin-section HRCT with bone window setting is the method of choice for the examination of the middle ear structures. The indications are acute and chronic inflammatory changes, cholesteatoma and tumor, the 'postoperative middle ear', and malformations. In most cases, HRCT enables differentiation between inflammatory changes, cholesteatoma, and tumor. The excellent depiction of subtle osseous details enables the identification of erosions of the ossicles or of the bony walls of the mastoid cells, of osseous defects of the tegmen, of the bony labyrinth, and of the tympanic course of the facial canal. In addition, HRCT enables excellent depiction of reconstructions of the ossicles or prosthesis of the ossicles. Although HRCT is the first method of choice, magnetic resonance imaging (MRI) may provide additional information and lead to a more accurte diagnosis in some cases. The is explained by the excellent soft tissue contrast provided by MRI. In addition, MRI offers the possibility of using various pulse sequences and the administration of IV contrast material. Therefore, MRI may allow the differentiation between inflammatory changes, cholesteatoma, and tumor in those cases in which accurate diagnosis cannot be made by HRCT. (orig./AJ)

  3. Mastoid Obliteration with Autologous Bone in Mastoidectomy Canal Wall Down Surgery: a Literature Overview.

    Science.gov (United States)

    Alves, Ricardo Dourado; Cabral Junior, Francisco; Fonseca, Anna Carolina de Oliveira; Bento, Ricardo Ferreira

    2016-01-01

    Introduction The objectives of mastoidectomy in cholesteatoma are a disease-free and dry ear, the prevention of recurrent disease, and the maintenance of hearing or the possibility to reconstruct an affected hearing mechanism. Canal wall down mastoidectomy has been traditionally used to achieve those goals with greater or lesser degrees of success. However, canal wall down is an aggressive approach, as it involves creating an open cavity and changing the anatomy and physiology of the middle ear and mastoid. A canal wall up technique eliminates the need to destroy the middle ear and mastoid, but is associated with a higher rate of residual cholesteatoma. The obliteration technics arise as an effort to avoid the disadvantages of both techniques. Objectives Evaluate the effectiveness of the mastoid obliteration with autologous bone in mastoidectomy surgery with canal wall down for chronic otitis, with or without cholesteatoma. Data Synthesis We analyzed nine studies of case series comprehending similar surgery techniques on 1017 total cases of operated ears in both adults and children, with at least 12 months follow-up. Conclusion Mastoid Obliteration with autologous bone has been utilized for many years to present date, and it seems to be safe, low-cost, with low recurrence rates - similar to traditional canal wall down procedures and with greater water resistance and quality of life improvements. PMID:26722350

  4. Mastoid Cavity Obliteration with Combined Palva Flap and Bone pâté

    Directory of Open Access Journals (Sweden)

    Samad ghiasi

    2015-01-01

    Full Text Available Introduction: This study was designed to evaluate the usefulness of mastoid cavity obliteration with combined bone pâté and Palva flap in the prevention of problematic mastoid cavities after canal wall down mastoidectomy.   Materials and Methods: In a prospective longitudinal study with a mean follow-up of 28 months conducted between 2008–2012, a series of 56 ears in 48 patients with chronic otitis media due to a cholesteatoma underwent canal wall down mastoidectomy that their mastoid cavity obliterated with combined bone pâté and Palva flap. Seventeen (30% ears were managed via revision surgery, with the reminder via primary surgery. Data included mastoid cavity status, results at second-look surgery with ossiculoplasty, and postoperative complications.   Results: All patients underwent second-look surgery. Forty-six (82% ears maintained a very small, dry and healthy mastoid cavity. Seven (13% ears had occasional otorrhea, and three (5% ears had small granulation tissue. Seven (12.5% ears had residual cholesteatoma pearl in the middle ear at second-look surgery. Four (7% ears exhibited wound infection.   Conclusion:  Canal wall down mastoidectomy and mastoid cavity obliteration with combined bone pâté and Palva flap is a effective option for the complete removal of cholesteatoma and prevention of postoperative mastoid cavity problems.

  5. Concomitancia de meningoencefalocele y colesteatomas en el oído medio: Comentarios sobre 1 caso

    Directory of Open Access Journals (Sweden)

    Armando J Figueroa Hernández

    1999-08-01

    Full Text Available Se presenta el caso de una niña de 9 años, con un meningoencefalocele mastoideo, adosado a un colesteatoma residual, secundarios a un colesteatoma primario petromastoideo, operado 2 años antes, que ocupaban toda la cavidad mastoidea hasta el meato auditivo externo. Conjuntamente se extirparon 3 perlas de colesteatoma de la caja timpánica que destruyeron parte de la cadena osicular, y fue necesario realizarle una columelización con los restos del martillo. Actualmente, 15 años después, conserva buena evolución clínica y audiométricaThe case of a 9-year-old girl with a mastoid meningoencephalocele adhered to a residual cholesteatoma, secondary to a primary petromastoid cholesteatoma, that occupied the whole mastoid cavity up to the external auditory meatus is presented. This patient had been operated on 2 years before 3 pearls of cholesteatoma were also removed from the tympanic cavity that destroyed part of the ossicular chain, and it was necessary to perform a columella with the rest of the malleus. At present, 15 years later, the patient has a good clinical and audiometric evolution

  6. The Validity of Computed Tomography in Complicated Chronic Otitis Media

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    M. Sadoghi

    2007-10-01

    Full Text Available Background/Objective: We assessed the validity of computed tomography (CT in the diagnosis of complicated chronic otitis media (COM. "nPatients and Methods: The findings obtained from a pre-operative high resolution CT of temporal bone including coronal and axial views of 20 patients with complicated COM were compared to their intraoperative findings."nResults: In our study, CT was helpful in determining the anatomy of the mastoid and could accurately predict the mastoid air cell aeration, size and status of ossicles, presence of lateral semicirculal canal (SCC fistula and post-auricular fistula (All sensitivities equal to 100%. But it overdiagnosed the erosion of tegmen (positive predictive value of 50%. CT was unable to distinguish between cholesteatoma and fluid (abscess or effusion and granulation tissue or polyps and was also unable to correctly reveal the facial nerve dehiscence and had a low sensitivity for showing erosion of facial canal (50% and sigmoid sinus (60%."nConclusion: Because most complications resulting from cholesteatoma are caused by bony erosions, CT is helpful in determining the complications of COM. CT can accurately predict the extent of disease and is helpful in detection of some complications such as fistula of Lateral Semicircular Canal (LSC, erosions of dural plate and ossicular erosions. However, it is unable to distinguish between cholesteatoma, mucosal disease and fluid, and little it did contribute to detecting the facial nerve course and dehiscence. It cannot also be used for the diagnosis of the sigmoid sinus problems which could be related to no contrast administration in our study.

  7. Complications of chronic suppurative otitis media: a retrospective review.

    Science.gov (United States)

    Yorgancılar, E; Yildirim, M; Gun, R; Bakir, S; Tekin, R; Gocmez, C; Meric, F; Topcu, I

    2013-01-01

    The purpose of this study was to review our patients with complications of chronic suppurative otitis media (CSOM) and compare with literature. This retrospective study was performed over 10 years in our tertiary referral university hospital. During this period 4,630 patients with CSOM were admitted to the department and 906 patients underwent a surgery. From the records of the 4,630 patients, 121 patients (2.6%) with complications were identified. Of the 906 CSOM patients that underwent a surgery, 511 had cholesteatoma, and 395 had granulation and/or polyp tissue. Ninety-four of 511 (18.4%) patients with cholesteatoma and 27 of 395 (6.8%) patients with granulation and/or polyp tissue had a complication. Of the 121 complicated CSOM patients, 57 extracranial (47.1%) and 37 intracranial (30.6%). Multiple combined complications were occurred in 27 (22.3%) patients. The mastoid abscess was the commonest extracranial complication (28.3%); it was followed by labyrinthitis (9%), facial nerve paralysis (8.4%), and Bezold's abscess (1.3%). The most common intracranial complication was lateral sinus thrombophlebitis (19.5%), followed by perisigmoid sinus abscess (13.5%), meningitis (9%), brain abscess (6.5%), and extradural abscess (4.5%). Most frequent intraoperative finding of complicated CSOM patients was cholesteatoma, with the exception of patients with facial nerve paralysis. There was no mortality in any of our patients. The additional morbidities were recorded in 25 patients (20.6%). In this study, we emphasize the importance of an accurate and early diagnosis, followed by adequate surgical therapy and a multidisciplinary approach. PMID:22249835

  8. Incus and stapes necrosis associated with diabetes mellitus.

    Science.gov (United States)

    Tüz, M; Doğru, H; Yasan, H; Döner, F; Yariktaş, M

    2006-07-01

    Chronic otitis media is often associated with ossicular defects, the most frequent being necrosis of the long process of incus. Except for infection and cholesteatoma; trauma and local pressure by chorda tympani are uncommon causes leading to incus erosion. In the literature, no case of incus necrosis has been reported associated with type II diabetes mellitus (DM). A patient is presented in this report with incus and stapes suprastructure necrosis and associated type II DM who was admitted to the out-patient clinic with complaints of conductive hearing loss. PMID:16834796

  9. Diagnostic value of the coronary CT scan

    International Nuclear Information System (INIS)

    Using high-resolution computed tomography, coronary scanning has been made to investigate the radiographical details of the middle and inner ear organs. Twenty patients with chronic otitis media, secondary cholesteatoma, sensorineural hearing loss, facial spasm, and suspected meningitis, were evaluated. In 26 of 40 ears in this series, the coronary scans sharply outlined almost all of the bony structures, and showed also the eardrum as a clearly defined soft tissue, but no abnormal radiographical findings were recognized. In the remaining ears with chronic otitis media, the scans were valuable in demonstration of mucosal thickening, granulation tissue, and destruction of the auditory ossicles. (author)

  10. Chronic silent otitis media.

    Science.gov (United States)

    Paparella, Michael M; Schachern, Patricia A; Cureoglu, Sebahattin

    2002-01-01

    Otitis media occurs along a continuum. For example, otitis media with effusion characterized by fluid pathology can lead to chronic otitis media plus chronic mastoiditis, characterized by the presence of intractable tissue pathology such as cholesteatoma, cholesterol granuloma or granulation tissue. The literature defines chronic otitis media as having a tympanic membrane perforation and otorrhea. Amongst many other sequelae, which can result from the continuum, an important common one is chronic silent otitis media. This overlooked entity which includes pathology beneath an intact tympanic membrane is commonly seen in our human temporal bone laboratory and in patients. The clinical pathological correlates of this important disease are discussed herein. PMID:12021496

  11. Diagnostic value of the coronary CT scan

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    Kiuchi, S. (Tsukuba Univ., Sakura (Japan))

    1982-09-01

    Using high-resolution computed tomography, coronary scanning has been made to investigate the radiographical details of the middle and inner ear organs. Twenty patients with chronic otitis media, secondary cholesteatoma, sensorineural hearing loss, facial spasm, and suspected meningitis, were evaluated. In 26 of 40 ears in this series, the coronary scans sharply outlined almost all of the bony structures, and showed also the eardrum as a clearly defined soft tissue, but no abnormal radiographical findings were recognized. In the remaining ears with chronic otitis media, the scans were valuable in demonstration of mucosal thickening, granulation tissue, and destruction of the auditory ossicles.

  12. Evaluation of high-resolution CT after tympanoplasty

    International Nuclear Information System (INIS)

    This paper reports on the condition of the middle ear cavity following tympanoplasty which is always of great interest to radiologists and otosurgeons. This study consisted of 21 patients who had various types of tympanoplasty (types I-IV) for chronic otitis media and cholesteatoma by using high-resolution CT (HRCT). HRCT following tympanoplasty was a valuable method for assessing the middle ear aeration and the state of ossicular reconstruction, including stapes prosthesis, although in some cases of soft-tissue mass in the middle ear it was necessary to correlate with clinical findings in order to differentiate between granulation and recurrence

  13. Determinants of sensorineural hearing loss in chronic middle-ear disease.

    Science.gov (United States)

    Kasliwal, Neeraj; Joshi, Sanjeev; Pareek, S M

    2004-10-01

    A statistical study was carried out on SNHL in CSOM. The study group consisted of 1,828 patients suffering from CSOM who underwent surgery at our centre from 1982 to 2001, out of these 510 cases with unilateral CSOM were selected for this study by a strict selection criteria so as to eliminate covariables such as exposure to acoustic trauma, head injury, previous ear surgery and hereditary causes. The healthy ear served as control. We determined the average SNHL in relation to the age of onset, duration of disease, examining it in relation to other eventual aural complications such as cholesteatoma, ossicular chain erosion und otorrhea.On the basis of data obtained we observed consistent co-relation between severity of SNHL and duration of the disease, presence of cholesteatoma, ossicular erosion, attic and subtotal perforations. These findings suggest that more severe middle ear disease may result in SNHL and thus early intervention in cases of chronic suppurative Otitis media is desired. PMID:23120094

  14. Radiologic and surgical findings in chronic suppurative otitis media.

    Science.gov (United States)

    Gül, Aylin; Akdağ, Mehmet; Kiniş, Vefa; Yilmaz, Beyhan; Şengül, Engin; Teke, Memik; Meriç, Faruk

    2014-11-01

    Our aim in this study was to evaluate the efficiency of preoperative temporal bone computed tomography (CT) in detecting pathologic conditions in patients with chronic suppurative otitis media (CSOM). The intraoperative findings and temporal bone CT results of 350 patients who were diagnosed with CSOM between September 1, 2010, and June 1, 2013, were compared. Comparison parameters were as follows: the presence of cholesteatoma, erosion of the outer ear bone canal, erosion of the middle ear chain, erosion of the dural plate, erosion of the lateral semicircular canal, erosion of the sigmoid sinus wall, and dehiscence of the facial canal. The contribution of CT was limited in showing the outer ear canal destruction, dural plate destruction, facial canal destruction, lateral semicircular canal destruction, and destruction of the sigmoid sinus wall. However, CT was more sensitive in detecting cholesteatoma and erosion of the ossicular chain. These results indicate that preoperative CT of patients with CSOM serves as an important guide for otolaryngologists, although there are limitations in the evaluation of the CT results. PMID:25377960

  15. Colesteatomas dos plexos coróides dos eqüídeos: observação de 14 casos Çholesteatomas of the choroid plexus of equidae: report on 14 cases

    Directory of Open Access Journals (Sweden)

    Milton Thiago de Mello

    1949-12-01

    Full Text Available O autor faz considerações sobre os colesteatomas dos plexos coróides dos ventrículos laterais do cérebro e da base do cerebelo dos eqüídeos, examinando alguns aspectos da etiologia dessas colesteatose, baseado na literatura e em suas observações pessoais. Descreve, pela primeira vez no Brasil, casos de colesteatomas em eqüídeos, em número de 14, num total de 38 solípedes examinados (38,8%. Constatou a presença da lesão em muar, fato ainda não registrado na literatura.The author discusses cholesteatomas of the choroid plexus of the lateral ventricles of the cerebrum and of the base of the cerebellum in Equidae, examining some aspects of aetiology of this cholesteatosis based on the literature and on his personal observations. He describes for the first time in Brazil, cases of cholesteatomas in Equidae, 14 in number of a total of 38 solipeds examined (36,8%. He found the presence of the lesion in the mule: a fact not yet men¬tioned in the literature.

  16. [Tuberculous Otitis media - a rare differential diagnosis in Germany].

    Science.gov (United States)

    Teschner, M; Kramer, S; Donnerstag, F; Länger, F; Lenarz, Th; Schwab, B

    2008-07-01

    A 28-year-old female patient with a migrant background presented for surgery with a suspected cholesteatoma in the left ear. The patient reported having had an aural discharge for several months; otoscopic examination revealed a runny ear, and discrete granulation tissue was seen. Pure-tone audiometry showed conduction hearing loss of 30-40 dB across all frequencies in the left ear; high-resolution computed tomography of the temporal bone revealed that the mastoid and tympanic cavity were completely obscured. The intraoperative finding showed a caseous space-occupying mass that completely filled the tympanic cavity. The suspected diagnosis of tuberculosis was corroborated by pathohistological, microbiological and molecular biological tests. Tuberculostatic therapy was initiated at a different location. Although tuberculosis of the middle ear is a rare condition in Germany, it should nevertheless be considered when making a differential diagnosis, especially in high-risk patients where cholesteatoma is suspected on clinical and radiological evidence or in patients with a chronic middle ear process. PMID:18688924

  17. MRI diagnosis of primary tumors in Molkick cave

    International Nuclear Information System (INIS)

    Objective: To explore the MRI characteristics of primary tumors in Meckel cave (MC), and to evaluate the diagnostic value of the changes of MC and adjacent structures. Methods: 14 pathologically confirmed primary tumors in Meckel cave were studied. Pre-contrast MRI scan was performed in 4 cases, post-contrast MRI scan in 2 cases, both pre- and post-contrast MRI scan in 8 cases. Results: (1) Schwannoma was the most common tumor, and followed by meningeoma, fibroneuroma, and cholesteatoma. (2) The meningeoma and cholesteatoma had characteristic signal in MRI, some Schwannoma and fibroneuroma had similar MRI demonstrations. (3) The change of MC included cave enlargement, bulging dural walls, trigeminal cistern narrowing or obliteration, loss of fibers-background contrast. (4) The changes of adjacent structures included compression of temporal lobe, pons, basilar artery, cerebellar hemisphere, and the forth ventricle, cavernous sinus narrowing, and petrous pyramid hone absorption. Conclusions: The signals of tumors were helpful to establish the diagnosis, and can be used to estimate the tumor pathological components, the changes of MC and adjacent structure can be used in localizing the tumors. (authors)

  18. HEARING OUTCOME IN CANAL WALL DOWN MASTOIDECTOMY WITH TYMPANOPLASTY

    Directory of Open Access Journals (Sweden)

    Praveen Kumar

    2015-04-01

    Full Text Available CONTEXT: Tympanomastoid cholesteatoma destroys the tympanic membrane and ossicles resulting in a conductive hearing loss . A canal wall down mastoidectomy with tympanoplasty is performed for disease removal and correction of deafness . This surgery is technically challenging and results depend upon a number of factors like eustachian tube function , severity of middle ear pathology , status of remnant ossicular chain , reconstruction technique employed and post - operative healing . AIM: To compare the pre - operative versus post - operative hearing in patients undergoing canal wall down mastoidectomy with tympanoplasty . SETTING AND DESIGN: Prospective study conducted at a tertiary referral institution . MATERIALS AND METHODS: Si xty six patients with chronic suppurative otitis media with cholesteatoma underwent a canal wall down mastoidectomy with tympanoplasty . Preoperative and postoperative airbo r ne gaps were compared . RESULTS: The preoperative mean air bone gap was 38 . 10 dB and the post - operative mean air bone gap was 29 . 30 dB with a gain of 8 . 8 dB . CONCLUSION: Canal wall down mastoidectomy with tympanoplasty is a good surgical procedure to augment the patients hearing to acceptable social levels .

  19. Pars tensa retraction pockets in children: treatment by excision and ventilation tube insertion.

    Science.gov (United States)

    Srinivasan, V; Banhegyi, G; O'Sullivan, G; Sherman, I W

    2000-08-01

    Tympanic membrane retraction pockets involving the pars tensa are not uncommon in clinical practice. Recurrent infections, ossicular erosion and cholesteatoma are the recognized sequelae. The management options include surveillance, medical treatment and surgery. The surgical procedures range from grommet insertion to extensive tympanoplasty procedures. We report our experience with simple excision and grommet insertion, performed in 31 ears in 26 patients as day cases. The follow-up ranged from 8 to 34 months with a mean of 16 months. The procedure was successful in 23 ears (success rate of 74%). Recurrence of retraction occurred in seven ears and in one ear there was a persistent perforation. Age, previous grommet insertion and severity of retraction did not have a statistically significant influence on the final outcome. We conclude that excision and grommet insertion is a simple, safe and efficient procedure for the management of tympanic membrane retraction pockets and can be considered in preference to extensive tympanoplasty. PMID:10971530

  20. Prospective study of tympanic membrane retraction, hearing loss, and multifrequency tympanometry.

    Science.gov (United States)

    Li, Y; Hunter, L L; Margolis, R H; Levine, S C; Lindgren, B; Daly, K; Giebink, G S

    1999-11-01

    Tympanic membrane retraction is a significant sequela of OME and has been linked clinically to atelectasis, ossicular erosion, and cholesteatoma. We investigated important factors for prediction of tympanic membrane retraction in a prospective study of 112 children. After 4 to 6 years of follow-up, 12% of ears had pars tensa retraction without atrophy, and 28% had various degrees of retraction with atrophy. Mild pars flaccida retraction was present in 23%, and severe pars flaccida retraction was present in 12%. Retraction severity was related to hearing level and multifrequency tympanometry. Three factors were significantly related to retraction severity: type of tube, male sex, and percent of visits in the second year with abnormal tympanograms. This study shows that type of tube was the most important factor in long-term outcome after tympanostomy tube treatment of OME. PMID:10547462

  1. Autograft ossicle selection in cholesteatomatous ear disease: histopathological considerations.

    Science.gov (United States)

    Rupa, V; Krishnaswami, H; Job, A

    1997-09-01

    In order to determine whether selection of autograft ossicles in cholesteatomatous ear disease should be based upon their appearance under the surgical operating microscope, we studied the histopathological features of 113 such ossicles. We attempted to correlate the extent of erosion of the ossicle, as noted under the surgical operating microscope, with their histopathological appearance. There were 60 mallei and 53 includes. Seventy-nine ossicles were eroded and 34 were intact. The commonest abnormality noted was erosion of the long process of the incus (75 per cent). Both intact and eroded ossicles had similar histological features. There was no evidence of intra-ossicular cholesteatoma. The results suggest that the extent of erosion of these ossicles as seen under the surgical operating microscope should in no way prejudice their use as autografts when required. PMID:9373543

  2. Diseases of the petrous bone - demands made on radiodiagnostics from an otosurgical viewpoint

    International Nuclear Information System (INIS)

    The present study aims at explaining by means of case reports the specific otosurgical problems in typical diseases of the otobase and at presenting the ranking of the individual imaging methods from the surgeon's point of view. For example, special features in the preoperative diagnosis of glomus tumours, acoustic neurinomas. Meniere's disease, cholesteatomas and so-called petrous bone tip processes are pointed out. A special aspect of radiological and surgical collaboration is seen in highly vascularised tumours of the otobase in respect of the possibilities offered by interventional angiography. The importance of MR-tomography in preoperative diagnostics is assessed with some reservation because this does not show up surgically relevant landmarks. (orig./MG)

  3. INTRAOPERATIVE FINDINGS IN REVISION MASTOID SURGERY

    Directory of Open Access Journals (Sweden)

    M. Sadoghi P. Dabirmoghaddam

    2007-08-01

    Full Text Available While the main goals of surgery for chronic otitis media are elimination of disease and improving hearing, sometimes persistent drainage continues and mandates revision surgery. The aim of this study is to assess the intraoperative findings during revision mastoid surgery and to ascertain the preventable factors. A total of 88 revision mastoidectomies performed from 1996 to 2000 at Amiralam university hospital in Tehran were reviewed. The most frequent findings during surgery were retained infected air cells, cholesteatoma and mucosal inflammation/granulation tissue. The overall success of revision surgery was 97.5%. (Providing a dry and safe ear While hearing preservation is possible in most cases, improvement of hearing is a difficult goal in these patients. With careful preoperative assessment and performing a complete surgical approach, the primary goal of revision mastoid surgery is obtainable in most patients.

  4. The evaluation of HRCT in the diagnosis of chronic otitis and mastoiditis

    International Nuclear Information System (INIS)

    Objective: To explore the value of' HRCT in the diagnosis of chronic otitis and mastoiditis. Method: Thirty-five patients with chronic otitis and mastoiditis received high resolution CT scan (HRCT). Results: (1) In cases of cholesteatoma, the mass was seen in tympanic sinus and the tympanum area; where the positive rate of' drum damage was 92% and most of the damage of substantia ossea involved the adjacent tissue. The positive rate of the disappearance, damage and cirrhosis of otosteon was 94% in patients with granuloma-type mastoiditis. The damage of eardrum wall was revealed in 15% cases of granuloma-type, in which ossicular chain was revealed wrapped with granulation tissue. The damage of ossicular chain was 23% in cases of granuloma-type. In cases of simple type, the damage of eardrum wall and the substantia ossea adjacent the ossicular chain was rare, and there was no mass. Conclusions: The HRCT is useful in the diagnosis of chronic mastoiditis. (authors)

  5. [Middle ear cancer hidden by chronic otitis media--a case report].

    Science.gov (United States)

    Wierzbicka, Małgorzata; Gawecki, Wojciech; Leszczyńska, Małgorzata; Kopeć, Tomasz

    2008-01-01

    The authors would like to present a rare case of the middle ear cancer which has been developed in postoperative cave in 67 years old patient operated for cholesteatoma 50 years earlier. The patient was admitted to the ENT Department of Poznań University of Medical Sciences because of the ear suppuration and headache occurring for 3 months. CT and MR images suggested granulation tissue filling the postoperative spaces with bone destruction, infiltration of the dura and temporal lobe abscess formation. Intraoperative findings allowed excluding the preliminary diagnosis of intracranial complication in the course of chronic otitis media, revealing the tissue masses resembling neoplastic infiltration. The histopathology examination confirmed the final diagnosis of squamous cell cancer. The patient was directed to radiotherapy. The authors report a case of middle ear squamous cell carcinoma and discuss its diagnostic aspect. PMID:19205537

  6. Magnetic resonance imaging in inflammatory lesions of the middle ear

    Energy Technology Data Exchange (ETDEWEB)

    Tono, Tetsuya; Saku, Kazuaki; Miyanaga, Satoshi; Kano, Kiyo; Morimitsu, Tamotsu; Suzuki, Yukiko.

    1988-05-01

    Eighteen patients with chronic otitis media, middle ear cholesteatoma, and postoperative inflammatory diseases of the middle ear underwent high resolution computerized tomography (CT) and magnetic resonance imaging (MRI) before surgical exploration of the middle ear. Results showed that CT provides higher detail resolution in middle ear structures, but provides limited density resolution in displaying inflammatory soft tissue lesions. By contrast, MRI differentiates among soft tissue lesions such as fluid-filled spaces, granulation tissues, and cholesteatomatous debris. Cholesterin granulomas show a particularly characteristic signal pattern with a very high intensity area in both T1 and T2 weighted images. It is concluded that MRI is useful in differentiating soft tissue density masses when used in conjunction with CT in middle ear inflammatory diseases.

  7. Magnetic resonance imaging in inflammatory lesions of the middle ear

    International Nuclear Information System (INIS)

    Eighteen patients with chronic otitis media, middle ear cholesteatoma, and postoperative inflammatory diseases of the middle ear underwent high resolution computerized tomography (CT) and magnetic resonance imaging (MRI) before surgical exploration of the middle ear. Results showed that CT provides higher detail resolution in middle ear structures, but provides limited density resolution in displaying inflammatory soft tissue lesions. By contrast, MRI differentiates among soft tissue lesions such as fluid-filled spaces, granulation tissues, and cholesteatomatous debris. Cholesterin granulomas show a particularly characteristic signal pattern with a very high intensity area in both T1 and T2 weighted images. It is concluded that MRI is useful in differentiating soft tissue density masses when used in conjunction with CT in middle ear inflammatory diseases. (author)

  8. STUDY OF VARIOUS CAUSES OF FACIAL PALSY AND ITS MANAGEMENT PROTOCOL

    Directory of Open Access Journals (Sweden)

    Venkataramana Rao

    2015-12-01

    Full Text Available Facial palsy is generally due to a congenital or acquired cause. It is often associated with severe disfigurement, emotional disturbance and anxiety. The causes for facial palsy vary in different age groups. In neonates and infants, the facial palsy is often associated with birth injuries or developmental anomalies of the ear. 1 In adults and older age group, infective conditions like cholesteatoma, tuberculous otitis media, encephalitis and neoplastic condition like glomus jugular tumour and facial nerve tumours are observed as a cause for facial palsy. Recovery from facial nerve palsy depends on the cause. Reasonably good recovery is seen in Bell’s palsy after medical treatment. Similar results are obtained in chronic suppurative otitis media associated with granulation tissue after surgical intervention.

  9. Graft Take-Rates After Tympanoplasty

    DEFF Research Database (Denmark)

    Andersen, Steven Arild Wuyts; Aabenhus, Kristine; Glad, Henrik; Sørensen, Mads Sølvsten

    2014-01-01

    OBJECTIVE: To present a prospective ear surgery database and investigate the graft take-rate and prognostic factors for graft take-rate in tympanoplasty using the database. STUDY DESIGN: Prospective database study. SETTING: Tertiary referral center. PATIENTS: A total of 1606 cases undergoing...... tympanoplasty types I to IV were registered in the database in the period from February 2004 to November 2013. INTERVENTION: A total of 837 cases underwent myringoplasty/tympanoplasty type I. MAIN OUTCOME MEASURE: Graft take-rate and prognostic factors (age, discharge at time of surgery, tuba function......, technique, graft material, and revision surgery) for tympanoplasty type I were studied. A comparison with the graft take-rates for tympanoplasty types II to IV and/or cholesteatoma was made. RESULTS: A user-friendly ear surgery database with fast data entry and direct import of audiometric data was...

  10. Congenital ossicular malformation. A study of 27 ears

    International Nuclear Information System (INIS)

    Despite otological surgerical progress improving clinical congenital ossicular malformation management, some cases remain inadequately treated. We report 27 cases of congenital ossicular malformation, focusing on reasons for remaining or delayed postoperative hearing loss evaluated in 27 congenital ossicular malformation cases in Kyoto Prefecture from 2002 to 2008. Overall success was 93% (25/27) 6 months postoperatively. Two ears had no hearing improvement and three delayed hearing loss 8 to 48 months postoperatively. The first two ears underwent small fenestration stapedotomy with malleus attachment piston, and the other three tympanoplasty type III using an autologous ossicle or total ossicular replacement prosthesis (TORP) as a columella. We discuss problems and solutions using a malleus attachment piston or prosthesis, preoperative audio- and radiological findings, and operative findings including facial nerve anomaly and congenital cholesteatoma. (author)

  11. Helical CT of congenital ossicular anomalies

    International Nuclear Information System (INIS)

    Since January 1996 to December 2000, 26 cases of congenital ossicular anomaly could be diagnosed with helical CT. All cases were unilateral. In 8 patients with malformation of the external ear, CT showed malleoincudal fixation (n=5), malleoincudal fixation and deformed incuts long process (n=1), deformed incus long process (n=1), and partial fusion of malleus neck and incus long process (n=1). In 18 patients with normal external ear, CT showed defect of the incus long process (n=5), defect of both the incus long process and stapes superstructure (n=8, 2 patients with congenital cholesteatoma, 1 with hypoplastic oval window), defect of the stapes superstructure (n=2, 1 patient with oval window absence), defect of the malleus manubrium (n=1), ossification of the stampede's tendon (n=1), and monopod stapes (n=1). Helical CT can evaluate the auditory ossicular chain in detail and is useful for diagnosing congenital ossicular anomaly. (author)

  12. Petrous apex lesions in the pediatric population

    Energy Technology Data Exchange (ETDEWEB)

    Radhakrishnan, Rupa [University of Cincinnati College of Medicine, Department of Radiology, Cincinnati, OH (United States); Cincinnati Children' s Hospital Medical Center, Department of Radiology, Cincinnati, OH (United States); Son, Hwa Jung [University of Cincinnati College of Medicine, Department of Otolaryngology-Head and Neck Surgery, Cincinnati, OH (United States); Koch, Bernadette L. [Cincinnati Children' s Hospital Medical Center, Department of Radiology, Cincinnati, OH (United States)

    2014-03-15

    A variety of abnormal imaging findings of the petrous apex are encountered in children. Many petrous apex lesions are identified incidentally while images of the brain or head and neck are being obtained for indications unrelated to the temporal bone. Differential considerations of petrous apex lesions in children include ''leave me alone'' lesions, infectious or inflammatory lesions, fibro-osseous lesions, neoplasms and neoplasm-like lesions, as well as a few rare miscellaneous conditions. Some lesions are similar to those encountered in adults, and some are unique to children. Langerhans cell histiocytosis (LCH) and primary and metastatic pediatric malignancies such as neuroblastoma, rhabomyosarcoma and Ewing sarcoma are more likely to be encountered in children. Lesions such as petrous apex cholesterol granuloma, cholesteatoma and chondrosarcoma are more common in adults and are rarely a diagnostic consideration in children. We present a comprehensive pictorial review of CT and MRI appearances of pediatric petrous apex lesions. (orig.)

  13. The bony crescent sign - a new sign of facial nerve schwannoma

    International Nuclear Information System (INIS)

    Schwannomas are relatively uncommon intracranial tumours. They most commonly involve the acoustic nerve followed in frequency by the trigeminal nerve. Other cranial nerves are rarely involved. Facial nerve schwannomas occurring within the petrous temporal bone are very rare. Their diagnosis may be missed prospectively even when appropriate computerized tomography (CT) scans are performed. Even in retrospect the site of abnormality may be difficult to identify, especially if there is an associated middle ear mass such as a cholesteatoma. In the 4 cases presented the facial nerve schwannoma was seen on high resolution CT as a soft tissue mass bounded anteriorly by a thin rim of bone. This bony crescent sign is a previously undescribed feature of facial nerve schwannoma which appears to be strongly indicative of the presence of this tumour. Recognition of this sign makes these tumours arising in the region of the geniculate ganglion easy to diagnose prospectively. 12 refs., 6 figs

  14. Surgical management of retraction pockets of the pars tensa with cartilage and perichondrial grafts.

    Science.gov (United States)

    Spielmann, P; Mills, R

    2006-09-01

    Stable, self-cleansing retraction pockets of the pars tensa are common incidental findings and require no treatment. In other cases, recurrent discharge occurs and there may also be associated conductive hearing loss. In a minority of cases, cholesteatoma may develop. This paper presents the results of surgery using a graft composed of cartilage and perichondrium for retraction pockets involving the posterior half of the tympanic membrane, as well as early results using a larger graft designed to manage retraction of the entire tympanic membrane. Data on 51 patients with posterior retraction pockets are presented. Forty-two (82 per cent) patients had no aural discharge one year following surgery and the tympanic membrane was not retracted in 43 (84 per cent). The larger 'Mercedes-Benz' graft was used in four patients and the results obtained suggested that it may prove a successful technique for extensive retraction pockets. PMID:16740207

  15. CHRONIC OTITIS MEDIA: HIGH RESOLUTION COMPUTED TOMOGRAPHIC EVALUATION OF THE TEMPORAL BONE WITH SURGICAL CORRELATION

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    Chakenahalli P.

    2016-05-01

    Full Text Available PURPOSE To correlate the sensitivity and specificity of High Resolution Computed Tomography (HRCT findings of temporal bone in chronic otitis media with surgical findings. MATERIALS & METHODS HRCT of temporal bone of fifty patients with chronic otitis media were evaluated prospectively between July 2012 and December 2013. The various pathological findings, complications and important anatomical variations were evaluated. These findings were compared with intraoperative findings. Statistical methods were carried out using SPSS for Windows (Version 16.0 and Minitab (Version 11.0 for windows. The sensitivity, specificity, false positive and false negative rates were calculated. The level of significance was considered significant for P-values <0.05. RESULTS HRCT is reliable for all the parameters like scutum erosion, ossicular erosion, mastoid pneumatisation, low lying dura, anterior lying sigmoid, Korner’s septum, cholesteatoma extension in middle ear and mastoid, and presence of complications like mastoiditis, mastoid abscess, mastoid cortex dehiscence, sigmoid sinus plate erosion, facial canal dehiscence, tegmen mastoideum erosion, labyrinthine fistula and intracranial complications with a P value <0.05 but not reliable for tegmen tympani erosion and posterior fossa dural plate erosion. Among the findings related to adjacent neurovascular structures, facial canal dehiscence was commonest followed by anterior lying sigmoid sinus and low lying dura. In ossicular erosion, incus was most commonly involved followed by stapes and malleus. Most of the mastoid in this study was sclerotic followed by pneumatised and diploic. The epitympanum and mastoid antrum were the most commonly involved areas in cholesteatoma followed by aditus, mastoid air cells, posterior tympanum, mesotympanum, hypotympanum, protympanum and perilabyrinthine air cells in decreasing order of frequency. CONCLUSIONS HRCT temporal bone is a reliable investigation in preoperative

  16. Temporal bone CT findings of tuberculous otitis media : comparison with chronic otitis media

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    Chang, Jeong A; Rho, Myung Ho; Kim, Young Min; Lee, Ho Seung; Choi, Pil Yeob; Seong, Young Soon; Kwon, Jae Soo; Lee, Sang Wook [Masan Samsung Hospital, Sungkyunkwan Univ. College of Medicine, Seoul (Korea, Republic of); Jung, Keon Sik [Pohang Sunrin Hospital, Pohang (Korea, Republic of)

    1999-06-01

    To compare the differential findings of tuberculous otitis media(TOM) with those of chronic sup purative otitis media with or without cholesteatoma, as seen on high resolution temporal bone CT. We retrospectively reviewed 14 cases of TOM, 30 cases of chronic suppurative otitis media(CSOM), and 30 cases of chronic otitis media with cholesteatoma(Chole). All had been pathologically confirmed. We evaluated the preservation of mastoid cells without sclerotic change, the location and extension of soft tissue to the external auditary canal, and erosion of ossicles, the tegmen tympani, scutum, bony labyrinth, facial nerve canal and sigmoid sinus, and the presence of intracranial complications. Soft tissue in the mastoid antrum was seen in all cases of TOM(100%), 29 cases of CSOM(96.7%), and 26 cases of Chole(86.7%). In contrast, the soft tissue in the entire middle ear cavity was noted in 13 cases of TOM(92.8%), 7 cases of CSOM(23.3%), and 12 cases of Chole(40%). Soft tissue extended to the superior aspect of the external auditory canal in 4 cases of TOM (28.6%) and 5 cases of Chole (16.7%). Mastoid air cells were seen in 9 cases of TOM (64.3%), 4 cases of CSOM (13.3%), and 3 cases of Chole(10%). Ossicular erosion was noted in 6 cases of TOM (42.9%), 12 cases of CSOM (40%), and 26 cases of Chole(86.7%), while in one case of TOM (7.1%), 5 cases of CSOM (16.7%), and 15 cases of Chole(50%) there was erosion of the scutum. In one case of TOM, follow-up CT study after 9 months of antituberculous medication without surgery revealed complete clearing of previously noted soft tissue in the middle ear cavity. Specific CT findings of TOM were not seen, but if there were findings of soft tissue in the entire middle ear cavity, soft tissue extension to the external auditory canal, preservation of mastoid air cells without sclerotic change, and intact scutum, TOM may be differentiated from other chronic otitis media.

  17. 慢性化脓性中耳炎并发全聋的临床研究%Clinical study of chronic suppurative otitis media with hearing loss

    Institute of Scientific and Technical Information of China (English)

    茹仙古丽•艾山

    2013-01-01

    Objective Study on chronic suppurative otitis media (CSOM) related factors associated with deafness. Methods Were retrospective analysis of 2007~2010 CSOM with extremely deaf or deaf in our hospital 32 cases of 34 ears (observation group) and the clinical data, with the same period without loss of CSOM operation in 34 ears (control group) were compared. Results Chronic suppurative otitis media caused total deafness or extremely deaf related risk factors include pus and blood lfow, ossicular damage and stapes footplate or board structure disappeared, accompanied by labyrinthine ifstula, the difference was obvious that there was statistically signiifcant (P<0.05). Conclusion Extremely complicated CSOM deaf or deaf with pus and blood lfow, cholesteatoma right ossicular erosion of the stapes footplate board structure or disappear, labyrinthine ifstula and other relevant, Should be promptly controlled cholesteatoma and middle ear infections.%目的:研究慢性化脓性中耳炎(CSOM)并发全聋的相关因素。方法回顾性分析我院2007至2010年CSOM并发极度聋或全聋的患者32例34耳(观察组)的临床资料,与同期不伴全聋的CSOM手术患者34耳(对照组)进行比较。结果慢性化脓性中耳炎致全聋或极度聋相关的危险因素包括流脓血,听骨链破坏及镫骨足板或板上结构消失、伴有迷路瘘管,两组比较差异明显,有统计学意义(P<0.05)。结论 CSOM并发极度聋或全聋与流脓血,胆脂瘤对听骨链侵蚀,镫骨板上结构或足板消失,迷路瘘管等相关,应及时控制胆脂瘤和中耳感染。

  18. Comparison of Conventional Versus Spiral Computed Tomography with Three Dimensional Reconstruction in Chronic Otitis Media with Ossicular Chain Destruction

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    Naghibi

    2015-12-01

    Full Text Available Background Chronic otitis media (COM can be treated with tympanoplasty with or without mastoidectomy. In patients who have undergone middle ear surgery, three-dimensional spiral computed tomography (CT scan plays an important role in optimizing surgical planning. Objectives This study was performed to compare the findings of three-dimensional reconstructed spiral and conventional CT scan of ossicular chain study in patients with COM. Patients and Methods Fifty patients enrolled in the study underwent plane and three dimensional CT scan (PHILIPS-MX 8000. Ossicles changes, mastoid cavity, tympanic cavity, and presence of cholesteatoma were evaluated. Results of the two methods were then compared and interpreted by a radiologist, recorded in questionnaires, and analyzed. Logistic regression test and Kappa coefficient of agreement were used for statistical analyses. Results Sixty two ears with COM were found in physical examination. A significant difference was observed between the findings of the two methods in ossicle erosion (11.3% in conventional CT vs. 37.1% in spiral CT, P = 0.0001, decrease of mastoid air cells (82.3% in conventional CT vs. 93.5% in spiral CT, P = 0.001, and tympanic cavity opacity (12.9% in conventional CT vs. 40.3% in spiral CT, P=0.0001. No significant difference was observed between the findings of the two methods in ossicle destruction (6.5% conventional CT vs. 56.4% in spiral CT, P = 0.125, and presence of cholesteatoma (3.2% in conventional CT vs. 42% in spiral CT, P = 0.172. In this study, spiral CT scan demonstrated ossicle dislocation in 9.6%, decrease of mastoid air cells in 4.8%, and decrease of volume in the tympanic cavity in 1.6%; whereas, none of these findings were reported in the patients' conventional CT scans. Conclusion Spiral-CT scan is superior to conventional CT in the diagnosis of lesions in COM before operation. It can be used for detailed evaluation of ossicular chain in such patients.

  19. Three cases of temporal bone osteoradionecrosis after nasopharyngeal carcinoma treatment

    International Nuclear Information System (INIS)

    Osteoradionecrosis is most commonly caused by radiation-induced injury. We report on 3 cases of temporal bone necrosis that occurred after chemoradiotherapy for nasopharyngeal carcinoma performed more than 10 years previously. Case 1 was a 42-year-old woman who had nasopharyngeal carcinoma in 1991. The patient underwent chemoradiotherapy (70 Gy total) in 1991, and gamma knife irradiation (20 Gy) in 1998 for local recurrence. The bone in the posterior wall of the left external auditory canal began to be exposed in 2003. Otorrhea from the left ear increased and we found a skin defect and ulcer formation in the postauricular region. We performed radical mastoidectomy and debridement on April, 2010. The area of the defect was covered and filled in with a pedicle musculoperiosteal flap. The intra-aural skin became dry in 6 months, however, she lost consciousness due to a temporal lobe abscess and underwent an emergency operation on April, 2011. After operation, the patient recovered with no neurological symptoms and infections up to the present date. Case 2 was a 58-year-old man who had nasopharyngeal carcinoma in 2001. The patient underwent chemoradiotherapy (66 Gy total) in 2001, and X knife irradiation (15 Gy) 3 months later due to the remaining tumor. The left posterior ear canal wall collapsed and the tympanic membrane retracted with pooling epithelial debris appearing in 2007. Left facial nerve palsy was seen in December 2010. We performed a mastoidectomy on January, 2011. Cholesteatoma and necrotic granuloma with fragile bone filled the mastoid cavity, and a facial canal bone defect was seen. Bone necrosis with cholesteatoma and inflammatory granuloma was revealed by the pathological examination. The facial palsy improved after the operation. Case 3 was a 59-year-old man who had left abducens palsy with nasopharyngeal carcinoma invading the clivus. The patient underwent chemoradiotherapy (60 Gy total) in 2001, and X knife irradiation (24 Gy) 4 months later for

  20. Clinical characteristics of the eardrum retraction pocket

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    Ješić Snežana

    2003-01-01

    Full Text Available Development of the eardrum retraction pocket, as pathologic finding, depends on Eustachian tube dysfunction, onset of the middle ear infection and site of development of retraction on the eardrum. The study is aimed at: 1. Determining the incidence of eardrum retraction pocket and cholesteatoma within it, as well as at the degree of eardrum retraction; 2. Determining of association between eardrum retraction pocket and changes of the eardrum mucosaand parstensa of the tympanic membrane; 3. Determining of onset and intensity of the bone destruction in eardrum retraction pocket; 4. Examining of Eustachian tube function based on time of mucocilliary transport according to the type of the eardrum retraction pocket. The study is based on the retrospective analysis of the results obtained from the patients treated at the Institute of Oto-Rhino-Laryngology and Maxillofacial Surgery Clinical Centre of Serbia in Belgrade for the diagnosis of the chronic suppurative otitis who underwent otosurgical procedures during the six-year period, from 1996-2001. In our series of 540 patients subjected to otosurgical treatment, the incidence of the retraction pocket of the eardrum was 11.23%. Onset of more severe degree of eardrum retraction was most frequent in the attic. Cholesteatoma was detected in 82.2% of patients of the group with the attic-retraction pocket of the eardrum, as well as in 25% of patients of the group of tensa-sinus retraction pocket of the eardrum. Atrophic changes of the tympanic membrane pars tensa were detected in almost all tensa-sinus retraction pockets of the eardrum. Approximately one half of the attic-retraction pockets of the eardrum were accompanied by eardrum atrophy. Bone destruction of the auditory ossicles was limited to the long process of incus and superior structures of stapes. Time of the mucocilliary transport was significantly longer (p<0.01 in attic-retraction pocket of the eardrum than in tensa-sinus retraction pocket of

  1. Temporal bone CT findings of tuberculous otitis media : comparison with chronic otitis media

    International Nuclear Information System (INIS)

    To compare the differential findings of tuberculous otitis media(TOM) with those of chronic sup purative otitis media with or without cholesteatoma, as seen on high resolution temporal bone CT. We retrospectively reviewed 14 cases of TOM, 30 cases of chronic suppurative otitis media(CSOM), and 30 cases of chronic otitis media with cholesteatoma(Chole). All had been pathologically confirmed. We evaluated the preservation of mastoid cells without sclerotic change, the location and extension of soft tissue to the external auditary canal, and erosion of ossicles, the tegmen tympani, scutum, bony labyrinth, facial nerve canal and sigmoid sinus, and the presence of intracranial complications. Soft tissue in the mastoid antrum was seen in all cases of TOM(100%), 29 cases of CSOM(96.7%), and 26 cases of Chole(86.7%). In contrast, the soft tissue in the entire middle ear cavity was noted in 13 cases of TOM(92.8%), 7 cases of CSOM(23.3%), and 12 cases of Chole(40%). Soft tissue extended to the superior aspect of the external auditory canal in 4 cases of TOM (28.6%) and 5 cases of Chole (16.7%). Mastoid air cells were seen in 9 cases of TOM (64.3%), 4 cases of CSOM (13.3%), and 3 cases of Chole(10%). Ossicular erosion was noted in 6 cases of TOM (42.9%), 12 cases of CSOM (40%), and 26 cases of Chole(86.7%), while in one case of TOM (7.1%), 5 cases of CSOM (16.7%), and 15 cases of Chole(50%) there was erosion of the scutum. In one case of TOM, follow-up CT study after 9 months of antituberculous medication without surgery revealed complete clearing of previously noted soft tissue in the middle ear cavity. Specific CT findings of TOM were not seen, but if there were findings of soft tissue in the entire middle ear cavity, soft tissue extension to the external auditory canal, preservation of mastoid air cells without sclerotic change, and intact scutum, TOM may be differentiated from other chronic otitis media

  2. Eye lens radiation exposure and repeated head CT scans: A problem to keep in mind

    International Nuclear Information System (INIS)

    Objectives: The deterministic character of radiation-induced cataract is being called into question, raising the possibility of a risk in patients, especially children, exposed to ionizing radiation in case of repeated head CT-scans. This study aims to estimate the eye lens doses of a pediatric population exposed to repeated head CTs and to assess the feasibility of an epidemiological study. Methods: Children treated for a cholesteatoma, who had had at least one CT-scan of the middle ear before their tenth birthday, were included. Radiation exposure has been assessed from medical records and telephone interviews. Results: Out of the 39 subjects contacted, 32 accepted to participate. A total of 76 CT-scans were retrieved from medical records. At the time of the interview (mean age: 16 years), the mean number of CT per child was 3. Cumulative mean effective and eye lens doses were 1.7 mSv and 168 mGy, respectively. Conclusion: A relatively high lens radiation dose was observed in children exposed to repeated CT-scans. Due to that exposure and despite the difficulties met when trying to reach patients’ families, a large scale epidemiological study should be performed in order to assess the risk of radiation-induced cataracts associated with repeated head CT.

  3. The superiority of 3D-CISS sequence in displaying the cisternal segment of facial, vestibulocochlear nerves and their abnormal changes

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    Liang Changhu, E-mail: tigerlch@163.co [Shandong University, Shandong Medical Imaging Research Institute, CT Room, 324, Jingwu Road, Jinan, Shandong (China); Zhang Bin, E-mail: liangchangbo.student@sina.co [Liao Cheng City People' s Hospital, Dongchang Road, Liaocheng, Shandong (China); Wu Lebin, E-mail: Lebinwu518@163.co [Shandong University, Shandong Medical Imaging Research Institute, CT Room, 324, Jingwu Road, Jinan, Shandong (China); Du Yinglin, E-mail: duyinglinzhuo@sohu.co [Shandong Provincial Center for Disease Control and Prevention, Public Health Institute, 72, Jingshi Road, Jinan, Shandong (China); Wang Ximing, E-mail: wxminmg369@163.co [Shandong University, Shandong Medical Imaging Research Institute, CT Room, 324, Jingwu Road, Jinan, Shandong (China); Liu Cheng, E-mail: cacab2a@126.co [Shandong University, Shandong Medical Imaging Research Institute, CT Room, 324, Jingwu Road, Jinan, Shandong (China); Yu Fuhua, E-mail: changhu1970@163.co [Weifang Medical College, 7166, West Road Baotong Weifang, Shandong (China)

    2010-06-15

    Objective: To select the best imaging method for clinical otologic patients through evaluating 3D constructive interference of steady state (CISS) image quality in visualizing the facial, vestibulocochlear nerves (CN:VII-VIII) and their abnormal changes. Methods: The CN:VII-VIII as well as inner ear structures in 48 volunteers were examined using 3D-CISS and 3D turbo spin echo (TSE) sequences respectively, and displayed to the full at the reformatted and maximum intensity projection (MIP) images. The nerve identification and image quality were graded for the CN:VII-VIII as well as inner ear structures. Statistical analysis was performed using the Wilcoxin test, p < 0.05 was considered significant. In addition, 8 patients with abnormality in facial or vestibulocochlear nerves were also examined using 3D-CISS sequence. Results: The identification rates for the cisternal segment of facial, vestibulocochlear nerves and corresponding membranous labyrinth were 100%. Abnormal changes of the facial or vestibulocochlear nerves were clearly shown in 8 patients, among them 1 was caused by bilateral acoustic neurinoma, 1 by cholesteatoma at cerebellopontine angle, 1 by arachnoid cyst, 1 by neurovascular adhesion, 4 by neurovascular compression. Conclusion: With 3D-CISS sequence the fine structure of the CN:VII-VIII and corresponding membranous labyrinth can be clearly demonstrated; lesions at the site of cerebellopontine angle can also be found easily.

  4. Otological Findings Ten Years after Myringotomy with Tympanostomy Tube Insertion

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    Ali Goljanian Tabrizi

    2011-01-01

    Full Text Available Introduction: To study the long-term complications of tympanostomy tube insertion in young children 10 years after surgery.   Materials and Methods: In September 2011, the medical records of all patients who had undergone myringotomy with tympanostomy tube insertion between February 2000 and March 2001 at the two general hospitals of Isfahan University of Medical Sciences were studied. Of the 98 patients who fulfilled the inclusion criteria, 82 patients agreed to participate and were enrolled in the study. The complications of the operation were evaluated in these patients.   Results: Of the 164 ears that were operated on, myringosclerosis was found in 17.1%, atrophy of the tympanic membrane in 1.2%, permanent perforation of the tympanic membrane in 0.6% and tympanic membrane atelectasis in 0.6%. None of the patients developed cholesteatoma as a complication of tympanostomy tube insertion.   Conclusion:  Considering the low risk of serious complications after 10 years, tympanostomy tube insertion is a safe and effective treatment option in the treatment of otitis media with effusion.

  5. EVALUATION OF HRCT TEMPORAL BONE AND PATHOLOGIES

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    Vivek

    2014-10-01

    Full Text Available AIM: To assess the role of High Resolution Computer Tomography as the prime modality in the diagnosis and characterization of lesions of the temporal bone. METHODOLOGY: Patients presenting with symptoms and clinical features suggestive of lesion involving temporal bone were included in the study. RESULTS: High Resolution Computed Tomography was highly sensitive and specific in evaluating lesions like mastoiditis, cholesteatoma, paragangliomas, cerebello pontine meningiomas and fractures. CONCLUSION: High Resolution Computed Tomography is the imaging modality of choice in evaluation of the temporal bone which is a relatively inaccessible area of the human anatomy. By using an orthogonal plane of 30° we are able to reduce the radiation to the eye with no compromise in the image quality. It also dictates proper and adequate medical treatment or timely surgery that can prevent further serious complications. High Resolution Computed Tomography has abled in planning more direct procedures like cochlear implantation, avoiding fatal surgical interventions on aberrant ICA etc, while preserving function of the essential structures of Temporal bone thereby making HRCT a valuable tool in diagnosis and treatment.

  6. CT of temporal bone II. OMPC

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    Ham, So Hie; Ahn, Jung Sook; Sung, Kyu Bo; Woo, Won Hyung [Koryo General Hospital, Seoul (Korea, Republic of)

    1987-10-15

    High resolution CT is well known excellent modality for evaluation of fine ear structures and its changes, but is not usual method for detection of inflammatory disease of ear. Forty cases of OMPC were reviewed advantage and advantage and limitations also evaluated. The results were as follows: 1. On CT findings of OMPC, abnormalities were external auditory canal in 14 cases(35%), tympanic membrane in 31 cases (77.5%), soft tissue mass in middle ear cavity and/or mastoid antrum in 34 cases (85%), middle ear effusion in 9 cases (22.5%), and bony labyrinth in 5 cases (12.5%). 2. Partial erosion and missing of ossicles were long process and lenticular process of incus, body of incus, head of malleus, and stapes in order. 3. Advantage of temporal bone CT were early detection of soft tissue mass, evaluation of extent of disease, destruction of bony structure and ossicular destruction. 4. Differentiation of cholesteatoma and granulation was difficult and examination of superstructures such as stapes and facial nerve canal were limit0008.

  7. Audiometry and ossicular condition in chronic otitis media

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    mohsen Rajati Haghi

    2009-07-01

    Full Text Available   Introduction: Ossicular chain injury is one of the most common causes of hearing loss in chronic otitis media (COM. Although definite diagnosis of ossicular discontinuity is made intraoperatively, preoperative determination of ossicular chain injury will help the surgeon decide about reconstruction options and hearing prognosis of the patient. In this study we compared preoperative pure tone audiometry (PTA findings of COM patients with the ossicular condition determined during surgery. Materials and Methods: 97 Patients with COM who underwent ear surgery for the first time were included in the study. A checklist of preoperative clinical findings, audiometric parameters and intraoperative findings was filled out for all patients. Results: Mean amount of Air-Bone Gap (ABG, Bone Conduction threshold (BC and Air Conduction threshold (AC of 97 Patients were 35.17, 13.13 and 48.30 respectively. In ears with or without cholesteatoma, granulation tissue, or otorrhea, mean of AC, BC, and ABG were not significantly different. In ossicular erosion and discontinuity (OD, mean of AC and BC thresholds increased significantly but ABG didn’t change significantly. Conclusion: According to the results of this study, in preoperative assessment of COM patients to predict ossicular condition we recommend considering AC, BC and ABG levels together instead of using ABG alone as is routine in our daily practice.

  8. ENDOSCOPIC TYPMPANOMASTOID EXPLORATION [FUNCTIONAL ENDOSCOPIC EAR SURGERY-FEES

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    Sanjay Kumar

    2012-03-01

    Full Text Available Tympano mastoidectomy is usually performed using operating microscope. This study reports a case series of tympanomastoidectomy which was performed using an endoscope.Endoscopic Tympanomastoidectomy for atticoantral type of CSOM is an excellent technique for complete removal of cholesteatoma especially from inaccessible areas of middle ear cleft including facial recess, sinustympani Transmeatal removal of disease from mastoid antrum and even tip cells is possible with endoscopes. Preservation of as much of normal mucosa of the middle ear cleft is possible with thistechnique, which promotes early reaeration of the mastoid cavity leading to better hearing outcome.Soft wall reconstruction has distinctive advantage of short additional time for reconstruction procedures, restoration of self cleaning EAC, early post operative epithelisation of tympanic membrane and the EAC. Limitation of endoscopic technique: The endoscopic technique of tympanomastoidectomy with softwall reconstruction is not possible in cases with large mastoid cavity and in ears where a thin lateral rim of bony meatal wall (that can support soft wall is retained, because of extensive disease.Like Functional Endoscopic sinus surgery (FESS for nose, Endoscopes have changed the treatment concept of atticoantral disease, with complete removal of the disease and preservation of normal mucosa, that restores the normal physiology of middle ear cleft. Thishas led to the development of new concept of Functional Endoscopic Ear Surgery (FEES for atticoantral type of CSOM.

  9. MR of 2270 TMJs: prevalence of radiographic presence of otomastoiditis in temporomandibular joint disorders

    International Nuclear Information System (INIS)

    Objective: : The purpose of this study is to determine the prevalence of radiographic presence of otomastoiditis while examining temporomandibular joint (TMJ) disorders in magnetic resonance images (MRI) in a series of 2270 temporomandibular joint magnetic resonance images and to examine the relationship between otomastoiditis and TMJ disorders. Materials and methods: : 2270 temporomandibular joint magnetic resonance images and patients' data were retrospectively investigated. Magnetic resonance images were obtained from the patients who referred to Osaka University Dental Hospital Outpatient Clinic with TMJ complaints for the last four years (from January 1998 to January 2003). The patients, who were diagnosed as otomastoiditis based on their temporomandibular joint magnetic resonance images, were sent to Osaka University Hospital Department of Otolaryngology for a medical consultation in order to have their pathologies certified following their MR process. Age and sex were recorded for all patients and for otomastoiditis cases; location of the disease, symptoms of patients and TMJ findings were noted as well. Results: : Seven patients were diagnosed as acute otomastoiditis and one patient diagnosed as chronic active otitis media with cholesteatoma in the series of 2270 MR, which were representing a prevalence of 0.39%. Neurilemoma diagnosed in left mastoid process in one patient. The final diagnoses of all patients were made after medical consultation. Conclusion: : While examining temporomandibular joint magnetic resonance images; it is not only important to examine just the TMJ structures, but also to look at the nearby anatomical features to check evidence for inflammatory disease

  10. Eye lens radiation exposure and repeated head CT scans: A problem to keep in mind

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    Michel, Morgane; Jacob, Sophie [Institute for Radiological Protection and Nuclear Safety, IRSN/DRPH/SRBE/Laboratoire d' Epidemiologie, BP 17, 92 262 Fontenay-aux-Roses (France); Roger, Gilles [Otolaryngology Department, Trousseau Hospital, Paris (France); Pelosse, Beatrice [Ophthalmology Department, Trousseau Hospital, Paris (France); Laurier, Dominique [Institute for Radiological Protection and Nuclear Safety, IRSN/DRPH/SRBE/Laboratoire d' Epidemiologie, BP 17, 92 262 Fontenay-aux-Roses (France); Le Pointe, Hubert Ducou [Radiology Department, Trousseau Hospital, Paris (France); Bernier, Marie-Odile, E-mail: marie-odile.bernier@irsn.fr [Institute for Radiological Protection and Nuclear Safety, IRSN/DRPH/SRBE/Laboratoire d' Epidemiologie, BP 17, 92 262 Fontenay-aux-Roses (France)

    2012-08-15

    Objectives: The deterministic character of radiation-induced cataract is being called into question, raising the possibility of a risk in patients, especially children, exposed to ionizing radiation in case of repeated head CT-scans. This study aims to estimate the eye lens doses of a pediatric population exposed to repeated head CTs and to assess the feasibility of an epidemiological study. Methods: Children treated for a cholesteatoma, who had had at least one CT-scan of the middle ear before their tenth birthday, were included. Radiation exposure has been assessed from medical records and telephone interviews. Results: Out of the 39 subjects contacted, 32 accepted to participate. A total of 76 CT-scans were retrieved from medical records. At the time of the interview (mean age: 16 years), the mean number of CT per child was 3. Cumulative mean effective and eye lens doses were 1.7 mSv and 168 mGy, respectively. Conclusion: A relatively high lens radiation dose was observed in children exposed to repeated CT-scans. Due to that exposure and despite the difficulties met when trying to reach patients' families, a large scale epidemiological study should be performed in order to assess the risk of radiation-induced cataracts associated with repeated head CT.

  11. MicroRNAs in sensorineural diseases of the ear

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    Kathy eUshakov

    2013-12-01

    Full Text Available Non-coding microRNAs have a fundamental role in gene regulation and expression in almost every multicellular organism. Only discovered in the last decade, microRNAs are already known to play a leading role in many aspects of disease. In the vertebrate inner ear, microRNAs are essential for controlling development and survival of hair cells. Moreover, dysregulation of microRNAs has been implicated in sensorineural hearing impairment, as well as in other ear diseases such as cholesteatomas, vestibular schwannomas and otitis media. Due to the inaccessibility of the ear in humans, animal models have provided the optimal tools to study microRNA expression and function, in particular mice and zebrafish. A major focus of current research has been to discover the targets of the microRNAs expressed in the inner ear, in order to determine the regulatory pathways of the auditory and vestibular systems. The potential for microRNA manipulation in development of therapeutic tools for hearing impairment is as yet unexplored, paving the way for future work in the field.

  12. Suppurative labyrinthitis associated with otitis media: 26 years' experience

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    André Souza de Albuquerque Maranhão

    2016-02-01

    Full Text Available ABSTRACT INTRODUCTION: Suppurative labyrinthitis continues to result in significant hearing impairment, despite scientific efforts to improve not only its diagnosis but also its treatment. The definitive diagnosis depends on imaging of the inner ear, but it is usually clinically presumed. OBJECTIVE: To analyze the clinical factors and hearing outcomes in patients with labyrinthitis secondary to middle ear infections and to discuss findings based on imaging test results. METHODS: Retrospective cohort study, based on the charts of patients admitted with middle ear infection-associated labyrinthitis. RESULTS: We identified 14 patients, eight (57% of whom were females and six (43% males. Mean age was 40 years. Cholesteatomatous chronic otitis media was diagnosed in six patients (43%, acute suppurative otitis media in six (43%, and chronic otitis media without cholesteatoma was diagnosed in two patients (14%. Besides labyrinthitis, 24 concomitant complications were identified: six cases (25% of labyrinthine fistula, five cases (21% of meningitis, five cases (21% of facial paralysis, five cases (21% of mastoiditis, two cases (8% of cerebellar abscess, and one case (4% of temporal abscess. There was one death. Eight (57% individuals became deaf, while six (43% acquired mixed hearing loss. CONCLUSION: Suppurative labyrinthitis was often associated with other complications; MRI played a role in the definitive diagnosis in the acute phase; the hearing sequel of labyrinthitis was significant.

  13. Epidermoid cyst in the cerebellopontine angle cistern presenting as trigeminal neuralgia

    International Nuclear Information System (INIS)

    This 29-year-old male had been suffering from left trigeminal neuralgia one year prior to admission. Admission was prompted by the development of pain in the third division of the left trigeminal nerve. Physical and neurological examinations were not remarkable except for the facial pain. The orbicularis oculi reflex showed delayed latency of R1 on the affected side. CT scans performed pre- and post-contrast enhancement revealed a low density area in the left cerebellopontine angle cistern. Metrizamide CT cisternography clearly revealed the margin of the lesion as the contrast media did not enter into the low density area. A left suboccipital craniectomy was performed. The trigeminal nerve was surrounded by a thin-capsulated mass and cholesteatoma materials. Histological diagnosis was epidermoid cyst. Since this surgical procedure, the trigeminal neuralgia has not recurred for one year. Without objective neurological deficits, it is difficult to distinguish symptomatic trigeminal from idiopathic neuralgia. Therefore, minor change of the orbicularis oculi reflex should help in objectively detecting dysfunction of the trigeminal nerve. Metrizamide CT cisternography is also useful in diagnosis of cystic lesions. (author)

  14. Epidermoid cyst in the cerebellopontine angle cistern presenting as trigeminal neuralgia. Diagnostic values of the orbicularis oculi reflex and metrizamide CT cisternography - case report -

    Energy Technology Data Exchange (ETDEWEB)

    Ueda, Takashi; Goya, Tomokazu; Kinoshita, Kazuo (Miyazaki Medical College, Miyazaki (Japan)); Fukui, Masashi

    1983-05-01

    This 29-year-old male had been suffering from left trigeminal neuralgia one year prior to admission. Admission was prompted by the development of pain in the third division of the left trigeminal nerve. Physical and neurological examinations were not remarkable except for the facial pain. The orbicularis oculi reflex showed delayed latency of R/sub 1/ on the affected side. CT scans performed pre- and post-contrast enhancement revealed a low density area in the left cerebellopontine angle cistern. Metrizamide CT cisternography clearly revealed the margin of the lesion as the contrast media did not enter into the low density area. A left suboccipital craniectomy was performed. The trigeminal nerve was surrounded by a thin-capsulated mass and cholesteatoma materials. Histological diagnosis was epidermoid cyst. Since this surgical procedure, the trigeminal neuralgia has not recurred for one year. Without objective neurological deficits, it is difficult to distinguish symptomatic trigeminal from idiopathic neuralgia. Therefore, minor change of the orbicularis oculi reflex should help in objectively detecting dysfunction of the trigeminal nerve. Metrizamide CT cisternography is also useful in diagnosis of cystic lesions.

  15. [An operative case of cholesterol granuloma of the petrous apex].

    Science.gov (United States)

    Saino, M; Kayama, T; Kuroki, A; Siraisi, Y; Sato, K; Nakai, O

    1996-11-01

    A 59-year-old man presented with a rare cholesterol granuloma of the petrous apex manifesting as headache, left facial dysesthesia, diplopia, left hearing impairment, and left tinnitus. Neurological examination revealed dysesthesia of territory in all divisions of the left trigeminal nerve, left incomplete abducens nerve palsy, left mixed hearing impairment, and left tinnitus. Plain CT scan showed a smoothly marginated mass involving the left petrous apex. The mass was isodense with the brain parenchyma and not enhanced by contrast medium. The mass appeared heterogeneously slightly hyperintense on the T1-weighted MR image and homogeneously hyperintense on the T2-weighted MR image except for the peripheral portion. The mass was not enhanced after intravenous gadolinium DTPA administration. Surgery via a petrosal approach totally removed the mass in the intracranial, extradural space. Histological examination showed typical features of cholesterol granuloma, with cholesterin clefts, hemosiderin deposits, and erythrocytes in non-specific granulation tissue. Cholesterol granuloma most commonly occurs in the middle ear cavity, and rarely in the petrous apex. The characteristic hyperintense appearance of cholesterol granuloma on T1- and T2-weighted MR images is very useful for differentiation from other lesions of the petrous apex and the cerebellopontine angle such as cholesteatoma, mucocele, chordoma, and meningioma. Solid cholesterol granuloma of the petrous apex should be treated by total removal via craniotomy, not by drainage which is commonly performed by otorhinologists. PMID:8934474

  16. [Giant cholesterol cysts of the petrous apex].

    Science.gov (United States)

    Pellet, W; Valenzuela, S; Malca, S; Cannoni, M; Perez-Castillo, A M

    1992-01-01

    In connection with their two own cases, the authors deal about the giant cholesterol cysts of the petrous apex. The lesions which are to be differentiated from epidermoid cysts are cholesterol granulomas. Their petrous apex location explains their characteristic large appearance. As each cholesterol granuloma, they occur when a bony cell is obstructed. This chronic obstruction induces mucosal edema then bleedings which lead to the formation and, by the lack of drainage, to the accumulation of cholesterol crystals. These crystals initiate a non specific reaction to foreign bodies, a granuloma, which also can bleed. Thus, a continuous cycle perpetuates the growth of the lesion. This lesion, when it is localized in the petrous apex, can reach a big size before the appearance of some signs. Usually, these are otologic (sensorineural hearing loss, tinnitus, vertigo) and/or cranial nerve palsies (V, VI, VII). C.T. scan (well defined, sharply marginated bony expansible lesion with isodense to the brain central part) and M.R.I. (central region of increased intensity on both T1 and T2 weighted images and peripheral rim of markedly decreased signal intensity in all instances) features are characteristic enough to allow diagnose with other petrous apex lesions (cholesteatoma, mucocele, epithelial cyst, histiocytosis X, ...). Surgical treatment must try to evacuate and to aerate the cavity or perhaps to obliterate it with fatty pieces in order to prevent the recurrence. PMID:1299772

  17. Hearing results in surgery for primary petrous apex lesions.

    Science.gov (United States)

    Gianoli, G J; Amedee, R G

    1994-09-01

    Hearing preservation is a frequently mentioned phrase in the growing field of skull base surgery. Many authors have attempted to identify prognostic factors for successful hearing preservation, and many have suggested alternative procedures for preserving serviceable hearing. Few have mentioned hearing improvement with skull base surgical procedures. In this article we present the hearing results of 25 surgical procedures for primary petrous apex lesions. These include 13 cholesterol granulomas, 5 cholesteatomas, 4 mucoceles, and 3 eosinophilic granulomas. Surgical approaches included 14 transmastoid/infralabyrinthine, 6 transphenoid, 3 suboccipital, and 2 transmastoid/translabyrinthine. Hearing was maintained in 14 patients (56%), improved in 9 patients (36%), and worse in 1 patient with nonserviceable hearing before surgery (4%); 1 patient had profound hearing loss before surgery (4%). Results of this review should have significant implications on the choice of surgical approach for petrous apex lesions. Additionally, the standard method of determining salvageable hearing for most skull base procedures may not apply for this specific group of lesions. Implications for future treatment plans will be discussed in detail. PMID:8084633

  18. Intratemporal facial nerve neuromas and their mimics: CT and MR findings

    Energy Technology Data Exchange (ETDEWEB)

    Han, Moon Hee; Chang, Kee Hyun; Lee, Kyung Hwan; Cha, Sang Hoon; Kim, Chong Sun [Seoul National University College of Medicine, Seoul (Korea, Republic of); Kim, Sang Joon [Chungang Gil General Hospital, Seoul (Korea, Republic of)

    1992-05-15

    CT and MR findings of nine cases with intra temporal facial nerve neuromas were described and compared with CT findings of 3 cases with facial nerve palsy and facial nerve canal erosion which may mimic facial nerve neuroma. The tympanic segment of the facial nerve was involved in 8 cases, mastoid segment in 7 cases and labyrinthine segment in 5 cases. The lesions were easily diagnosed with high resolution CT with bone algorithms by showing the expansion of bony structures along the course of the facial nerves. In 4 cases with large vertical segment tumors, extensive destruction of mastoid air cells and external auditory canals posed difficulty in making a diagnosis. Two out of 5 cases with labyrinthine segment involvement were presented as middle cranial fossa masses. MRI with enhancement was performed in 4 cases and was useful in characterizing the lesion as a tumor with its superior sensitivity to enhancement. Three cases of facial neuroma-mimicking lesion including post-inflammatory peri neural thickening, peri neural extension from parotid adenoid cystic carcinoma, and congenita; cholesteatoma showed irregular erosion or mild expansion of the facial nerve canal which may be helpful for differential diagnosis from neuromas.

  19. MR of 2270 TMJs: prevalence of radiographic presence of otomastoiditis in temporomandibular joint disorders

    Energy Technology Data Exchange (ETDEWEB)

    Orhan, Kaan [Department of Oral Diagnosis and Radiology, Faculty of Dentistry, Ankara University, 06500 Besevler, Ankara (Turkey)]. E-mail: call53@yahoo.com; Nishiyama, Hideyoshi [Department of Oral Maxillofacial Radiology, Graduate School of Dentistry, Osaka University, Osaka (Japan); Tadashi, Sasaki [Department of Oral Maxillofacial Radiology, Graduate School of Dentistry, Osaka University, Osaka (Japan); Shumei, Murakami [Department of Oral Maxillofacial Radiology, Graduate School of Dentistry, Osaka University, Osaka (Japan); Furukawa, Souhei [Department of Oral Maxillofacial Radiology, Graduate School of Dentistry, Osaka University, Osaka (Japan)

    2005-07-01

    Objective: : The purpose of this study is to determine the prevalence of radiographic presence of otomastoiditis while examining temporomandibular joint (TMJ) disorders in magnetic resonance images (MRI) in a series of 2270 temporomandibular joint magnetic resonance images and to examine the relationship between otomastoiditis and TMJ disorders. Materials and methods: : 2270 temporomandibular joint magnetic resonance images and patients' data were retrospectively investigated. Magnetic resonance images were obtained from the patients who referred to Osaka University Dental Hospital Outpatient Clinic with TMJ complaints for the last four years (from January 1998 to January 2003). The patients, who were diagnosed as otomastoiditis based on their temporomandibular joint magnetic resonance images, were sent to Osaka University Hospital Department of Otolaryngology for a medical consultation in order to have their pathologies certified following their MR process. Age and sex were recorded for all patients and for otomastoiditis cases; location of the disease, symptoms of patients and TMJ findings were noted as well. Results: : Seven patients were diagnosed as acute otomastoiditis and one patient diagnosed as chronic active otitis media with cholesteatoma in the series of 2270 MR, which were representing a prevalence of 0.39%. Neurilemoma diagnosed in left mastoid process in one patient. The final diagnoses of all patients were made after medical consultation. Conclusion: : While examining temporomandibular joint magnetic resonance images; it is not only important to examine just the TMJ structures, but also to look at the nearby anatomical features to check evidence for inflammatory disease.

  20. Atypical radiographic features of skull base cholesterol granuloma.

    Science.gov (United States)

    Dinh, Christine T; Goncalves, Stefania; Bhatia, Rita; Truong, Kim; Telischi, Fred; Angeli, Simon; Morcos, Jacques; Eshraghi, Adrien A

    2016-06-01

    Cholesterol granulomas (CGs) are the most common benign lesions of the petrous apex (PA) and have distinct computed tomography (CT) and magnetic resonance imaging (MRI) characteristics. On CT, CGs of the PA (PACG) present as expansile lesions with erosion of bony trabeculae. MRI shows a hyperintense lesion on T1-and T2-weighted images and do not enhance with gadolinium. The objective is to describe the radiographic features of CGs of the skull base that do not arise from the PA. This study is a retrospective review. Three patients were operated on for suspected recurrent endolymphatic sac tumor, intracranial cholesteatoma, and recurrent sphenoid wing meningioma based on CT and MRI findings. Pathology results were consistent with CG in all three cases. All patients had bone erosion on CT. These skull base CGs did not demonstrate similar MRI features. These lesions were hyperintense, iso-to-hyperintense, and hypointense on T1-weighted MRI, respectively. These CGs were hyperintense in two cases and iso-to-hyperintense in one case on T2-weighted MRI. These lesions either demonstrated central or rim enhancement after gadolinium administration. Skull base CGs that do not arise from the PA demonstrate a broad spectrum of radiographic characteristics on MRI that are not typical of PACG. PMID:26164292

  1. Clinical investigation of flat panel CT following middle ear reconstruction: a study of 107 patients

    International Nuclear Information System (INIS)

    After middle ear reconstruction using partial or total ossicular replacement prostheses (PORP/TORP), an air-bone gap (ABG) may persist because of prosthesis displacement or malposition. So far, CT of the temporal bone has played the main role in the diagnosis of reasons for postoperative insufficient ABG improvement. Recent experimental and clinical studies have evaluated flat panel CT (fpCT) as an alternative imaging technique that provides images with high isovolumetric resolution, fewer metal-induced artefacts and lower irradiation doses. One hundred and seven consecutive patients with chronic otitis media with or without cholesteatoma underwent reconstruction by PORP (n = 52) or TORP (n = 55). All subjects underwent preoperative and postoperative audiometric testing and postoperative fpCT. Statistical evaluation of all 107 patients as well as the sole sub-assembly groups (PORP or TORP) showed a highly significant correlation between hearing improvement and fpCT-determined prosthesis position. FpCT enables detailed postoperative information on patients with middle ear reconstruction. FpCT is a new imaging technique that provides immediate feedback on surgical results after reconstructive middle ear surgery. Specific parameters evaluated by fpCT may serve as a predictive tool for estimated postoperative hearing improvement. Therefore this imaging technique is suitable for postoperative quality control in reconstructive middle ear surgery. (orig.)

  2. Preoperative diagnosis and surgical strategy in congenital auditory ossicular malformation of 26 ears

    International Nuclear Information System (INIS)

    We retrospectively analyzed 26 ears of 21 subjects having auditory ossicular malformation and who had undergone auditory reconstruction between April 2004 and December 2010 at our clinic. We checked preoperative condition, pathological classification, surgical procedure, and hearing improvement. We could predict pathological conditions precisely from preoperative computed tomography (CT), including incudostapedial disconnection (9/12, 75%) and malleus and/or incus fixation (7/12, 58%), which tended to be present in external ear malformation, and stapes footplate fixation (0/12, 0%). We could not, however, predict complex malformation (0/8, 0%). Overall success was 90% (18/20) in the 20 ears observed for at least 1 year. In the 2 ears without improved hearing, the first had congenital cholesteatoma and no stapes superstructure, was treated with type IV tympanoplasty. The second had malleus, incus, and stapes fixation and discontinuity between the incus and stapes, and was treated with type III tympanoplasty and stapes mobilization. Preoperative diagnosis is difficult in mixed congenital auditory ossicular malformation, especially stapes footplate fixation, possibly requiring unexpected procedures, with a poor hearing outcome. Preoperative status must thus be evaluated precisely using hearing, tympanometry, acoustic reflex test, and CT. Temporal bone CT and external ear findings are useful in diagnosing middle-ear malformation. Subjects' informed consent should also be obtained due to the possible need for changing procedure based on findings during surgery. (author)

  3. Computed tomography and magnetic resonance imaging of pathologic conditions of the middle ear

    International Nuclear Information System (INIS)

    Computed tomography (CT) is an excellent technique for demonstrating even small abnormalities of the thin and complex bony structures of the middle ear. For this reason, it is the modality of choice in the study of conductive hearing loss (CHL). However, not every patient complaining of CHL requires a CT study. In fact, established indications encompass complex conditions, such as the complications of acute and chronic otomastoiditis, the postoperative ear in chronic otomastoiditis or in the localization of prosthetic devices, and the assessment of congenital or vascular anomalies. Particularly, the precise extent of bone erosion associated with cholesteatoma is correctly demonstrated by high resolution CT. Conversely, although fistulization through the tegmen tympani or the posterior wall of temporal bone is usually detectable by CT, the actual involvement of meninges and veins are better assessed by magnetic resonance (MR). MR is also indicated when complicated inflammatory lesions are suspected to extend into the inner ear or towards the sigmoid sinus or jugular vein. Neoplasms arising from or extending into the middle ear require the use of both techniques as their combined data provide essential information. Most important data for surgical planning concern the destruction of thin bony structures and the relationships of the lesion with the dura and surrounding vessels. DSA and interventional vascular techniques maintain an essential role in the presurgical work-up and embolization of paragangliomas extended into the middle ear

  4. A comparative study of outcome of ossiculoplasty using cartilage graft, bone and different alloplasts in chronic otitis media

    Directory of Open Access Journals (Sweden)

    Sougata Mahanty

    2015-01-01

    Full Text Available Objective: The objective was to determine which material, among autologous cartilage, autologous incus and partial ossicular replacement prosthesis (PORP, gives better postoperative hearing result in ossiculoplasty. Study Design: Nonrandomized prospective cohort (longitudinal study. Settings: Tertiary referral center. Materials and Methods: Patients were selected from outpatients department with the clinical diagnosis of chronic suppurative otitis media with cholesteatoma or granulation tissue. Patients underwent necessary preoperative investigations including pure tone audiometry (PTA. Total 67 patients were selected for this study, among them 12 patients did not fit the selection criteria and 5 patients lost during follow-up. Hence, total 50 patients were taken in the study group. Intervention: Ossiculoplasty with cartilage, incus and PORP after modified radical mastoidectomy. Main Outcome Measure: Hearing results were measured by PTA-air bone gap (PTA-ABG after 6 months of operation. Results: Selecting the criteria <20 dB ABG as success when stapes superstructure is present, cartilage has 60% success rate, incus has 73.68%, and PORP has 56.25% success. Extrusion rate of different prosthesis shows, PORP has 25%, cartilage has 20% extrusion. Incus has the lowest (5.26% extrusion rate. Conclusion: Among the ossiculoplasty materials, autologous incus gives best postoperative hearing gain and lowest extrusion rate.

  5. Intracranial abscesses associated with chronic suppurative otitis media.

    Science.gov (United States)

    Seven, Huseyin; Coskun, Berna Uslu; Calis, Asli B; Sayin, Ibrahim; Turgut, Suat

    2005-10-01

    Intracranial abscesses are serious complications of chronic suppurative otitis media (COM). This study included 32 patients presenting with intracranial abscesses from 780 patients hospitalized for treatment of COM. The 32 patients had 59 intracranial complications. Perisinus abscess (13 of 32) was the most common intracranial abscess, followed by temporal lobe abscess (8 of 32), epidural abscess (7 of 32), cerebellar abscess (6 of 32) and subdural empyema (2 of 32). Headache (93%), fever (87%) and altered mental status (62%) were the most common presenting symptoms and signs, along with symptoms of COM. All patients were treated with intravenous antibiotics and canal wall down mastoidectomy. Cholesteatoma with granulation tissue and bony defects at the sinus plate and/or dural plate were seen in most of the patients. Gram negative bacilli and anaerobes were the most common organisms cultured from the abscesses. Three patients had neurological sequels. One patient died. The early diagnosis of these complications requires a high index of suspicion and imaging studies. A multidisciplinary and coordinated approach is important for the management of these patients. PMID:15959795

  6. A hybrid feature-based segmentation and classification system for the computer aided self-diagnosis of otitis media.

    Science.gov (United States)

    Shie, Chuen-Kai; Chang, Hao-Ting; Fan, Fu-Cheng; Chen, Chung-Jung; Fang, Te-Yung; Wang, Pa-Chun

    2014-01-01

    We propose a novel hybrid otitis media (OM) computer aided detection (CAD) system, designed to aid in the self-diagnosis of various forms of OM. OM is a prevalent disease in both children and adults. Our system is able to differentiate normal ear from acute otitis media (AOM), otitis media with effusion (OME) and the multi-categories of chronic otitis media including perforation, retraction, cholesteatoma, etc. We propose a modified double active contour segmentation method designed for use with otoscope images, and enabled to handle user acquired data. To describe the visual symptoms (e.g., red, bulging, effusion, perforation, retraction, etc.) of otitis media accurately, we extract color, geometric and texture features by grid color moment, Gabor filter, local binary pattern and histogram of oriented gradients. A powerful classification structure based on Adaboost is used to select the most useful features and build a strong classifier. Our system achieves classification accuracy as high as 88.06% and is suitable for real use. In addition, some interesting observations about OM otoscope images are also discussed. PMID:25571030

  7. Description of 34 patients with complicated cholesteatomatous chronic otitis media

    Directory of Open Access Journals (Sweden)

    Bento, Ricardo Ferreira

    2008-09-01

    Full Text Available Introduction: Cholesteatomas are cystic destructive lesions that affect any pneumatized area of the temporal bone. They can cause intracranial and extracranial complications. Objective: To register the patients with complicated cholesteatomatous chronic otitis media, who were interned in the otorhinolaryngology nursing of the Clinical Hospital of São Paulo, between the years of 2001 and 2008. Method: Retrospective study involving 34 patients with complicated cholesteatomatous chronic otitis media, who had been otorhinolaryngology nursing in the Clinical Hospital of the Medicine College of the University of São Paulo, from 2001 through 2008. Results: The age of the patients ranged from 7 to 83 years, with predominance of the masculine sex (76%. The extracranial complications were more frequent than the intracranial complications, and some patients presented both types of complication. All the patients received endovenous antibiotic, and only one patient was not submitted to surgical procedure. No patient died, and in the six-month follow-up no incapacitating severe neurological sequels occurred. Conclusion: The precocious and aggressive treatment of the complicated cholesteatomatous chronic otitis media diminishes the disease morbimortality.

  8. [Treatments for otorhinolaryngological patients with psychiatric disorders].

    Science.gov (United States)

    Nishio, Ayako; Sumi, Takuro; Yamada, Masato; Kuwahata, Yuko

    2013-02-01

    There are few systems in place for patients with psychiatric disorders who need treatments for physical complications. In Tokyo, "The Tokyo metropolitan psychiatric emergency system" was established in 1981, and Ome Municipal General Hospital participated in it. Under this system, fifteen patients with psychiatric disorders were treated for otorhinolaryngological diseases in our department from April 2005 to March 2011. We reviewed the fifteen patients. The coexisting psychiatric disorders were schizophrenia in twelve patients, and mental retardation, Korsakoff's syndrome, and Alzheimer's dementia in one patient each, respectively. All the patients had been receiving psychiatric treatment. The otorhinolaryngological diseases were head and neck cancer in nine patients, chronic sinusitis in three patients, and benign salivary gland tumor, cholesteatoma, and epistaxis in one patient each, respectively. Among the fifteen patients, thirteen could complete their treatment, but two dropped out due to exacerbation of their psychiatric symptoms. The therapeutic course is uncertain in otorhinolaryngological diseases occurring concomitantly with psychiatric disorders, especially in head and neck cancer, because it may be difficult to prioritize the problem when determining the treatment options and delivering the treatment. Thus, we should treat patients with psychiatric disorders carefully on a case-by-case basis depending on their psychiatric symptoms. It is also important to cooperate with psychiatrists and patients' families. PMID:23539958

  9. SUBJECTIVE TINNITUS AS FIRST PRESENTATION IN A PATIENT WITH METASTATIC LUNG CANCER IN TEMPORAL BONE-A CASE REPORT

    Institute of Scientific and Technical Information of China (English)

    ZHANG Jing; WANG Hongtian; JIA Jingjie; XIAO Yueyong; SHI Huaiyin; YANG Weiyan

    2013-01-01

    Metastasis of lung cancer to the temporal bone is a very rare disease and subjective tinnitus as the present-ing symptom in these patients is even rarer. Here we report a case in which a 42-year-old male presented with subjective tinnitus of three months, with no pulmonary disease symptoms. Pure tone audiometry indi-cated moderate conductive deafness in left ear with an air-bone gap of 21.3 dB. HRCT temporal bone scan-ning indicated high-density shadows in the left epitympanic cavity, sinus tympani and mastoid cavity. Chron-ic otitis media with cholesteatoma was suspected and surgical treatment recommended. However, preopera-tive chest x-ray revealed high-density millet lesions scattered widely in both lungs. HRCT lung scanning confirmed the lungs lesions and indicated lung cancer. In order to determine correlations between the tempo-ral bone and pulmonary lesions, a CT-guided trans-mastoid aspiration biopsy and immunohistochemical study were conducted, which confirmed that the temporal bone lesion was metastatic from the lungs. The pa-tient was given a series of chemotherapy immediately and his tinnitus significantly improved after three months of treatment, with full recovery of his hearing and complete resolution of shadows in the mastoid cavity. Unfortunately, he subsequently developed multiple bone metastases in the 9th month and cerebral metastasis in the 18th month. Multiple organ failure resulted in death in 2.5 years.

  10. Clinical investigation of flat panel CT following middle ear reconstruction: a study of 107 patients

    Energy Technology Data Exchange (ETDEWEB)

    Zaoui, K. [University Hospital Heidelberg, Ruprecht Karls University, Department of Otorhinolaryngology, Head and Neck Surgery, Heidelberg (Germany); Kromeier, J. [St. Josefs Hospital, RkK, Department of Radiology, Freiburg (Germany); Neudert, M.; Beleites, T.; Zahnert, T. [University Hospital Dresden, Technical University, Department of Otorhinolaryngology, Head and Neck Surgery, Dresden (Germany); Laszig, R.; Offergeld, C. [University Hospital Freiburg, Albert Ludwigs University, Department of Otorhinolaryngology, Head and Neck Surgery, Freiburg (Germany)

    2014-03-15

    After middle ear reconstruction using partial or total ossicular replacement prostheses (PORP/TORP), an air-bone gap (ABG) may persist because of prosthesis displacement or malposition. So far, CT of the temporal bone has played the main role in the diagnosis of reasons for postoperative insufficient ABG improvement. Recent experimental and clinical studies have evaluated flat panel CT (fpCT) as an alternative imaging technique that provides images with high isovolumetric resolution, fewer metal-induced artefacts and lower irradiation doses. One hundred and seven consecutive patients with chronic otitis media with or without cholesteatoma underwent reconstruction by PORP (n = 52) or TORP (n = 55). All subjects underwent preoperative and postoperative audiometric testing and postoperative fpCT. Statistical evaluation of all 107 patients as well as the sole sub-assembly groups (PORP or TORP) showed a highly significant correlation between hearing improvement and fpCT-determined prosthesis position. FpCT enables detailed postoperative information on patients with middle ear reconstruction. FpCT is a new imaging technique that provides immediate feedback on surgical results after reconstructive middle ear surgery. Specific parameters evaluated by fpCT may serve as a predictive tool for estimated postoperative hearing improvement. Therefore this imaging technique is suitable for postoperative quality control in reconstructive middle ear surgery. (orig.)

  11. DISCHARGING MASTOID CAVITY: A CLINICAL ANALYSIS

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    Praveen Kumar

    2015-05-01

    Full Text Available CONTEXT: A discharging mastoid cavity is a frustrating condition for both patient and surgeon and can occur after a canal wall down mastoidectomy operation . AIMS: To determine the percentage of patients having a discharging mastoid cavity and to establish the aetiological factors responsible for it . SETTING: Academic tertiary care referral institution . DESIGN: Prospective study MATERIALS AND METHODS: One hundred and sixty nine patie nts with chronic suppurative otitis media with cholesteatoma who underwent a canal wall down mastoidectomy were included in the study . These patients were regularly followed up to detect the occurrence of discharging mastoid cavity . RESULTS: Forty one ( 24 . 26% patients had a discharging mastoid cavity after a mean follow up of 4 . 2 years . The main causes were tympanic membrane perforation with exposed middle ear mucosa and open eustachian tube in thirty two patients ( 78 . 04% , followed by meatal stenosis in twenty five patients ( 60 . 97% and high facial ridge in twenty patients ( 48 . 78% . CONCLUSIONS: Tympanic membrane perforation with exposure of middle ear mucosa , meatal stenosis and a high facial ridge are important causes for a discharging mastoid cavity .

  12. An Otogenic Trapezius Abscess: A Case Report

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    Fazal I Wahid

    2012-03-01

    Full Text Available Introduction: An otogenic brain abscess is a common ENT problem but an otogenic trapezius abscess can also be experienced in otolaryngological practice, particularly in patients with chronic suppurative otitis media.   Case Report: We report a rare case of a trapezius abscess in an eight-year-old girl who presented at the ENT, Head and Neck Surgery Postgraduate Medical Institute, Lady Reading Hospital, Peshawar, Pakistan on 15th December, 2010, with a presenting complaint of discharge from her right ear that had been occurring for the last five years. An exploration of the patient’s right ear was performed, which showed that there was extensive cholesteatoma and tissue granulation tissues the antrum, attic and middle ear. The trapezius abscess had spread down to her back and was repeatedly drained. The patient was discharged on the 14th day following admission after making a complete recovery. After a regular follow-up period the child has remained disease free. The rare nature of this case prompted us to write this report.   Conclusion: Chronic suppurative otitis media is a common clinical problem in developing countries. It can result in a number of complications if not treated properly. Although an otogenic trapezius abscess is a rare complication of chronic suppurative otitis media, it must be kept in mind.    

  13. Cutaneous and Labyrinthine Tolerance of Bioactive Glass S53P4 in Mastoid and Epitympanic Obliteration Surgery: Prospective Clinical Study

    Directory of Open Access Journals (Sweden)

    Daniele Bernardeschi

    2015-01-01

    Full Text Available Objective. To evaluate the cutaneous and the inner ear tolerance of bioactive glass S53P4 when used in the mastoid and epitympanic obliteration for chronic otitis surgery. Material and Methods. Forty-one cases have been included in this prospective study. Cutaneous tolerance was clinically evaluated 1 week, 1 month, and 3 months after surgery with a physical examination of the retroauricular and external auditory canal (EAC skin and the presence of otalgia; the inner ear tolerance was assessed by bone-conduction hearing threshold 1 day after surgery and by the presence of vertigo or imbalance. Results. All surgeries but 1 were uneventful: all patients maintained the preoperative bone-conduction hearing threshold except for one case in which the round window membrane was opened during the dissection of the cholesteatoma in the hypotympanum and this led to a dead ear. No dizziness or vertigo was reported. Three months after surgery, healing was achieved in all cases with a healthy painless skin. No cases of revision surgery for removal of the granules occurred in this study. Conclusion. The bioactive glass S53P4 is a well-tolerated biomaterial for primary or revision chronic otitis surgery, as shown by the local skin reaction which lasted less than 3 months and by the absence of labyrinthine complications.

  14. Petrous apex lesions outcome in 21 cases

    Directory of Open Access Journals (Sweden)

    Hekmatara M

    1997-09-01

    Full Text Available Petrous apex lesions of temporal bone progress slowly. Most of the time not only destruct this area but also involve neighbouring element. The symptoms of the neighbouring neuro-vasculare involvement we can recognize these lesions. The most common symptoms of involvement of the petrous apex are: headache, conductive hearing loss or sensorineural type, paresthesia and anesthesia of the trigeminal nerve, paresia and paralysis of the facial nerve, abducent nerve. In retrospective study which has been in the ENT and HNS wards of Amiralam hospital, 148 patients have been operated due to temporal bone tumor; from these numbers, 21 (13.6% patients had petrous apex lesions of temporal bone. Eleven (52.9% patients of these 21 persons were men and the remaining 10 (47-6% were women. The average age of the patients was 37 years. The common pathology of these patients were glomus jugulare tumors, hemangioma, schwannoma, meningioma, congenital cholesteatoma, giant cell granuloma. The kind of operations that have been done on these patients were: infratemporal, translabyrinthine and middle fossa approaches. The conclusion of this study shows that petrous apex area is an occult site. The symptoms of this lesion are not characteristic, meticulous attention to the history and physical examination are very helpful to recognition of these lesions and it's extention.

  15. Immediate Postoperative Bell's Palsy: Viral Etiology or Post-Traumatic Phenomena?

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    Mohammad Ghasem Shams

    2010-12-01

    Full Text Available Introduction: Bell’s palsy is a sudden unilateral paralysis of the facial nerve. Postoperative Bell’s palsy following surgery is rare. It occurs in less than 1% of operations. The hypothesis: We premise that the main cause of immediate postoperative Bell's palsy is latent herpes viruses (herpes simplex virus type 1 and herpes zoster virus, which are reactivated from cranial nerve ganglia. Inflammation of the nerve initially results in a reversible neurapraxia, but ultimately Wallerian degeneration ensues. The palsy is often sudden in onset and evolves rapidly, with maximal facial weakness developing within two days. Associated symptoms of-ten seen in idiopathic Bell’s palsy are tearing problems, hyperacusis and altered taste.Evaluation of the hypothesis: Facial paralysis presenting postoperatively is distressing and poses a diagnostic chal-lenge. A complete interruption of the facial nerve at the sty-lomastoid foramen paralyzes all the muscles of facial expression. Taste sensation may be lost unilaterally and hye-racusis may be present. Idiopathic Bell’s palsy is due to inflammation of the facial nerve in the facial canal. Bell’s palsy may also occur from lesions that invade the temporal bone (carotid body, cholesteatoma, dermoid cyst, acoustic neu-romas. Although traumatic Bell’s palsy cannot be ruled out, it seems logic to postulate that the main cause of immediate postoperative Bell's palsy is latent herpes viruses.

  16. The Dehiscent Facial Nerve Canal

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    Sertac Yetiser

    2012-01-01

    Full Text Available Accidental injury to the facial nerve where the bony canal defects are present may result with facial nerve dysfunction during otological surgery. Therefore, it is critical to know the incidence and the type of facial nerve dehiscences in the presence of normal development of the facial canal. The aim of this study is to review the site and the type of such bony defects in 144 patients operated for facial paralysis, myringoplasty, stapedotomy, middle ear exploration for sudden hearing loss, and so forth, other than chronic suppurative otitis media with or without cholesteatoma, middle ear tumors, and anomaly. Correlation of intraoperative findings with preoperative computerized tomography was also analyzed in 35 patients. Conclusively, one out of every 10 surgical cases may have dehiscence of the facial canal which has to be always borne in mind during surgical manipulation of the middle ear. Computerized tomography has some limitations to evaluate the dehiscent facial canal due to high false negative and positive rates.

  17. Facial nerve palsy: incidence of different ethiologies in a tertiary ambulatory

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    Atolini Junior, Nédio

    2009-06-01

    Full Text Available Introduction: The ethiologic diferencial diagnostic for facial nerve paralisis is still a challenge and the literature has shown conflictive results concerning its epidemiology. Objective: To outline the incidence of the different ethiologies and the profile of peripheral facial nerve paralysis patients in the otolaryngology ambulatory of the Faculdade de Ciencias Medicas e Biologicas da PUC-SP - campus Sorocaba. Method: The records of 54 patients with facial nerve paralysis seen during the years of 2007 and 2008 were analysed retrospectively. Results: From the 54 patients analysed, 55,5% were male, median age of 40,6 years and had the right side of the face acomitted in 66,6%. Parestesia of the accomited side in 51,85% and increased tears in 66,6% of the patients were observed as associated symptoms. Bell´s palsy was the most frequent ethiology (53,7%, follwed by: traumatic (24%, Ramsay Hunt syndrome (9,2%, Cholesteatoma (5,5%, malignant otitis media (3,7% and acute otits media (3,7%. Three cases of Bell´s palsy during pregancy was also seen in this series. Conclusion: The data found are similiar of the most of the literature, showing that Bell´s palsy is still the most frequent, followed by traumatic causes and others. There is an equilibrium concerning to the gender, with a slight prevalence for males and for the right side of the face.

  18. 多层螺旋CT对慢性化脓性中耳炎的诊断价值%Diagnostic value of MSCT in the diagnosis of chronic suppurative otitis media

    Institute of Scientific and Technical Information of China (English)

    闫呈新; 杨可乐; 岳云; 刘林祥

    2011-01-01

    Objective To evaluate the value of multislice spiral computed tomography ( MSCT ) and its post-processing images in the diagnosis and guiding clinical treatment of the chronic suppurative otitis media ( CSOM ). Methods Seventy-five cases (90 ears) with CSOM were examined by MSCT. The classifications of CSOM were done on the basis of axial images, coronal and sagittal of multiplanar reconstruction images and compared with those of clincal and pathological results in all cases. Results The classifications of CSOM with MSCT in 90 ears included pure type in 14 , type of cholesteatoma in 40 and type of granuloma in 36 , while were 12 ,44 and 34 respectively after operation,the diagnostic accurate rate were 97. 8%, 95. 6% and 97. 8%, the sensitivity was 100%, 90. 9% and 100% ,respectively in classification of SCOM with CT. There was no bony destruction in pure type,and ossicular chain and bony erosion in the tympanic cavity and antrum were severe in the type of cholesteatoma than that in the type granuloma. The direct axial plane and coronal,sagittal multiplanar reformation in diagnosing CSOM were correspondent,but in showing the middle ear structure and lesions were different. Conclusion Combination of CT axial image, coronal and sagittal of MPR is helpful in the diagnosis of CSOM,anatomical variances and otogenic intracranial and extracranial complications, which can provide valuable information for project of clinical treatment and the choice of operative pathway.%目的 探讨多层螺旋CT及其图像后处理技术对慢性化脓性中耳炎(CSOM)诊断分型及临床治疗的价值.方法 对75例90耳CSOM病人行HRCT薄层扫描,将横断面图像、MPR图像(冠状位和矢状位)相结合,进行CSOM诊断分型,然后与临床诊断及手术病理结果进行对照分析.结果 经MSCT诊断的CSOM为单纯型14耳,肉芽肿型40耳,胆脂瘤型36耳,临床及手术诊断结果的分型分别为12耳、44耳、34耳,MSCT与临床手

  19. Morphometric Analysis of Bone Resection in Anterior Petrosectomies.

    Science.gov (United States)

    Ahmed, Osama; Walther, Jonathan; Theriot, Krystle; Manuel, Morganne; Guthikonda, Bharat

    2016-06-01

    Introduction The anterior petrosectomy is a well-defined skull base approach to lesions such as petroclival meningiomas, posterior circulation aneurysms, petrous apex lesions (chondrosarcomas, cholesteatomas), ventrolateral brainstem lesions, clival chordomas, trigeminal neurinomas, and access to cranial nerves III, IV, V, and VII. Methods and Materials Fourteen anterior petrosectomies on eight cadaveric heads were performed in a skull base dissection laboratory. Predissection and postdissection thin-cut computed tomography scans were obtained to compare the bone resection. A computer program was used (InVivo5, Anatomage, San Jose, California, United States) to measure the bone resection and the improved viewing angle. Results The average bone removed in each plane was as follows: anterior to posterior plane was 10.57 mm ± 2.00 mm, superior to inferior was 9.39 mm ± 1.67 mm, and lateral to medial was 17.46 mm ± 4.64 mm. The average increased angle of view was 13.01 ± 2.35 degrees (Table 1). The average volume was 1786.94 ± 827.40 mm(3). Conclusions Anterior petrosectomy is a useful approach to access the ventrolateral brainstem region. We present a cadaveric study quantitating the volume of bone resection and improvement in the viewing angle. These data provide useful preoperative information on the utility of this skull base approach and the gain in the viewing angle after bony removal. PMID:27175319

  20. Our experience of unsafe ear

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    Nagendran Navaneethan

    2015-01-01

    Full Text Available Aim: To evaluate the commonest presentation and intraoperative findings and significant post operative challenges in patients who underwent modified radical mastoidectomy in Melmaruvathur adhiparasakthi Institute of medical sciences and research. Design: Retrospective study. Materials and Methods: Fifty six patients who underwent modified radical mastoidectomy for unsafe ear disease were included in this study. The study period was from 2009 to 2012.The commonest presentation was evaluated with the history taken from the patient′s records. The intraoperative evaluation of primary pathology and its anatomic extension and ossicular status were identified. Common problems we faced postoperatively were documented. Results: Of the 56 patients,thirty eight(68% were male and eighteen(32% were female. The age ranged from nine years -fifty years of age. The commonest presentation in this study was foul smelling scanty discharge (75% and the primary pathology was isolated cholesteatoma (54%. The involvement of mesotympanum, attic, aditus & antrum with primary disease was more than the isolated involvement of attic,aditus and antrum. Stapes erosion was more common than incus erosion in our study. We faced a very rare postoperative complication of delayed facial palsy in one patient who had no facial nerve dehiscence. Conclusion: Good attention given to patients with infrequent, minimal ear discharge helps to identify unsafe ear. In unsafe ear, otologists should be well prepared to face the stapes erosion during surgery. Even though rare, otologists should be aware of delayed facial palsy and be cautious about the past history of herpes simplex and varizella infection and consider antiviral prophylaxis before surgery.

  1. Radiological study of the temporal bone in chronic otitis media: Prospective study of 50 cases

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    Thripthi Rai

    2014-01-01

    Full Text Available Aim: To assess radiological findings in Chronic otitis media (COM, its involvement in middle ear and adjacent structure and to compare with similar published data. The ability of the radiological investigations to detect the various pathological and anatomical variations were evaluated and compared with intraoperative findings. COM is a long standing inflammation of the middle ear cleft without reference to etiology or pathogenesis. Due to the strategic location of the tympanomastoid compartment, separated from the middle and posterior cranial fossa by the thinnest of bony partitions, otitis media has the potential for intracranial extension. Hence, it becomes very important to know the location and extent of the disease before proceeding to surgical treatment. Radiological examination of the temporal bone helps us to achieve this objective. The present work has been undertaken to study the role of radiological imaging of the temporal bone as a diagnostic modality in COM and its use in determining the lines of management as in the type of surgical intervention required. Materials and Methods: This is a prospective study in which total of 50 cases with COM were studied. Results: HRCT is reliable for all the parameters like scutum erosion, ossicular erosion, mastoid pneumatisation, low lying dura, anterior lying sigmoid, Korner′s septum, cholesteatoma extension in the middle ear and mastoid, and presence of complications such as mastoiditis and mastoid abscess, mastoid cortex dehiscence, sigmoid sinus plate erosion, facial canal dehiscence, tegmen mastoideum erosion and labyrinthine fistula and intracranial complications with a P < 0.05 but not reliable for tegmen tympani erosion and posterior fossa dural plate erosion. Conclusion: HRCT is highly reliable and findings are in par with intraoperative findings in this study.

  2. Typical tumors of the petrous bone; Typische Tumoren des Felsenbeins

    Energy Technology Data Exchange (ETDEWEB)

    Ahlhelm, F.; Mueller, U. [Kantonsspital Baden AG, Abteilung fuer Neuroradiologie, Institut fuer Radiologie, Baden (Switzerland); Ulmer, S. [Medizinisch-Radiologisches Institut, Zuerich (Switzerland)

    2014-04-15

    In the region of the petrous bone, inner acoustic canal and cerebellopontine angle, a variety of different tissues can be found, such as bony, epithelial, neural and vascular structures. Tumorous or tumor-like lesions, vascular or bony malformations or other pathologies can therefore be found in all of these areas. We discuss various frequently occurring tumorous or tumor-like pathologies including congential lesions, such as mucoceles, inflammatory disorders including osteomyelitis, pseudotumors and Wegener's granulomatosis. Benign non-neoplastic lesions, such as cholesteatoma, cholesterol granuloma, epidermoid and benign neoplastic tumors, such as the most commonly found vestibular schwannoma, meningeoma, paraganglioma, vascular pathologies and finally malignant lesions, such as metastasis, chordoma or chondrosarcoma and endolymphatic sac tumor (ELST) are also discussed. The emphasis of this article is on the appearance of these entities in computed tomography (CT) and more so magnetic resonance imaging (MRI), it provides key facts and typical images and discusses possibilities how to distinguish these pathologies. (orig.) [German] In der Region des Felsenbein, inneren Gehoerkanals und Kleinhirnbrueckenwinkels findet sich eine Vielzahl an unterschiedlichen Gewebearten inklusive knoechernes, epitheliales, nervales und vaskulaeres Gewebe. Tumoren oder tumoraehnliche Laesionen, ossaere oder vaskulaere Pathologien koennen entsprechend dort gefunden werden. Wir diskutieren verschiedene Tumoren oder tumoraehnliche Pathologien inklusive angeborene Laesionen wie Muko- und Meningozelen, entzuendliche Veraenderungen wie die Osteomyelitis, Pseudotumoren, die Wegener-Granulomatose, nichtneoplastische Tumoren wie das Epidermoid, Cholesteatom oder Cholesterolgranulom und gutartige neoplastische Tumoren wie das am haeufigsten zu findende Vestibularisschwannom, das Paragangliom und das Meningeom, Gefaessprozesse/-pathologien und schliesslich maligne Laesionen wie Metastasen

  3. A CLINICAL STUDY ON EXTRA CRANIAL COMPLICATIONS OF CHRONIC SUPPURATIVE OTITIS MEDIA

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    Devi Prasad

    2015-06-01

    Full Text Available OBJECTIVES : The Objective is to study the risk of extra - cranial complications in cases of CSOM and to study the common extra - cranial complications of CSOM with respect to age , sex and socio - economic status . METHODS: The present study comprises of 60 patients with extra - cranial complications secondary to Chronic Suppurative Otitis media who attended to the Dept . o f E. N. T S rivenkateswara G overnment General Hospital, T irupathi . An analysis was made regarding the demographic profile , clinical features , surgical techniques , operative findings , and the outcome of the study . RESULTS : In this study of 60 cases , the most common ext racranial complication of CSOM is Postauralabscess . These extra cranial complications are associated with 15% of intracranial complications of which Meningitis is most common . The complications are more commonly seen in the younger population in second to third decades of life with Male predominance . The duration of ear discharge is not associated with the increasing number of complications . Cholesteatoma is commonly responsible for the development of Extracranial complications of CSOM . Pseudomonas aerugino sa is the commonest organism found in the complications . Canal wall down surgery is the main mode of treatment in this category of patients . The Facial canal dehiscence is associated with a poor outcome in the cases of Facial nerve paralysis . CONCLUSION: The extra - cranial complications of CSOM pose a great challenge to the Developing countries despite its declining incidence . It is in this situation that early diagnosis and prompt surgical intervention are most important for the decreased morbidity and mor tality of patients .

  4. The Importance of Integration of Stakeholder Views in Core Outcome Set Development: Otitis Media with Effusion in Children with Cleft Palate.

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    Nicola L Harman

    Full Text Available Approximately 75% of children with cleft palate (CP have Otitis Media with Effusion (OME histories. Evidence for the effective management of OME in these children is lacking. The inconsistency in outcome measurement in previous studies has led to a call for the development of a Core Outcome Set (COS. Despite the increase in the number of published COS, involvement of patients in the COS development process, and methods to integrate the views of patients and health professionals, to date have been limited.A list of outcomes measured in previous research was identified through reviewing the literature. Opinion on the importance of each of these outcomes was then sought from key stakeholders: Ear, Nose and Throat (ENT surgeons, audiologists, cleft surgeons, speech and language therapists, specialist cleft nurses, psychologists, parents and children. The opinion of health professionals was sought in a three round Delphi survey where participants were asked to score each outcome using a bespoke online system. Parents and children were also asked to score outcomes in a survey and provided an in-depth insight into having OME through semi-structured interviews. The results of the Delphi survey, interviews and parent/patient survey were brought together in a final consensus meeting with representation from all stakeholders. A final set of eleven outcomes reached the definition of "consensus in" to form the recommended COS: hearing; chronic otitis media (COM; OME; receptive language skills; speech development; psycho social development; acute otitis media (AOM; cholesteatoma; side effects of treatment; listening skills; otalgia.We have produced a recommendation about the outcomes that should be measured, as a minimum, in studies of the management of OME in children with CP. The development process included input from key stakeholders and used novel methodology to integrate the opinion of healthcare professionals, parents and children.

  5. 3D-FT MRI of the facial nerve

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    Girard, N. (Neuroradiology, Hopital Nord, 13 Marseille (France)); Raybaud, C. (Neuroradiology, Hopital Nord, 13 Marseille (France)); Poncet, M. (Neuroradiology, Hopital Nord, 13 Marseille (France))

    1994-08-01

    Contrast-enhanced 3D-FT MRI of the intrapetrous facial nerve was obtained in 38 patients with facial nerve disease, using a 1.0 T magnet and fast gradient-echo acquisition sequences. Contiguous millimetric sections were obtained, which could be reformatted in any desired plane. Acutely ill patients, were examined within the first 2 months, included: 24 with Bell's palsy and 6 with other acute disorders (Herpes zoster, trauma, neuroma, meningeal metastasis, middle ear granuloma). Six patients investigated more than a year after the onset of symptoms included 3 with congenital cholesteatoma, 2 with neuromas and one with a chronic Bell's palsy. The lesion was found incidentally in two cases (a suspected neurofibroma and a presumed drop metastasis from an astrocytoma). Patients with tumours had nodular, focally-enhancing lesions, except for the leptomeningeal metastasis in which the enhancement was linear. Linear, diffuse contrast enhancement of the facial nerve was found in trauma, and in the patient with a middle ear granuloma. Of the 24 patients with an acute Bell's palsy 15 exhibited linear contrast enhancement of the facial nerve. Three of these were lost to follow-up, but correlation of clinical outcome and contrast enhancement showed that only 4 of the 11 patients who made a complete recovery and all 10 patients with incomplete recovery demonstrated enhancement. Possible explanations for these findings are suggested by pathological data from the literature. 3D-FT imaging of the facial nerve thus yields direct information about the of the nerve condition and defines the morphological abnormalities. It can also demonstrate contrast enhancement which seems to have some prognostic value in acute idiopathic Bell's palsy. (orig.)

  6. Clinical Value of MR in Diagnosis of Tumors in the Angle of the Bridge%桥小脑角区肿瘤MR诊断价值

    Institute of Scientific and Technical Information of China (English)

    刘付广

    2015-01-01

    目的探讨桥小脑角区(CPA)肿瘤MR诊断价值。方法搜集经手术和病理证实的单侧桥小脑角区肿瘤56例,回顾性分析其MR表现。结果听神经瘤29例,三叉神经瘤10例,脑膜瘤6例,胆脂瘤(表皮样囊肿)6例,蛛网膜囊肿4例,转移瘤1例。结论听神经瘤是桥小脑角区最常见的肿瘤,MR因其具有无颅骨伪影和多维成像的特点成为CPA区肿瘤诊断的重要方法。%Objective To investigate the cerebel opontine angle (CPA) value of MR in diagnosis of tumor. Methods Col ected by 56 cases of unilateral cerebel opontine angle operation and pathology of tumors, retrospective analysis of the MR performance. Results 29 cases of acoustic neuroma, 10 cases of trigeminal neuroma, 6 cases of meningioma, cholesteatoma (epidermoid cyst) in 6 cases, 4 cases of arachnoid cyst, 1 cases of metastatic tumor. Conclusion Acoustic neuroma is the most common cerebel opontine angle tumors, MR because of its characteristic of skul artifacts and multi-dimensional imaging has become an important method for tumor diagnosis CPA.

  7. Three-dimensional CT of the ossicles of the middle ear

    International Nuclear Information System (INIS)

    This study was performed to evaluate the usefulness and limitations of three-dimensional (3-D) imaging of the ossicular chain in the middle ear by high speed helical CT. One dissected human temporal bone, five normal ears, and twelve diseased ears (trauma, ossicular anomaly, cholesteatoma, chronic otitis media) were scanned in 1.0 mm slices and reconstructed at a thickness of 0.2-0.5 mm. All 3-D CT specimens can be observed in any plane and from any direction. Ossicular 3-D CT temporal bone images were reconstructed as if the malleus, incus and stapes were being observed under a microscope. No defect in the ossicles or their joints was seen in the images. The entire structure of the stapes could not be represented by conventional two-dimensional CT, but the 3-D CT in our study showed the head, crus and foot plate of the stapes in detail. Ossicular 3-D CT images of normal ears yielded the same findings as those recorded in the temporal bone. Preoperative diagnostic findings of ossicles in diseased ears were very useful. 3-D CT was diagnostic and its accuracy was confirmed by surgical observations, especially in ossicular anomalies. 3-D CT was also an important method of postoperative evaluation of ossicular reconstruction, i.e. TORP and PORP. It could represent the anatomical relation between prosthesis and the oval window. Postoperative hearing improvement can be compared with 3-D CT findings. High-speed helical CT can scan an object more quickly and clearly than conventional CT, and its biological damage in humans is less than that of other methods. 3-D CT allows obviously clearer reconstruction by helical CT than the other methods. (author)

  8. Avoiding mastoid cavity Problems: Mastoid obliteration using Bioactive glass

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    Said Shokry, Al`Sayed Hossieni Al`Sayed, Mohammed Fatehy Zidan,

    2012-04-01

    Full Text Available Background and objective: The aim of this study was to evaluate bioactive glass as an ideal material for the purpose of mastoid cavity elimination after mastoid surgery to avoid mastoid cavity problems.Materials and methods: In 20 patients diagnosed as cholesteatoma or chronic unsafe ear, we used different surgical techniques according to pathology and situation during surgical exploration, basically adhering to standard principles of eradicating disease in chronic unsafe ear. After performing the canal wall down (CWD or the canal wall up (CWU technique, mastoidectomy was followed by obliteration of mastoid cavity by particulate form Bioglass®. Cases were divided according to operative procedures, type of reconstruction and material used into 3 groups A- Canal wall up mastoidectomy followed by obliteration of mastoid cavity by particulate form Bioglass®. B- Canal wall down mastoidectomy followed by reconstruction of posterior meatal wall and obliteration of mastoid cavity by particulate form Bioglass®. C- Canal wall down mastoidectomy followed by reconstruction of posterior meatal wall by conchal cartilage and obliteration of mastoid cavity by Bioglass®.Results: Bioactiveglass paste is very effective for mastoid obliteration in the three groups with good integration to the surrounding tissues either connective tissue, bone, meninges or lateral dural sinus without any adverse reaction on the dura even with contact to Bioglass®. Infection was seen in 2 cases (10%, however was readily controlled by topical application of antibiotics daily for one week. In both cases no extrusion of the material occurred. Conclusion: The successful formation of bone with elimination of mastoid cavity problems proved that using Bioglass is appropriate for performing clinical mastoid obliteration.

  9. Otologic and Audiologic Outcomes With the Furlow and von Langenbeck With Intravelar Veloplasty Palatoplasties in Unilateral Cleft Lip and Palate

    Science.gov (United States)

    Antonelli, Patrick J.; Jorge, José C.; Feniman, Mariza R.; Piazentin-Penna, Sílvia H.A.; Dutka-Souza, Jeniffer C.R.; Seagle, M. Brent; Williams, William N.; Nackashi, John A.; Boggs, Steve; Graciano, Maria I.G.; Souza, Telma V.; Neto, José S.M.; Garla, Luis A.; Silva, Marcos L.N.; Marques, Ilza L.; Borgo, Hilton C.; Martinelli, Ângela P.M.C.; Shuster, Jonathan J.; Pimentel, Maria C.M.; Zimmermann, Maria C.; Bento-Gonçalves, Cristina G.A.; Kemker, F. Joseph; McGorray, Susan P.; Pegoraro-Krook, Maria I.

    2013-01-01

    Objective Cleft palate increases the risk of chronic middle ear disease and hearing loss. The goal of this report was to determine which of two palate surgeries and which timing of palate surgery were associated with better otologic and audiologic outcomes in children with unilateral cleft lip and palate at 5 to 6 years of age. Design Subjects were randomly assigned to the von Langenbeck with intravelar veloplasty or Furlow palate repair, to palate surgery at 9 to 12 months or 15 to 18 months of age, and to the Spina or Millard lip repair. Setting Centralized, tertiary care craniofacial treatment center. Patients A total of 673 infants with unilateral cleft lip and palate. Interventions Palate and lip were repaired using established techniques. Serial otoscopic and audiometric evaluations were performed. Main Outcome Measures Hearing and otoscopic findings at 5 to 6 years old. Results There were 370 children available for analysis. Hearing and need for tympanostomy tube placement did not differ by palatoplasty, age at palatoplasty, cheiloplasty, or surgeon. Risk of developing cholesteatoma or perforation was higher with Millard cheiloplasty (odds ratio = 5.1, 95% confidence interval = 1.44 to 18.11, p = .012). Type and age at palatoplasty were not significantly associated with either the rate of developing these sequelae or the rate of achieving bilaterally normal hearing and ear examinations. Conclusions Type of palatoplasty did not influence otologic and audiologic outcomes in 5- to 6-year-olds with unilateral cleft lip and palate. The potential influence of lip repair on otologic outcomes warrants further investigation. PMID:20536371

  10. Complications of Chronic Suppurative Otitis Media and Their Management: A Single Institution 12 Years Experience.

    Science.gov (United States)

    Sharma, Neeta; Jaiswal, Ashwin Ashok; Banerjee, Praveer Kumar; Garg, Amrish Kumar

    2015-12-01

    To determine the incidence of otogenic complications of Chronic suppurative otitis media (CSOM) and its management. The study was conducted at the tertiary referral centre and teaching hospital. An analysis was made about the clinical and operative findings, surgical techniques and approaches, the overall management and recovery of the patient. The data were then compared with the relevant and available literature. Over the study period of 12 years, a total 45 cases of CSOM with complications were reviewed. Out of these 45 cases, 20 cases had extracranial (EC) while 25 cases had intracranial (IC) complications. The prevalence of each complication was 0.17 and 0.13 %, IC and EC respectively. The commonly encountered IC complications were brain abscess, meningitis and lateral sinus thrombophlebitis. Among the EC complications, mastoid abscess followed by labyrinthitis and facial nerve palsy were encountered. The reliable warning signs and symptoms of IC complications were fever, headache, earache vestibular symptoms, meningeal signs and impairment of consciousness. Proteus mirabilis, Pseudomonas aeruginosa, Staphylococcus epidermidis were the common organism isolated. Cholesteatoma and granulation in the middle ear were the major findings in both groups of cases. Surgery was main modality of management of these conditions. We observed that two patients fail to regain full facial nerve function despite of surgery. Mortality rate was zero but morbidity was seen in 15 % (3) and 28 % (7) of cases in EC and IC group respectively. The epidemiological presentation, clinical features and results of treatment are discussed. CSOM complications, despite its reduced incidence still pose a great challenge in developing countries, as the disease present in the advanced stage leading to difficulty in management and consequently higher morbidity. In this study we emphasize the importance of the accurate and early diagnosis followed by adequate surgical therapy with

  11. The effects of bone pâté on human osteoblasts cell cultures.

    Science.gov (United States)

    Quaranta, Nicola; Buccoliero, Cinzia; De Luca, Concetta; Mori, Giorgio; Brunetti, Giacomina; Colucci, Silvia; Colaianni, Graziana; Grano, Maria

    2016-06-01

    The aim of the present study was to evaluate the effect of bone pate on human osteoblast differentiation by measuring cell viability, alkaline phosphatase activity and expression of the transcription factors and of the major components of the extracellular matrix. Although bone paté has been used in ear surgery for many years and when placed in contact with mastoid and external auditory canal bone become viable, the cellular mechanisms that lead to its osteointegration have never been described. Bone paté taken from four patients subjected to mastoidectomy and affected by middle ear and mastoid cholesteatoma was placed in contact with osteoblast-like cell cultures. Four experimental conditions were obtained: cell cultures treated with bone patè, with bone paté mixed with fibrin glue, with fibrin glue and untreated. After 24 h, the viability of the cells was evaluated; after 1 week, alkaline phosphatase activity and the expression of transcription factors and bone matrix proteins were assessed by quantitative polymerase chain reaction. After 24 h osteoblasts showed increased viability when treated with bone paté (19 % increase) and bone pate mixed with fibrin glue (34 % increase). After 1 week, the number of alkaline phosphatase positive cells increased by 97 and 94 % in cultures treated with bone paté alone and bone pate mixed with fibrin glue. Treatment with bone patè upregulated transcription factors and components of the extracellular matrix. The present data show that bone paté has a high osteoinductive potential on human osteoblasts, enhancing their activity. PMID:26133919

  12. Cartilage Tympanoplasty: Is it more effective than temporalis fascia grafting for tympanoplasty?

    Directory of Open Access Journals (Sweden)

    Shyamakant Prasad

    2015-12-01

    Full Text Available Chronic suppurative otitis media is a disease which is a major cause of morbidity in our country. A large proportion of these patients have safe (mucosal chronic suppurative otitis media. It leads to otorrhoea and deafness which hampers productivity of many individuals. Otolaryngologist play an important role in its correction and amelioration by con-servative or operative procedures. One such procedure is tympanoplasty. AIMS AND OBJECTIVES 1. To evaluate improvement in hearing following tympanoplasty using temporalis fascia graft and cartilage island graft at 8 weeks after surgery. 2. Graft status after tympanoplasty using temporalis fascia graft and cartilage island graft. 3. Assess other complications after surgery in both groups. This study was conducted in the Department of Otorhinolaryngology and Head and Neck Sur-gery, ST. STEPHEN’S HOSPITAL, DELHI between November 2010 to November 2012. INCLUSION CRITERIA 1. Includes patient in the age group of 20-40 years, having good general physical condition. 2. No evidence of active infection in nose, throat or paranasal sinuses, central perforation of pars tensa of the tympanic membrane with dry ear for a minimum period of 3 weeks be-fore the day of operation. 3. Patients having good eustachian tube function with good cochlear reserve. Exclusion criteria: 1. Patients having blocked eustachian tube, with polyp, granulations or cholesteatoma 2. Failed myringoplasty in the same ear 3. Otogenic intra cranial complications in the past 4. Evidence of otitis externa or otomycosis 5. Per operative ossicular discontinuity, fixed foot plate 6. Patients with evidence of focal sepsis

  13. Value of Multislice Spiral Computed Tomography in demonstrating Ossicular Chain and diagnosis of Ossicular Destruction in Chronic Otomastoiditis%多层螺旋CT对中耳乳突炎骨质破坏的诊断价值

    Institute of Scientific and Technical Information of China (English)

    吴宏; 赖清泉; 黄启明

    2016-01-01

    目的:探讨多层螺旋CT对中耳乳突炎患者听骨链形态及骨质破坏情况的诊断价值。方法选取于2013年10月~2015年10月笔者所在医院就诊的中耳乳突炎患者40例中患耳48耳,采用多层螺旋CT以多平面重组技术及容积重建技术,对入选患者耳听骨链形态及骨质破坏情况进行扫描检查,评价多层螺旋CT诊断的准确性。结果正常组多平面重组技术及容积重建技术结果对锤骨柄、砧骨短脚、锤骨头、砧骨体及砧骨长脚检查结果无统计学差异(P>0.05),但对镫砧关节以及镫骨的状态观察多平面重组技术优于容积重建技术,结果具有统计学差异(P0.05), but the MPR technology was superior to volume rendering technique in showing the stapes and incudostapedial joint (P<0.05). The accuracy of multislice spiral computed tomography was 100%on the Fallopian canal, incus body and short crus, 94.4%on tympanic cavity walls, long crus of incus and stapes, and 88.8%on malleus in otomastoiditis with granulation;100%on tympanic cavity walls, Fallopian canal and all ossicles in simple otomastoiditis;and 100%on the incus and its long crus, malleus and Fallopian canal, 92.3%on short crus of incus and tympanic cavity walls, and 84.6%on the stapes in otomastoid-itis with cholesteatoma. Conclusion multislice spiral CT provides clear viewing of morphology of middle and inner ear bony structures and erosion in patients with otomastoiditis, and is valuable in distinguishing different types of otomastoid-itis. MPR technology and bulk reconstruction technique can show fine structure of the ear and is valuable in guiding ear sur-geries.

  14. Cochlear implantation at the ear, nose and throat clinic of the Clinical center of Vojvodina

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    Komazec Zoran

    2007-01-01

    Full Text Available Introduction. A cochlear implant is a small electronic device that can provide a sense of sound to a person who is profoundly deaf or severely hard-of-hearing. Cochlear implants bypass the damaged hearing systems and directly stimulate the auditory nerve. Signals generated by the implant are sent by way of the auditory nerve to the brain, which recognizes the signals as sound. Hearing through a cochlear implant differs from normal hearing and takes time to learn or relearn. Cochlear implantations have been performed at the ENT Clinic in Novi Sad since 2002. The aim of this retrospective investigation was to evaluate performance of cochlear implanted patients in regard to the age of hearing loss identification, age at implantation, as well as complications. Material and Methods. During a 5-year period (2002-2007, 45 patients underwent cochlear implantation (46 implants at the ENT Clinic in Novi Sad. Only four patients were postlingually deaf adults. Forty-one implanted patients were children with a mean age at implantation of 42.2 months (range: 2 to 8 years. Out of these patients, 28 (68.2% had congenital deafness of unknown cause. The commonest known cause was meningitis, found in 4 (9.7% patients, followed by use of ototoxic drugs and hereditary deafness. Etiological factors included: postnatal hypoxia, intracranial hemorrhage, pre term birth, cytomegalovirus infection during pregnancy, middle ear cholesteatoma, as well as sudden bilateral deafness. The time span between diagnosis of hearing loss and implantation was 34.6 months in 2002 and only 10 months in 2007. Results. 6 (13% patients presented with complications. There were 4 major, and two minor complications. The following complications were noted: ossified cochlea which required reoperation, unsuccessful operation in a patient with Down syndrome, facial tics, temporary facial weakness and ataxia. Five out of six complications were successfully resolved. Conclusion. New, more

  15. BACTERIOLOGICAL PROFILE OF CHRONIC SUPPURATIVE OTITIS MEDIA AND ITS CLINICAL SIGNIFICANCE IN RURAL AREA

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    Mohit

    2015-11-01

    Full Text Available BACKGROUND: Middle ear infection is one of the most common condition in ENT practice, particularly in our country. Its significance lies in its chronicity and its dreaded complications like hearing loss and cholesteatoma. Chronic suppurative Otitis media and its complications are among the most common conditions seen by both the otologist and pediatrician. Both gram positive and negative organisms are responsible for infection of the middle ear. AIMS: The study was primarily carried out in 200 cases of C.S.O.M. to determine the bacteriological flora and to study the antibiotic sensitivity pattern of the organisms isolated on culture from discharging ears. RESULTS: In our study Pseudomonas aeruginosa was found to be the most common isolated bacteria (40.65% [100/246], followed by Staphylococcus aureus (14.63%[36/246], Klebsiella aerogenes (11.78%[29/246] and Proteus Mirabilis (10.56%[26/246]. Among the anerobic organisms Peptostreptococcus (5.69% was the most common followed by Propionibacterium (4.06% and Bacteroids spp. (3.65%. Amikacin was the most effective antibiotic in the present study. It was effective against maximum number of strains 97(95.48% followed by Gentamycin 95(92.36% and Ciprofloxacin 93(91.30%. Cefoperazone 88(86.42%, Cefotaxime 78(74.54% and Ofloxacin 64(62.68%. CONCLUSION: Efficient and effective treatment of CSOM is based on the knowledge of causative micro-organisms and thus their antimicrobial sensitivity ensures proper clinical recovery and avoidance of the possible dreaded complications. It has been observed that human negligence is one of the main factor responsible for the development of antibiotic resistance. Along with the indiscriminate use of antibiotics by the treating physician the lack of compliance on part of the patient also results in emergence of resistance and thus in treatment failure. It has been frequently encountered that as soon as the symptoms subside and improvement in condition occurs, many

  16. BACTERIOLOGICAL PROFILE OF CHRONIC SUPPURATIVE OTITIS MEDIA AND ITS CLINICAL SIGNIFICANCE IN RURAL AREA

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    Mohit Srivatsava

    2015-12-01

    Full Text Available Background: Middle ear infection is one of the most common condition in ENT practice, particularly in our country. Its significance lies in its chronicity and its dreaded complications like hearing loss and cholesteatoma. Chronic suppurative Otitis media and its complications are among the most common conditions seen by both the otologist and pediatrician. Both gram positive and negative organisms are responsible for infection of the middle ear. Aims: The study was primarily carried out in 200 cases of C.S.O.M. to determine the bacteriological flora and to study the antibiotic sensitivity pattern of the organisms isolated on culture from discharging ears. Results: In our study Pseudomonas aeruginosa was found to be the most common isolated bacteria (40.65% [100/246], followed by Staphylococcus aureus (14.63% [36/246], Klebsiella aerogenes (11.78% [29/246] and Proteus Mirabilis (10.56% [26/246]. Among the anerobic organisms Peptostreptococcus (5.69% was the most common followed by Propionibacterium (4.06% and Bacteroids spp. (3.65%. Amikacin was the most effective antibiotic in the present study. It was effective against maximum number of strains 97 (95.48% followed by Gentamycin 95 (92.36% and Ciprofloxacin 93 (91.30%. Cefoperazone 88 (86.42%, Cefotaxime 78 (74.54% and Ofloxacin 64 (62.68%. Conclusion: Efficient and effective treatment of CSOM is based on the knowledge of causative micro-organisms and thus their antimicrobial sensitivity ensures proper clinical recovery and avoidance of the possible dreaded complications. It has been observed that human negligence is one of the main factor responsible for the development of antibiotic resistance. Along with the indiscriminate use of antibiotics by the treating physician the lack of compliance on part of the patient also results in emergence of resistance and thus in treatment failure. It has been frequently encountered that as soon as the symptoms subside and improvement in condition occurs

  17. A clinical case of pseudotumorous chronic parainfectious limbic encephalitis

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    N. A. Shnaider

    2014-01-01

    Full Text Available Parainfectous limbic encephalitis (PILE associated with viruses of the Herpesviridae family is one of the forms of chronic herpes encephalitis characterized by limbic system dysfunction and a prolonged course with frequent exacerbations. There are two types of the course of the disease: latent autoimmune limbic encephalitis (LE progressing to mesial temporal sclerosis and pseudotumorous granulomatous LE. The latter (inflammatory pseudotumor or granuloma is characterized by the formation of a polymorphic inflammatory infiltrate with the elements of fibrosis, necrosis, and a granulomatous reaction and by myofibroblast cells. This is a slowly growing benign pseudotumor that contains much more plasma cells than inflammatory ones. The diagnosis of pseudotumorous LE is difficult and requires the participation of a neurologist, an immunologist, an oncologist, and a neurosurgeon. Perfusion computed tomography, magnetic resonance imaging, and magnetic resonance spectroscopy give proof to the adequacy of the term inflammatory pseudotumor because it is histologically difficult to characterize the lesion as a tumor or inflammation. When a chronic lesion in the central nervous system is lately diagnosed, the prognosis of the disease may be poor and complicated by the development of resistant symptomatic focal epilepsy and emotional, volitional, and cognitive impairments. It was differentially diagnosed from brain tumors (astrocytic, oligodendroglial, and mixed gliomas, ependymal, neuronal, neuroglial, and embryonal tumors, meningiomas, cholesteatomas, dermoid cysts, teratomas, and cysts, other reactive and inflammatory processes (leukemic infiltrations, systemic lupus erythematosus, multiple sclerosis, encephalomyelitis, hypoparathyroidism, Addison's disease, vitamin A intoxication, and the long-term use of glucocorticoids and contraceptives. The authors describe a clinical case of the pseudotumorous course of chronic PILE in a 28-year-old woman

  18. Gustatory alteration evaluation in patients with chronic otitis media Avaliação de alteração gustatória em pacientes com otite média crônica

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    Felippe Felix

    2009-08-01

    Full Text Available Many studies have shown the consequent gustatory alteration caused by ear surgeries. However, few have reported this alteration in patients with chronic otitis media (COM, prior to surgical treatment. AIM: to identify gustatory alterations due to chorda tympani nerve involvement in patients with COM without prior surgery. METHODS: Clinical essay, with tests based on "taste strips" with different concentrations of salt, sweet, bitter, and sour, was performed in 45 patients with unilateral cholesteatomatous or suppurated COM not previously submitted to otological surgery, using the disease-free ear on the contralateral side as control. The score ranged between 0 and 16. RESULTS: A total of 25 patients presented cholesteatoma and 20 had non-cholesteatomatous disease. The mean score was 6.65 for the affected side and 9.93 for the half of the tongue on the side of the healthy ear (pMuitos estudos mostraram a consequente alteração do paladar após cirurgia otológica. Entretanto, poucos reportaram essa alteração como uma queixa de pacientes com otite média crônica (OMC previamente à cirurgia. OBJETIVO: Avaliar alterações na função gustatória na área inervada pelo nervo corda do tímpano em pacientes com OMC ainda não submetidos à cirurgia. MATERIAL E MÉTODOS: O ensaio clínico, com teste gustatório baseado em "tiras gustativas" com diferentes concentrações de sal, doce, amargo e azedo, foi realizado em 45 pacientes com OMC colesteatomatosa e não-colesteatomatosa unilateral, nunca antes submetidos à cirurgia otológica, utilizando a metade da língua do lado livre de doença otológica como controle. As notas variavam de 0 a 16. RESULTADOS: 25 pacientes apresentavam colesteatoma e o restante OMC não-colesteatomatosa. A pontuação média foi de 6,65 para o lado afetado e 9,93 para a metade da língua do lado sadio (p<0,001. Nenhum paciente se queixava de alteração do paladar antes do exame. Encontramos 24 casos de hipogeusia do

  19. Bibliometric analysis of the trends of otitis media literatures%中耳炎相关研究趋势的文献计量学分析

    Institute of Scientific and Technical Information of China (English)

    田芳洁; 刁明芳; 孙建军

    2013-01-01

    OBJECTIVE To understand the tendency of otitis media research over the past 10 years through a bibliometic approach. METHODS The literatures were searched in Web of Science citation database (2001 -2010) . The searching results were analyzed by Microsoft Office Excel 2007 concerning the literatures numbers of different countries and institutions, magazine distribution and characteristics of key words in recent years. RESULTS The annual number of otitis media literature had little change from 2001 to 2010. The independent literatures accounted for 90.59%. The literature number of USA and its institution ranked first. The literature number of China ranked 16th, Taiwan and Hong Kong was particularly prominent. Streptococcus pneumonia, children, cholesteatoma, antibiotics, haemophilus influenza, vaccine, and hearing loss were the focuses of otitis media research in the world in tie recent years. The research contents and focuses of china was broadly in line with the international ones. CONCLUSION Independent research was the main way in otitis media research, international and institutional cooperation need to be strengthened. The developed countries were in the leading position in the research of otitis media. China still lagged behind its international peers and needed further basic research.%目的 从文献计量的角度分析近10年来中耳炎及其相关研究的趋势.方法 以Web of Science数据库作为检索对象,从中耳炎研究的国家与机构分布、研究内容、期刊登载和关键词特征等进行综合分析.结果 统计范围内中耳炎独立研究文献占比90.59%,年度间文献发表变量不大.美国及其科研机构发文量仍居首位,我国发文量名列第16位,台湾和香港地区表现较为突出.肺炎链球菌、流感嗜血杆菌、儿童患病率、中耳胆脂瘤、抗生索与疫苗应用、听力损失等为研究重点.国内研究热点与国际上基本一致.结论 独立研究在中耳炎研究中处于

  20. Mastoiditis aguda: estudio epidemiológico de una década Acute mastoiditis: one-decade long epidemiological study

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    C. Suárez Castañón

    2009-01-01

    : Retrospective study on cases of children admitted to Hospital Cabueñes (Gijón with a diagnosis of acute mastoiditis from 1997 to 2007 .
    Results: Twenty-eight patients (54% males with a mean age of 35.5 months were included. Seven cases (25% occurred in 2007. Eight patients had a history of recurrent otitis media. Sixty-one percent of children received antibiotics before diagnosis of mastoiditis. Swelling, erythema and postauricular inflammation (96%, fever (86%, pain (64% and othorrea (36% were the most frequent symptoms and signs. The white blood cell count was greater than 15,000/mm3 in 79% of the cases and the CRP mean value was 79.3 mg/L. Cultures were obtained from 21 children (75%. S. pneumoniae and P. aeruginosa (3 cases each were the most common etiological agents. Mean hospital stay was 8 days. Miringotomy was performed in 15 patients (53.6%. Seven patients needed surgery. Complications included one case each of deafness (a patient with S. aureus labyrinthitis, transitory facial palsy, temporal subperiostic abscess and cholesteatoma.
    Conclusions: Acute mastoiditis remains a relatively frequent complication of acute otitis media, responsible for considerable morbidity. Epidemiological surveillance is required to confirm a real amount of incidence in our population.

  1. Cocleostomia transcanal: resultados em longo prazo de um estudo de coorte Transcanal cochleostomy in cochlear implant surgery: long-term results of a cohort study

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    Michelle Lavinsky-Wolff

    2012-04-01

    Full Text Available A técnica de acesso combinado (TAC ao implante coclear (IC é uma variação da técnica clássica de mastoidectomia e timpanotomia posterior (MPTA. A TAC combina um acesso transcanal à cocleostomia com uma timpanotomia posterior reduzida para a inserção dos eletrodos. OBJETIVO: Avaliar e comparar a segurança e efetividade em longo prazo alcançados com a TAC e MPTA em pacientes submetidos a IC em um centro brasileiro. Desenho científico: Estudo de série. MATERIAL E MÉTODO: Pacientes submetidos a IC usando TAC e MPTA foram acompanhados em um estudo de coorte. Os desfechos avaliados foram complicações, avaliação audiométrica e radiológica pós-operatórias. RESULTADOS: Quarenta e quatro pacientes foram implantados usando a TAC e 31 usando MPTA. Não houve casos de paralisia facial, mastoidite, colesteatoma ou fístula após 3,4±1,0 anos. A avaliação radiológica da posição dos eletrodos a mediana de eletrodos fora da cóclea foi de 0 no grupo TAC e de 3 no MPTA (p The combined approach technique (CAT is a variation of the classical the mastoidectomy-posterior tympanotomy technique (MPTA that combines a transcanal approach to cochleostomy with a reduced posterior tympanotomy for insertion of electrodes. AIM: To compare and evaluate long-term safety and effectiveness outcomes obtained with the CAT and with MPTA approach in patients submitted to cochlear implant (CI surgery. Design: series study. METHODS: Patients who underwent CI using CAT or MPTA at a Brazilian center were followed in a cohort study. Main outcomes were complications,audiometric performance and radiological evaluation of electrode position. RESULTS: Fourty-four patients were implanted using CAT and 31 MPTA. There were no cases of facial nerve paralysis, mastoiditis, cholesteatoma or cerebrospinal fluid leaks after 3.4±1.0 years. Radiological evaluation of electrode position revealed that the median number of electrodes outside the cochlea was 0 in CAT and 3 in

  2. Outcomes of using titanium ossicular prosthesis in one stage tympanoplasty%钛人工听骨在Ⅰ期鼓室成形术中的临床疗效分析

    Institute of Scientific and Technical Information of China (English)

    罗五根; 张剑; 曾亮; 蔡艳臣; 江红群

    2012-01-01

    PORP (Group 2), and no bridge plus TORP (Group 3). The 112 patient were followed up for 3 months to 1 years and their pre- and postoperative pure tone threshold results were available for comparison. Result Postoperative air-bone gap was reduced to ≤20 dB in 43 cases (42 using PORP and 1 using TORP). While post-operative air-bone gap was decreased compared to before surgery among all three groups, especially for those using PORP as compared to those using TORP, the improvement was not statistically different between Groups 1 and 2, There was no recurrence of Cholesteatoma. Titanium ossicular prosthesis was protruded in 3 patients. Conclusion Whether bone bridge is preserved does not appear to affect postoperative hearing results, whereas the type of titanium ossicular prosthesis does.

  3. Clinical analysis of otogenic intracranial complications%耳源性颅内并发症临床特点分析

    Institute of Scientific and Technical Information of China (English)

    杨华; 陈晓巍; 高志强; 倪道凤; 姜鸿; 徐春晓; 刘正印; 周宝桐; 杨大海

    2008-01-01

    用可以弥补CT的不足.%Objective To analyze the clinical features and treatment protocols of otogenic intracranial complications in Peking Union Medical College ospital. Methods Retrospective study of 14 patients (10 males and 4 females, aged between 12 -62 years, mean age 32. 1 years) hospitalized from 1982 - 2006. Twelve cases were otitis media (OM) with cholesteatoma, the other 2 cases were non-cholesteatomatons OM. All the otogenic intracranial complications located at the same sides as otologic disorders. Brain abscess was the most common type of orogenic complications and Proteus was the most common microorganism detected. Suppurative ear discharge, headache, high fever and nausea with vomiting were the most common clinical manifestations with very high incidences. All the patients received combined protocols of mastoid surgeries and antibiotics treatment. Results All the 14 patients recovered clinically. For patients discharged before 1987, there were 4 patients followed up for 22. 5 - 24. 4 years with a mean time of 23. 8 without recurrence, 1 patient died of cardiovascular disease 19. 2 years later after discharge, 4 patients lost follow-up. For the 5 patients discharged after 1997 ,brain abscess recurred in one patient with pseudo-recovery after 24 days and he fitlly recovered after re-hospitalization and treatment. All the five patients were followed up for 1.5 years to 10. 6 years with a mean time of 6. 5 years without recurrence. Conclusions Youngsters and males seemed to be more vulnerable. Brain abscess was the most common intracranial complication and Proteus was the most common pyogenic microorganism. Combination of mastoid surgery and antibiotics were essential for effectively controlling the intracranial complications and improvingthe recovery. CT and MRI were essential for correct diagnosis betimes and MRI seemed to have a better performance.

  4. CT中耳仿真内窥镜成像对中耳结构空间解剖关系的显示价值%Computed tomography virtual endoscopy imaging for spacial anatomy of the middle ear

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    杨智云; 刘春玲; 周旭辉; 严超贵; 谢红波; 彭谦

    2009-01-01

    CT仿真内窥镜耗时不长,可以临床常规使用.%BACKGROUND: The middle ear is a little aerated cavity with a complex anatomy and a deep location. Computed tomagraphy virtual endoscopy (CTVE) can be used to reconstruct the stereoscopic images of internal surface of hollow organs using spiral CT volumetric data, providing findings similar to fiberendoscope.OBJECTIVE: To vedfy the ability to show the normal middle ear and the clinical application of virtual endoscopy based on 64-detector CT data.DESIGN, TIME AND SETTING: A confirmatory controlled observation was performed at Department of Radiology, First Affiliated Hospital of Sun Yat-sen University between October 2005 and March 2006.PARTICIPANTS: A total of 33 patients (66 ears) with suspected middle ear disease who underwent spiral CT examination were included in this study. Among included ears, 35 were normal, and 31 were impaired, including 24 ears presenting with chronic suppurative otitis media (10 simple otitis media, 5 granulomatous otitis media, and 9 middle ear cholesteatoma), 2 ears with post-operative recurred suppurative otitis media, 2 ears with carcinoma of middle ear, and 2 ears with temporal bone fracture, and lear with foreign body granuloma.METHODS: CT images of the temporal bone were obtained using 0.5 mm thick axis slices with a soft reconstruction kemel at 0.3 mm intervals. Virtual endoscopic images of middle ear on CT were generated from volumetric data using the Navigator software. CTVE images were observed from multiple directions using the Fly Through software, and compared with the axial and coronal images and surgery findings.MAIN OUTCOME MEASURES: The following structures were observed: auditory ossicle and joints, superior, middle, and inferior tympanum, sinus tympani, external acoustic meatus, tympanum, facial recess, tegmental wall, anterior and superior ligaments of malleus, posterior ligament of incus, and retrotympanum.RESULTS: A series of images were acquired as the virtual