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Sample records for cholesteatoma

  1. MR imaging of cholesteatoma

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    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)

  2. Etiopathology of acquired cholesteatoma

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    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.

  3. Etiopathogenesis of cholesteatoma.

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    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

  4. Ear canal cholesteatoma.

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    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

  5. Postoperative MRI findings after cholesteatoma surgery

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    Segawa, Yuko; Tono, Tetsuya; Kano, Kiyo; Morimitsu, Tamotsu [Miyazaki Medical Coll., Kiyotake (Japan)

    1995-07-01

    This study was designed to show MRI findings of postoperative middle ear pathologies and to discuss the usefulness of Gadolinium-enhanced MRI in evaluating the postoperative state of cholesteatoma. Thirty-eight ears which underwent intact canal wall tympanoplasty for cholesteatoma were examined. Recurrent cholesteatoma was detected as an iso-intensity area on T1-weighted images with negative enhancement. Notably, residual cholesteatoma were generally depicted as a round iso-intensity area with negative enhancement. Residual cholesteatoma less than 5 mm in diameter were, however, not generally detectable with our MRI scanner. Granulation tissue can be separated from cholesteatoma as an area with positive enhancement. Cholesterol granuloma shows a characteristic high signal pattern on both T1 and T2-weighted images. Hypovascular fibrous tissue and fluid collection may be depicted as a pattern similar to that of cholesteatoma. However, the signal is usually more homogeneous than that of cholesteatoma. We conclude that Gadolinium-enhanced MRI is useful for detecting postoperative cholesteatoma and avoiding unnecessary second-look operations after cholesteatoma surgery, by the canal-up procedure. (author).

  6. Animal Models of Middle Ear Cholesteatoma

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    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...

  7. Altered permeability barrier structure in cholesteatoma matrix

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    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...

  8. Congenital cholesteatoma: delayed diagnosis and its consequences.

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    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

  9. 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

  10. Cholesteatoma

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    ... 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 ...

  11. Giant Cholesteatoma : Recommendations for Follow-up

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    Geven, Leontien I.; Mulder, Jef J. S.; Graamans, Kees

    2008-01-01

    This report presents the management of five patients who presented with giant recurrent or residual cholesteatoma after periods of 2 to 50 years. Their case histories are highly diverse, but all provide evidence of the need for long-term follow-up.

  12. 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.

  13. School performance in cholesteatoma-operated children in Denmark

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    Djurhuus, Bjarki; Hansen, Tom Giedsing; Pedersen, Jacob Krabbe;

    2016-01-01

    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...... 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......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...

  14. Stratum corneum barrier lipids in cholesteatoma

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

    2000-01-01

    Specimens from primary cholesteatomas were examined under the electron microscope using a lipid-retaining method that is best suited for intracellular lipids and a method that is best for intercellular lipids. In the stratum granulosum of the squamous epithelium, a large number of Odland bodies...... 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......, as seen in the formation and maintenance of the cutaneous permeability barrier. In this study we draw the attention to the facts that the cholesteatoma epithelium is capable of producing not only cholesterol, but also several lipids, and that the lipid molecules are organized in multilamellar structures...

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

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    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...

  16. Imaging evaluation of middle ear cholesteatoma: iconographic essay

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    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)

  17. 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)

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

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    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

  19. [Cholesteatoma by osteoma of the external auditory canal].

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    Maliki, O; Aderdour, L; Ziad, T; Nouri, H; Rouchdi, Y; Marrat, A; Raji, A

    2012-01-01

    Osteoma in the external auditory canal (EAC) is an uncommon benign tumor. The association of a cholesteatoma with an osteoma of EAC is extremely rare. We report a case of a 26-year-old woman with an osteoma of the left EAC that was complicated by a cholesteatoma in the EAC between the osteoma and left tympanic membrane. Surgical removal of the osteoma and cholesteatoma proved successful by postauricular approach. The follow up without recurrence is 24 months. Osteoma of the EAC is a solitary, unilateral, and slow-growing bony benign tumor. The foremost differential diagnosis is exostose that is multiple and bilateral. Cholesteatoma of the EAC is uncommon. Its basic pathogenesis is a chronic occlusion of the EAC. Surgical treatment avoids complications related to local aggressiveness of cholesteatoma.

  20. Cholesteatoma fibroblasts promote epithelial cell proliferation through overexpression of epiregulin.

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    Mamoru Yoshikawa

    Full Text Available To investigate whether keratinocytes proliferate in response to epiregulin produced by subepithelial fibroblasts derived from middle ear cholesteatoma. Tissue samples were obtained from patients undergoing tympanoplasty. The quantitative polymerase chain reaction and immunohistochemistry were performed to examine epiregulin expression and localization in cholesteatoma tissues and retroauricular skin tissues. Fibroblasts were cultured from cholesteatoma tissues and from normal retroauricular skin. These fibroblasts were used as feeder cells for culture with a human keratinocyte cell line (PHK16-0b. To investigate the role of epiregulin in colony formation by PHK16-0b cells, epiregulin mRNA expression was knocked down in fibroblasts by using short interfering RNA and epiregulin protein was blocked with a neutralizing antibody. Epiregulin mRNA expression was significantly elevated in cholesteatoma tissues compared with that in normal retroauricular skin. Staining for epiregulin was more intense in the epithelial cells and subepithelial fibroblasts of cholesteatoma tissues than in retroauricular skin. When PHK16-0b cells were cultured with cholesteatoma fibroblasts, their colony-forming efficiency was 50% higher than when these cells were cultured with normal skin fibroblasts. Also, knockdown of epiregulin mRNA in cholesteatoma fibroblasts led to greater suppression of colony formation than knockdown in skin fibroblasts. Furthermore, the colony-forming efficiency of PHK16-0b cells was significantly reduced after treatment with an epiregulin neutralizing antibody in co-culture with cholesteatoma fibroblasts, but not in co-culture with skin fibroblasts. These results suggest that keratinocyte hyperproliferation in cholesteatoma is promoted through overexpression of epiregulin by subepithelial fibroblasts via epithelial-mesenchymal interactions, which may play a crucial role in the pathogenesis of middle ear cholesteatoma.

  1. 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

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

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    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

  3. Structural characterization and lipid composition of acquired cholesteatoma

    DEFF Research Database (Denmark)

    Bloksgaard, Maria; Svane-Knudsen, Viggo; Sørensen, Jens A;

    2012-01-01

    along a depth of more than 200 μm and resembles the stratum corneum of hyperorthokeratotic skin. Lipid compositional analyses of the cholesteatoma show the presence of all major lipid classes found in normal skin stratum corneum (ceramides, long chain fatty acids, and cholesterol). Consistent with this...... corneum within the cholesteatoma. The lipid composition and extracellular membranes similar to those of normal skin stratum corneum are present, indicating that a defensive/permeability barrier is present in the cholesteatoma. Finally, it is demonstrated that multiphoton excitation fluorescence microscopy...

  4. CONGENITAL CHOLESTEATOMA ISOLATED TO MASTOID PROCESS : A CASE REPORT

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    Anju Chauhan

    2015-04-01

    Full Text Available Congenital cholesteatoma(CC accounts for 2-5% of all cholesteatomas[1] most common site being middle ear. We report an extremely rare case of congenital cholesteatoma isolated to the mastoid process, with no middle ear involvement. An 18 year old male presented with ear ache and minimal discharge for 4 months. On examination, external auditory canal was found narrowed with granulations and bony defect present in the posteroinferior part of canal. Computed tomography showed soft tissue contents in the mastoid bone causing full thickness erosion of the same along with attenuation of ear canal. At surgery, a large cholesteatoma sac was found within the mastoid process completely eroding it and extending to posterior part of external auditory canal. The mastoid antrum and aditus were found normal. Tympanic membrane was intact. CC isolated to the mastoid was diagnosed. Diagnosis of CC isolated to the mastoid should be based on clinical examination and radiological evaluation.

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

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    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.

  6. Biochemical and Bioimaging Evidence of Cholesterol in Acquired Cholesteatoma

    DEFF Research Database (Denmark)

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

    2016-01-01

    OBJECTIVES: To quantify the barrier sterols and image the lipid structures in the matrix of acquired cholesteatoma and compare the distribution with that found in stratum corneum from normal skin, with the goal to resolve their potential influence on cholesteatoma growth. METHODS: High-performanc......OBJECTIVES: To quantify the barrier sterols and image the lipid structures in the matrix of acquired cholesteatoma and compare the distribution with that found in stratum corneum from normal skin, with the goal to resolve their potential influence on cholesteatoma growth. METHODS: High......-performance thin-layer chromatography (HPTLC) was used to achieve a quantitative biochemical determination of the sterols. The intercellular lipids were visualized by Coherent Anti-Stokes Raman scattering (CARS) microscopy, which enables label-free imaging of the lipids in intact tissue samples. RESULTS...

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

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    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

  8. 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.

  9. 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...

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

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    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

  11. 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.

  12. Acute unilateral hearing loss as an unusual presentation of cholesteatoma

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    Bickerton Richard C

    2005-09-01

    Full Text Available Abstract Background Cholesteatomas are epithelial cysts that contain desquamated keratin. Patients commonly present with progressive hearing loss and a chronically discharging ear. We report an unusual presentation of the disease with an acute hearing loss suffered immediately after prolonged use of a pneumatic drill. Case presentation A 41 year old man with no previous history of ear problems presented with a sudden loss of hearing in his right ear immediately following the prolonged use of a pneumatic drill on concrete. The cause was found to be a fractured long process of incus which had been eroded by the presence of an attic cholesteatoma. A tympanomastoidectomy and ossiculoplasty was performed with good result. Conclusion Cholesteatomas may be asymptomatic and insidious in their onset. This case illustrates the point that an indolent disease such as this may present in unusual ways and the clinician must always have a high index of suspicion combined with thorough assessment and examination of every patient.

  13. 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.

  14. 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.

  15. 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

  16. A review of current progress in acquired cholesteatoma management.

    Science.gov (United States)

    Kuo, Chin-Lung; Liao, Wen-Huei; Shiao, An-Suey

    2015-12-01

    The aim of this study was to review recent advances in the management of acquired cholesteatoma. All papers referring to acquired cholesteatoma management were identified in Medline via OVID (1948 to December 2013), PubMed (to December 2013), and Cochrane Library (to December 2013). A total of 86 papers were included in the review. Cholesteatoma surgery can be approached using either a canal wall up (CWU) or canal wall down (CWD) mastoidectomy with or without reconstruction of the middle ear cleft. In recent decades, a variety of surgical modifications have been developed including various "synthesis" techniques that combine the merits of CWU and CWD. The application of transcanal endoscopy has also recently gained popularity; however, difficulties associated with this approach remain, such as the need for one-handed surgery, the inability to provide continuous irrigation/suction, and limitations regarding endoscopic accessibility to the mastoid cavity. Additionally, several recent studies have reported successes in the application of laser-assisted cholesteatoma surgery, which overcomes the conflicting goals of eradicating disease and the preservation of hearing. Nevertheless, the risk of residual disease remains a challenge. Each of the techniques examined in this study presents pros and cons regarding final outcomes, such that any pronouncements regarding the superiority of one technique over another cannot yet be made. Flexibility in the selection of surgical methods according to the context of individual cases is essential in optimizing the outcomes.

  17. 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

  18. Modification of closed tympanoplasty in middle ear cholesteatoma

    Institute of Scientific and Technical Information of China (English)

    ZHANG Zhi-gang; LIU Xiang; CHEN Sui-jun; CHEN Bin; ZHENG Yi-qing

    2010-01-01

    Background Classic mastoidectomy and modified mastoidectomy are traditional surgical procedures for middle ear cholesteatoma with goals of eradicating diseases, creating dry ears and preventing severe complications. However, the drawback of these procedures is the lack of hearing improvement. Therefore, our study aimed to investigate the effects and safety of a modification of closed tympanoplasty for middle ear cholesteatoma.Methods Eighty-three patients were recruited in this study based on the following two criteria: each patient had middle ear cholesteatoma in one ear; the affected ears had a functional eustachian tube and had neither intracranial nor extracranial complications. All the patients received a modification of closed tympanoplasty which included ossicular reconstruction with total ossicular replacement prosthesis (TORP) or partial ossicular replacement prosthesis (PORP) and membrane repair with conchal cartilage-perichondral complex.Results All the 83 cases had dry ears with membranes healed within 4-6 postoperative weeks. After 6 postoperative months, there were 3 cases with re-perforation at the tympanic membrane center and after 1.5 postoperative years, there were 5 cases with cholesteatoma recurrence (6.02%). Function tests after one postoperative year exhibited an improvement of pure tone audiometry (PTA) in 27 cases that was more than 30 dB, in 33 cases between 20-29 dB, 14 cases with improvement between 10-19 dB, and in 9 cases there was no improvement.Conclusions The modified closed tympanoplasty procedure for middle ear cholesteatoma in the present study has all the advantages of both close-cavity and open-cavity procedures. It has low recurrence rate and good hearing improvement.

  19. 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

  20. Cholesteatoma of the hypotympanum in a patient with Treacher Collins syndrome.

    Science.gov (United States)

    Mann, Wolf; Al-Nawas, Bilal; Wriedt, Susanne; Mann, Sophie; Koutsimpelas, Dimitrios

    2014-02-01

    In the present article we report a cholesteatoma of the hypotympanum extending to the jugular foramen in a 16-year-old male with Treacher Collins syndrome. Preoperative imaging excluded jugular paraganglioma and set the diagnosis of cholesteatoma. We discuss the operative treatment via a large hypotympanotomy and creation of an open hypotympanic cavity. To the authors' knowledge this is the first description of hypotympanal cholesteatoma with such an extension, being treated through this approach.

  1. Bilateral congenital cholesteatoma of the temporal bone in Crouzon syndrome

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    Đerić Dragoslava

    2015-01-01

    Full Text Available Introduction. Crouzon syndrome is an autosomal dominant genetic disease characterized by bicoronal craniosynostosis, exorbitism with hypertelorism, and maxillary hypoplasia with mandibular prognathism. Case Outline. We present the first reported case of Crouzon syndrome associated with a bilateral congenital cholesteatoma of the temporal bone and discuss about the potential pathogenesis. Conclusion. Early diagnosis and management are crucial to prevent complications and an otologist should be an integral part of the multidisciplinary team.

  2. 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.

  3. Decreasing incidence rate for surgically treated middle ear cholesteatoma in Denmark 1977-2007

    DEFF Research Database (Denmark)

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

    2010-01-01

    The objective was to estimate the annual incidence rate of surgically treated middle ear cholesteatoma (STMEC) in Denmark from 1977 to 2007, taking age, gender and secular trends into consideration.......The objective was to estimate the annual incidence rate of surgically treated middle ear cholesteatoma (STMEC) in Denmark from 1977 to 2007, taking age, gender and secular trends into consideration....

  4. 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

  5. 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

  6. Cartilage ossiculoplasty in cholesteatoma surgery: hearing results and prognostic factors.

    Science.gov (United States)

    Quaranta, N; Taliente, S; Coppola, F; Salonna, I

    2015-10-01

    Cartilage tympanoplasty is an established procedure for tympanic membrane and attic reconstruction. Cartilage has been used as an ossiculoplasty material for many years. The aim of this study was to evaluate hearing results of costal cartilage prostheses in ossicular chain reconstruction procedures in subjects operated on for middle ear cholesteatoma and to determine the presence of prognostic factors. Candidates for this study were patients affected by middle ear cholesteatoma whose ossicular chain was reconstructed with a chondroprosthesis. 67 cases of ossiculoplasty with total (TORP) or partial (PORP) chondroprosthesis were performed between January 2011 and December 2013. Follow-up examination included micro-otoscopy and pure tone audiometry. The guidelines of the Committee on Hearing and Equilibrium of the American Academy of Otolaryngology Head and Neck Surgery were followed and pure-tone average (PTA) was calculated as the mean of 0.5, 1, 2 and 4 kHz thresholds. Statistical analysis was performed with ANOVA tests and regression models. Average air-bone gap (ABG) significantly improved from 39.2 dB HL (SD 9.1 dB HL) to 25.4 dB HL (SD 11 dB HL) (p costal cartilage as material of choice when autologous ossicles are not available. The maintenance of the posterior canal wall was the only prognostic factor identified. PMID:26824916

  7. 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.

  8. 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...

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

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    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.

  10. 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.

  11. 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.

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

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    Yashant Aswani

    2016-01-01

    Full Text Available 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.

  13. 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.

  14. 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

  15. Histological Changes of the Middle Ear Ossicles Harvested During Cholesteatoma Surgery

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    Lukáš Školoudík

    2016-03-01

    Full Text Available Background: In the cholesteatoma surgery ossicles can be replaced to reconstruct middle ear function. It is important that these ossicles are free of squamous epithelium, to prevent residual disease. This study focuses on the histological findings of the malleus and incus harvested during cholesteatoma surgery. Materials and Methods: Eighty middle ears ossicles were examined in vivo and histologically to consider the relationship of cholesteatoma to ossicles, grade of bone destruction and invasion of cholesteatoma to deeper layers of bone. Results: Serious ossicular destruction was observed more frequently in incus compared to malleus (p = 0.0065. Difference of ossicles destruction between children and adults was not significant (p = 0.3032. Deep invasion of cholesteatoma into the vascular spaces or inner core of the bone was not observed. Conclusions: Autograft ossicles from cholesteatomatous ears should not necessarily be rejected for reconstruction of the ossicular chain. Regarding the histological finding, the authors suggest mechanical cleaning of the ossicle surface to eliminate residual disease.

  16. [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

  17. 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.

  18. 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

  19. 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

  20. 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. 

  1. 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

  2. [External auditory canal osteoma resulting in cholesteatoma which is complicated with meningitis].

    Science.gov (United States)

    Yorgancılar, Ediz; Kınış, Vefa; Gün, Ramazan; Bakır, Salih; Ozbay, Musa; Topçu, Ismail

    2013-01-01

    Osteoma of external auditory canal is a unilateral benign tumor which usually presents with no symptoms. They only cause symptoms when cerumen collection or conduction type hearing loss occurs. They are the most common osseous lesions of the temporal bone. It very rarely presents with cholesteatoma. So far, no osteoma case concomitant with, cholesteatoma and meningitis has not been reported. In this article, we report an interesting case presenting with external auditory canal osteoma, cholestatoma and meningitis concomitantly who was treated successfully using the canal Wall-down mastoidectomy technique.

  3. 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

  4. 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

    OBJECTIVES/HYPOTHESIS: To estimate the risk of surgically treated middle ear cholesteatoma in individuals with a nonsyndromic orofacial cleft and in their siblings compared with the general population. STUDY DESIGN: Historical cohort study. METHODS: Using the unique civil registration number for ...

  5. The Bony Obliteration Tympanoplasty in Pediatric Cholesteatoma: Long-term Safety and Hygienic Results

    NARCIS (Netherlands)

    Dinther, J.J.S. van; Vercruysse, J.Ph.LPW; Camp, S.; Foer, B. De; Casselman, J.; Somers, T.; Zarowski, A.; Cremers, C.W.R.J.; Offeciers, E.

    2015-01-01

    OBJECTIVE: To present the safety and hygienic results of a 5-year longitudinal study in a pediatric population undergoing surgery for extensive cholesteatoma using a canal wall up approach with bony obliteration of the mastoid and epitympanic space. STUDY DESIGN: Retrospective consecutive study. PAT

  6. 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 ...

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

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    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.

  8. 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;

    2015-01-01

    -standardized incidence rates for first-time surgically treated middle ear cholesteatoma increased from 8 to 15 per 100,000 person-years with an estimated annual increase of 1.8% (95% confidence interval (CI) 1.3-2.2%). From 2002 to 2010 the rates decreased from 15 to 10 per 100,000 person-years with an annual decrease...... 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......OBJECTIVE: To describe temporal trends in the incidence rate of surgically treated middle ear cholesteatoma in Danish children from 1977 to 2010. METHODS: Data on surgically treated middle ear cholesteatoma was drawn from the Danish National Patient Register. A change in incidence rate over time...

  9. 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

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

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    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.

  11. 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.

  12. Detection of postoperative residual cholesteatoma with delayed contrast-enhanced MR imaging: initial findings

    Energy Technology Data Exchange (ETDEWEB)

    Williams, Marc T.; Heran, Francoise; Lafitte, Francois; Elmaleh-Berges, Monique; Piekarski, Jean-Daniel [Department of Medical Imaging, Fondation Ophthalmologique Adolphe de Rothschild, 25, rue Manin, 75940 Paris (France); Ayache, Denis [Department of Otorhinolaryngology, Fondation Ophthalmologique Adolphe de Rothschild, 25, rue Manin, 75940 Paris (France); Alberti, Corinne [Department of Biostatistics, Hopital Saint-Louis, 1 Avenue Claude Vellefaux, 75010 Paris (France)

    2003-01-01

    Our objective was to assess the value of delayed contrast-enhanced T1-weighted spin-echo MR imaging in the detection of residual cholesteatoma in patients who have undergone canal wall-up tympanoplasty procedure. The MR imaging was obtained prior to revision surgery in 18 patients with opacity of the post-operative cavity at CT examination 12-18 months after canal wall-up tympanoplasty. In each patient the following was performed: precontrast T1- and T2-weighted images; and early and delayed contrast-enhanced axial and coronal T1-weighted imaging. Early and delayed MR imaging results were separately compared with surgical second-look findings. Sensitivity, specificity, and predictive values were evaluated for early and delayed post-contrast MR imaging, compared with second-look surgery findings. A residual cholesteatoma was correctly identified in 8 of 9 cases with delayed contrast-enhanced T1-weighted MR imaging. Mean sensitivity, specificity, positive predictive value, and interobserver agreement (evaluated by kappa statistics) were, respectively, 85.2, 92.6, 92.6%, and kappa=0.78 for the delayed contrast-enhanced MR imaging technique. The same parameters were, respectively, 96.3, 33.3, 60.6, and 0.30 for the early contrast-enhanced T1-weighted MR images. We conclude that delayed contrast-enhanced T1-weighted MR imaging is reliable for the detection of residual cholesteatomas of the middle ear in patients who have undergone canal wall-up tympanoplasty. (orig.)

  13. A CASE REPORT OF POST-TRAUMATIC CHOLESTEATOMA FOLLOWING TEMPORAL BONE FRACTURE

    Directory of Open Access Journals (Sweden)

    Vijay

    2016-05-01

    Full Text Available We report a case of chronic suppurative otitis media squamous disease following temporal bone fracture. Patient had road traffic accident and longitudinal fracture with facial palsy four years back with recent onset ear discharge. Upon further evaluation, patient was found to have attic cholesteatoma which was managed with canal wall down mastoidectomy and type IV tympanoplasty. We would like to recommend a longterm follow-up in all cases of temporal bone fracture even with a negative history of prior ear discharge or hard of hearing.

  14. 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.

  15. 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

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

    Energy Technology Data Exchange (ETDEWEB)

    Jung, Cheol Kyu; Park, Dong Woo; Seong, Jin Yong; Lee, Kak Soo; Park Choong Ki; Lee, Seung Ro; Hahm, Chang Kok [College of Medicine, Hanyang University, Seoul (Korea, Republic of)

    2000-01-01

    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

  17. 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.

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

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    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

  19. 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;

    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 Statistics Denmark. Cumulative incidence proportions were estimated by the Kaplan-Meier method and hazard ratios with Cox regression analysis. The first surgically treated middle ear cholesteatoma in a child (STMEC1) was considered an event. RESULTS: A total of 217,206 children, born after December 31, 1996......, who had VTI from January 1, 1997 to August 31, 2011 were identified. Of these, 374 subsequently had a STMEC1. A corresponding 36,981 children without any VTI were identified for comparison using a random 5% sample of the Danish population. Of these, 5 had a STMEC1. The cumulative incidence proportion...

  20. 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

    OBJECTIVES/HYPOTHESIS: To compare cartilage palisades with fascia grafting in reconstruction of the eardrum after surgery for sinus or tensa retraction cholesteatoma in children, with respect to long-term postoperative eardrum retraction and perforation, cholesteatoma recurrence, and hearing acuity....... 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...... 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...

  1. 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)

  2. A Systematic Review of Non-Echo Planar Diffusion-Weighted Magnetic Resonance Imaging for Detection of Primary and Postoperative Cholesteatoma

    NARCIS (Netherlands)

    van Egmond, Sylvia L; Stegeman, Inge; Grolman, Wilko; Aarts, Mark C J

    2016-01-01

    OBJECTIVE: To investigate the diagnostic value of non-echo planar diffusion-weighted magnetic resonance imaging (DW-MRI) for primary and recurrent/residual (postoperative) cholesteatoma in adults (≥18 years) after canal wall up surgery. DATA SOURCES: We conducted a systematic search in PubMed, Embas

  3. 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.)

  4. 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)

  5. 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...

  6. 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.

  7. Atticotomy with canaloplasty and tympanoplasty for limited epitympanic cholesteatoma%上鼓室进路并外耳道及鼓室成形术的临床分析

    Institute of Scientific and Technical Information of China (English)

    邓毅; 邢奋丽; 吴元庆; 初亭; 陈荣荣; 陈尔东; 樊贤超

    2012-01-01

    Objective:To observe the surgical results of atticotomy with canalopalsty and tympanoplasty for limited cholesteatoma. Method: Thirty-one cases of limited epitympanic cholesteatoma and retraction pocket received atticotomy. The surgical procedure consisted of eliminating cholesteatoma and pocket, reconstructing lateral epitympanic wall and tympanoplasty with cartilage/perichondrium island flap. Result:The anatomic pattern of external ear canal appeared near normal, and the hearing level improved or remained normal during 2-year follow up except for 2 cases with tympanosclerosis. No epitympanic retraction pocket or cholesteatoma relapsed. 1 case appeared tympanic perforation. Conclusion: Atticotomy. contemporaneous reconstruction of lateral epitympanic wall and tympanoplasty with cartilage/perichondrium, indicated to be a reliable treatment and prevention technique for epitympanic cholesteatoma. It can achieve good morphological and functional results.%目的:观察上鼓室切开结合外耳道和鼓室成形术治疗主要局限于上鼓室胆脂瘤的临床疗效.方法:采用上鼓室进路治疗31例病灶主要限于上鼓室的胆脂瘤患者,并于清除病灶后,用耳屏或耳甲腔软骨/软骨膜行外耳道成形和鼓室成形术,重建上鼓室外侧壁和恢复传音结构.结果:经上鼓室外侧壁重建和鼓室成形术后,除2耳鼓室硬化者外,余听力都有提高或保持正常状态,仅有1例出现鼓膜穿孔,31例均未发现囊袋状内陷或胆脂瘤再发.结论:上鼓室切开进路,1期用软骨/软骨膜行外耳道成形和鼓室成形术,较好地恢复了外耳道及中耳结构形态和功能,对治疗局限于上鼓室的胆脂瘤和防止复发的效果好.

  8. 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

  9. Aplicação da ressonância magnética no acompanhamento da cirurgia do colesteatoma The role of magnetic resonance imaging in the postoperative management of cholesteatomas

    Directory of Open Access Journals (Sweden)

    Carlos Toyama

    2008-10-01

    Full Text Available A tomografia computadorizada e ressonância magnética (RM com seqüências convencionais têm baixa especificidade para a diferenciação entre tecido de granulação e recidiva de colesteatoma. OBJETIVO: Avaliar a aplicação da RM com sequência de difusão e pós-contraste T1 tardio na detecção de recidiva de colesteatoma. MATERIAL E MÉTODO: Realizado estudo transversal prospectivo de dezessete pacientes estudados no pós-operatório de colesteatoma utilizando RM de 1.5 T com seqüência difusão, T1, T2 e pós-contraste T1 tardio nos planos coronal e axial. Dois radiologistas avaliaram e decidiram em consenso a presença de foco de hipersinal na difus��o e T2, iso/hipossinal em T1 e ausência de impregnação pelo contraste como suspeitos de recidiva de colesteatoma. Os achados da revisão cirúrgica foram comparados com o resultado da RM. RESULTADOS: Onze dos doze casos de recidiva de colesteatoma apresentaram hipersinal na difusão. Todos os pacientes com tecido de granulação na cavidade cirúrgica não apresentaram alteração de sinal na difusão. Um paciente com abscesso no conduto auditivo interno também apresentou hipersinal na difusão. A sensibilidade, especificidade, valor preditivo positivo e negativo foram respectivamente 91,6%, 60%, 84,6% e 75%. CONCLUSÃO: A seqüência de difusão combinada com pós-contraste tardio pode ser útil na diferenciação entre tecido de granulação e recidiva de colesteatoma.Conventional CT and MRI scans have low specificity when it comes to differentiating granulation tissue from relapsing cholesteatoma. AIM: this paper aims to analyze the use of DWI and delayed post-contrast T1-weighed imaging in the detection of recurring cholesteatomas. MATERIALS AND METHOD: this is a cross-sectional prospective study that looked at 17 cholesteatoma patients postoperatively. All patients underwent diffusion magnetic resonance imaging at 1.5T, T1, T2, and delayed post-contrast T1 and images were

  10. 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

  11. Clinical Observation of Mastoidectomy With Tympanoplasty in Treatment of Chronic Otitis Media With Cholesteatoma%乳突根治鼓室成形术治疗胆脂瘤型中耳炎的临床观察

    Institute of Scientific and Technical Information of China (English)

    杜卫峰

    2015-01-01

    Objective To investigate the clinical effect of radical mastoidectomy with tympanoplasty operation in patients with cholesteatoma otitis media. Methods 50 cases of otitis media with cholesteatoma in our hospital were treated with radical mastoidectomy and tympanoplasty operation, observed the treatment effect. Results 3 patients were ineffective, the recovery of hearing was greater than or equal to 24 cases of 35 dB patients, increased by 10~19 dB in 10 patients, 20~29 dB of patients and 13 cases improved, 10 cases had complications. Conclusion Patients with chronic otitis media treated with cholesteatoma of mastoidectomy and tympanoplasty can achieve remarkable effect.%目的:探讨乳突根治鼓室成形手术对胆脂瘤型中耳炎患者的临床效果。方法我院接收患胆脂瘤型中耳炎患者50例,对患者进行乳突根治鼓室成形手术,观察治疗效果。结果3例患者无效,听力恢复≥35 dB患者24例,提高10~19 dB患者10例,提高20~29 dB患者13例,出现并发症10例,经治疗均好转。结论胆脂瘤型中耳炎患者进行乳突根治鼓室成形术治疗,效果显著。

  12. 开放式鼓室成形术在胆脂瘤型中耳炎治疗中的应用价值%Open tympanoplasty in chronic otitis media with cholesteatoma treatment value

    Institute of Scientific and Technical Information of China (English)

    蒋杏丽

    2015-01-01

    目的:分析开放式鼓室成形术在胆脂瘤型中耳炎治疗中应用的价值。方法随机将我院收治的60例胆脂瘤型中耳炎患者分为对照组和观察组,临床对对照组患者主要采用乳突根治术治疗,而对观察组患者在对照组的基础上实施开放式鼓室成形术治疗,并观察两组患者疗效。结果观察组患者治疗的总有效率为93.33%明显高于对照组80.0%两组比较差异有统计学意义(P<0.05)。结论乳突根治术联合开放式鼓室成形术治疗胆脂瘤型中耳炎效果显著,可行性高。%Objective To analyze the value of open tympanoplasty technique applied in the treatment of cholesteatoma.Methods The 60 cases in our hospital cholesteatoma patients were divided into a control group and observation group, the control group of patients clinically mainly mastoidectomy treatment, while the implementation of the observation group were open on the basis of the control group tympanoplasty treatment, and treatment groups were observed.Results The patients in the observation group, the total effective rate of 93.33%was significantly higher than 80.0% between the two groups (P<0.05), the difference was statistically significant. Conclusion mastoidectomy joint open tympanoplasty treatment cholesteatoma significant effect, high feasibility.

  13. 探讨乳突根治联合鼓室成形术治疗胆脂瘤中耳炎的效果%To Explore the Curative Effect of Radical Mastoidectomy Combine With Tympanoplasty Treatment Cholesteatoma Otitis Media

    Institute of Scientific and Technical Information of China (English)

    姚旭光; 孙福生

    2015-01-01

    Objective Observation curative effect of radical mastoidectomy with tympanoplasty for cholesteatoma otitis media effect.Methods Selected 90 patients with cholesteatoma otitis media were divided into two groups, the control group adopt mastoidotympanectomy, and the study group adopt mastoid effect a radical cure joint tympanoplasty.Results The study group normal rate was higher than the control group, the team plane form bones guide poor total period, complications and recurrence rates were better than the control group,P<0.05, had difference statistically significance.Conclusion The curative effect of radical mastoidectomy with tympanoplasty for cholesteatoma otitis media with good effect, less complications, low recurrence rate.%目的 观察乳突根治联合鼓室成形术治疗胆脂瘤中耳炎的效果.方法 将90例胆脂瘤中耳炎患者分为两组,对照组行乳突根治术,研究组行乳突根治联合鼓室成形术治.结果 研究组外耳道形态正常率高于对照组,气骨导差总改善率、并发症发生率和复发率均优于对照组, P<0.05,差异具有统计学意义.结论 乳突根治联合鼓室成形术治疗胆脂瘤中耳炎效果好,并发症少,复发率低.

  14. 颞骨先天性胆脂瘤并发周围性面瘫的诊治%Diagnosis and Treatment of Congenital Cholesteatoma in Temporal Bone with Facial Paralysis

    Institute of Scientific and Technical Information of China (English)

    马慧敏; 陈智斌; 周涵; 赵晓埝; 李芳丽; 邢光前

    2014-01-01

    Objective To study the diagnosis and the treatment of temporal bone congenital cholesteatoma with facial paralysis. Methods The clinical data of 7 patients treated in our department between April 2001 and April 2014 were re-viewed. Results All the 7 patients recovered well without postoperative complications. There is no sign of recurrence of cho-lesteatoma during the 2 months to 14 years follow-up. Facial nerve function was completely recovered in 3 patients, partially improved in 2 patients, and showed no obvious improvement in 2 patients. As for hearing function, 5 patients ended up with total deafness in the affected ear, of whom 3 were diagnosed with dead labyrinth before surgery and 2 received partial labyrin-thectomy due to inner ear invasion of cholesteatoma. In the other 2 patients, hearing improved by 15 dB in 1 patient and re-mained unchangeable in the other postoperatively. Conclusions Early detection is the key to lower incidence of facial paraly-sis in temporal bone congenital cholesteatoma and to obtain satisfactory postoperative outcomes.%目的:探讨合并面瘫的颞骨先天性胆脂瘤的诊断及治疗。方法对2001年4月至2014年4月间在我科手术治疗的7例患者的临床资料进行回顾分析。结果所有病例术后恢复良好,无并发症,随访2月-14年胆脂瘤无复发。面瘫完全恢复者3例,好转者2例,无改善2例。术后患耳全聋者5例,3例为就诊时已确诊全聋,另2例为因胆脂瘤侵入内耳而行迷路部分切除术;1例听力提高15dB;1例无变化。结论早期诊断是降低先天性胆脂瘤面瘫发生率及获得良好术后效果的重要保障。

  15. 三种乳突根治术治疗胆脂瘤中耳炎疗效分析及术后胆脂瘤复发的处理措施%Analysis of the efficacy of three radical mastoidectomy surgery treatment of cholesteatoma otitis media and explore treatment measures for cholesteatoma recurrence after surgery

    Institute of Scientific and Technical Information of China (English)

    吴军武; 肖芒; 金云飞

    2015-01-01

    Objective To compare clinical efficacy of open radical mastoidectomy (ORM) and complete bi-style radical mastoid surgery (CRMS) and open radical mastoidectomy-mastoid tamponade(ORM-MT) treatment of cholesteatoma otitis media (COM), and explore treatment measures for cholesteatoma recurrence after surgery. Methods The 130 cases of COM patients were randomly divided into ORM group(46 cases), CRMS group (38 cases) and ORM-MT group (46 cases). The values of average air conduction hearing threshold value and Air-bone difference and recurrence rate during fol-low-up were compared. Results The values of average air conduction hearing threshold value and Air-bone difference in CRMS group after three months were significantly lower than ORM group (q=12.055, 7.761, P0.05). Recurrence rate of ORM, CRMS and ORM-MT group was 5 ears (10.9%), 9 ears (23.7%) and 4 ears (8.7%), respectively. Recurrence rate of CRMS group was significantly higher than ORM group and ORM-MT group (χ2=6.640, 9.072, P0.05);术后3个月CRMS组气导听阈值和气骨导差值均明显低于ORM组(q=12.055、7.761,P0.05);ORM、CRMS及ORM-MT组分别复发5耳(10.9%)、9耳(23.7%)、4耳(8.7%),CRMS组复发率明显高于ORM组和ORM-MT组(χ2=6.640、9.072,P<0.05)。结论CRMS术、ORM-MT术在改善COM患者听力方面优于ORM术,但CRMS术后复发率较高,因此ORM-MT术最佳。对面神经嵴较高、引流不畅的胆脂瘤复发患者应行乳突再根治术。

  16. 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.

  17. 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.

  18. Curative effect of mastoidectomy combined with tympanoplasty on cholesteatoma otitis media%乳突根治联合鼓室成形术治疗胆脂瘤中耳炎的疗效观察

    Institute of Scientific and Technical Information of China (English)

    吴湘明

    2014-01-01

    目的:探讨乳突根治联合鼓室成形术治疗胆脂瘤中耳炎的临床效果。方法将该院收治的86例胆脂瘤中耳炎患者随机分为观察组和对照组,每组43例,观察组采用乳突根治联合鼓室成形术进行治疗,对照组采用单纯的乳突根治术进行治疗,对两组患者的治疗情况进行跟踪观察并加以比较。结果对所有患者进行1~5年的随访,观察组的气骨导差情况明显优于对照组(P<0.01),外耳道正常比例显著高于对照组(P<0.01),术后气骨导差值变化明显优于对照组(P<0.01)。结论乳突根治联合鼓室成形术治疗胆脂瘤中耳炎的效果良好,在改善患者听力状况方面可以发挥突出作用。%Objective To investigate the curative effect of combined mastoidectomy and tympanoplasty on cholesteatoma otitis media . Methods Eighty-six cases of cholesteatoma otitis media were randomly assigned into observation group and control group with 43 cases in each group .The observation group was treated with mastoidectomy combined with tympanoplasty ,while the control group was treated with conventional surgery .The two groups were observed and compared .Results All patients were followed up for 1 to 5 years.ABG of observation group was better than that of control group (P<0.01).Normal ratio of the external auditory canal of observation group sig-nificantly higher than that of control group (P<0.01),and postoperative air-bone conductivity changed significantly better than the control group (P<0.01).Conclusions Mastoidectomy combined with tympanoplasty has good effect on cholesteatoma otitis media which can play a prominent role in improving patients ’ hearing status .

  19. Clinical Observation on 21 Cases Cholesteatoma Otitis Media Treated with Open Method Tympanoplasty%开放式鼓室成形术治疗胆脂瘤型中耳炎21例临床观察

    Institute of Scientific and Technical Information of China (English)

    王灿; 李培华

    2013-01-01

    Objective: To observe the application of open method tympanoplasty to treat cholesteatoma otitis media for providing basis for clinical treatment. Method: 21 patients with cholesteatoma otitis media treated with open method tympanoplasty in our hospital from Jan. 2009 to Jan. 2012 were selected randomly, and the clinical data and operation mode were analyzed retrospectively. Result: After the treatment, there were 18 patients of shift planting membrane surviving completely among 21 cases, 2 patients occurring tympanic membrane perforation, 1 case of tympanic membrane imagination and recurrence of pus, all the patients dried ears. Patients were given pure tone test after operation, there were 10 cases of hearing improvement of 10dB, 7 cases of hearing improvement of 15-20dB, 1 case of hearing improvement of 25-30dB and 3 cases of hearing no change. Conclusion: In the premise of complete removal of middle ear diseases and mastoid, open method tympanoplasty in treating the patients with cholesteatoma otitis media can eliminate the middle ear inflammation and make the ventilation function recovered, which has the curative effect. Therefore , open method tympanoplasty not only can prevent the recurrence of cholesteatoma effectively but also can improve the listening comprehension of patients significantly, which has higher application value and is worthy of clinical application.%目的:探讨开放式鼓室成形术治疗胆脂瘤型中耳炎的疗效,为临床治疗提供依据.方法:随机选取2009年1月至2012年1月在我院应用开放式鼓室成形术(乳突根治伴鼓室成形术)治疗胆脂瘤型中耳炎的患者21例,对其临床资料以及手术方式进行回顾性分析.结果:治疗后,本组21例患者中18例移植筋膜完全成活,2例发生鼓膜再穿孔,1例鼓膜内陷、复发流脓,所有患者全部干耳.术后对患者听力进行纯音测试,其中10例听力提高10dB,7例听力提高15-20dB,1例听力提高25-30dB,3例听力未见

  20. The effects of tympanoplasty through mastoidectomy treatment of 30 cases with otitis media with cholesteatoma%乳突根治鼓室成形术治疗胆脂瘤型中耳炎30例疗效分析

    Institute of Scientific and Technical Information of China (English)

    赵翠英

    2012-01-01

    Objective: To investigate the effects of tympanoplasty through mastoidectomy in treatment of otitis media with cholesteatoma. Methods: Thirty cases with otitis media with cholesteatoma were treated with tympanoplasty through mastoidectomy. Results: Survival of transplanted fascia and dry ears of 30 cases were observed during following up for 6 months to 2 years. Puretone audiometry and the gas Guide mean of language frequency were improved after sugery. Conclusions: Treatment of otitis media with cholesteatoma by tympanoplasty through mastoidectomy can completely remove lesion, improve hearing and decrease recurrence rates, which has certain clinical application value.%目的:观察乳突根治鼓室成形术治疗胆脂瘤型中耳炎的疗效.方法:对30例行乳突根治鼓室成形术治疗的胆脂瘤型中耳炎的临床资料进行回顾分析.结果:随访6个月至2年,30例获得干耳,移植筋膜成活.术后纯音测听,语言频率气导均值提高.结论:乳突根治鼓室成形术治疗胆脂瘤型中耳炎,能根治病灶,提高听力,复发率低,有临床应用价值.

  1. 乳突根治鼓室成形术在胆脂瘤型中耳炎治疗中的临床价值探究%The Clinical Value of Mastoidectomy and Tympanoplasty in the Treatment of Chronic Otitis Media With Cholesteatoma

    Institute of Scientific and Technical Information of China (English)

    张春林

    2016-01-01

    Objective To analyze the clinical value of mastoidectomy and tympanoplasty in the treatment of chronic otitis media with cholesteatoma. Methods Randomly selected in our hospital accepted treatment of 36 cases of cholesteatoma otitis media patients, the patients take mastoid radical tympanoplasty therapy. Results The total effective rate of the patients was 97.2%, and the indexes were improved after the operation, P<0.05. Conclusion Mastoidectomy and tympanoplasty for cholesteatoma achieved remarkable effect, can improve patient listening.%目的:分析乳突根治鼓室成形术在胆脂瘤型中耳炎治疗中的临床价值。方法随机抽取在我院接受治疗的36例胆脂瘤型中耳炎患者,对患者采取乳突根治鼓室成形术治疗。结果患者治疗总有效率为97.2%,术后各指标较术前改善,P <0.05。结论乳突根治鼓室成形术治疗胆脂瘤型中耳炎取得显著效果,能够提高患者听力。

  2. 开放式鼓室成形术在胆脂瘤型中耳炎治疗中的应用研究%Application Research of Open Tympanoplasty in the Treatment of Chronic Otitis Media with Cholesteatoma

    Institute of Scientific and Technical Information of China (English)

    李卫平

    2012-01-01

    目的 探讨开放式鼓室成形术在胆脂瘤型中耳炎治疗中的应用效果.方法 选择我院2009年10月至2010年12月收治的胆脂瘤型中耳炎患者70例作为研究对象,均采用开放式鼓室成形术治疗,观察该治疗方法的疗效及安全性.结果术后3个月干耳70例,干耳率为100%;术后6个月鼓膜生长良好67例,愈合率为95.7%.术后3个月、9个月测得患者的听力与治疗前比较均明显提高,且差异具有统计学意义(P<0.05).术后患者出现眩晕1例,低调耳鸣2例,经对症处理后症状明显改善,无其他严重并发症发生.结论 开放式鼓室成形术在胆脂瘤型中耳炎治疗中的应用效果满意,经过治疗患者听力明显提高,且无严重并发症发生,是一种安全、有效的治疗方案.%Objective To explore the application effect oi open tympanoplasty in the treatment oi chronic otitis media with cholesteatoma. Methods 70 capes of rhronir otitis media with cholesteatoma from October 2009 to December 2010 in our hospital were selected as the objects of the study,they were treated with open tympanoplasty, and the treatment efficacy and safety were observed. Results Alter 3 months, dry ear in 70 cases,the dry ear rate was 100% ; after 6 months,the tympanic membrane grew well in 67 cases,the healing rate was 95.1% . Alter 3 months and 9 months,the patient's healing were significantly improved ,and the difference was statistically significant( P <0. 05 ). Postoperative dizziness in 1 case,low-key tinnitus in 2 cases, which after symptomatic treatment were significantly improved, no other serious complications. Conclusion Open tympanoplasty in the treatment oi chronic otitis media with cholesteatoma has satisfactory results, alter treatment patients' hearing are improved significantly, and no serious complications,thus is a sale and effective treatment.

  3. The Efficacy of Open Mastoid Modified Radical + Tympanoplasty Cholesteatoma Otitis Media%开放式乳突改良根治+鼓室成形术治疗胆脂瘤中耳炎的疗效

    Institute of Scientific and Technical Information of China (English)

    田大清

    2013-01-01

    Objective To study cholesteatoma otitis media implementation the open mastoid modified radical + the tympanoplasty treatment effect. Methods 31 patients open mastoid improvement in patients with otitis media with cholesteatoma radical + open tympanoplasty analysis of 31 patients with clinical data, and follow-up of 1-4 years. Results All 31 patients fascia transplant survival, in 3 patients eardrum scar retraction, the two cases of otitis media in patients with tympanic membrane perforation and then, six months after surgery, the pure-tone air conduction hearing threshold (39.25 ± 6.84) dBHL before surgery increased by less than 10dB 4 patients, 5 patients than 20dB improvement of hearing (ears), a significant rate of 16.13%;improve (11-19) dB 17 patients (ear), apparent rate of 54.83%; (ears) improvement rate was 12.90%; no improvement in 5 patients (ear), efficiency of 16.13%. Conclusion open mastoid modified radical + tympanoplasty can completely remove the lesion of cholesteatoma otitis media, hearing results of patients recovered satisfactorily.%  目的研究胆脂瘤中耳炎实施开放式乳突改良根治+鼓室成形术的治疗效果。方法胆脂瘤中耳炎病患31例实施开放式乳突改良根治+鼓室成形术,分析31例患者临床资料,并随访1~4年。结果31例患者筋膜移植全部成活,3例患者鼓膜瘢痕出现内陷,中耳炎患者2例鼓膜发生再穿孔,手术半年后,纯音气导均听阈是(39.25±6.84)dB 与手术前比较,听力提高20dB 以上患者5例(耳),显著率16.13%;提高(11~19)dB 之间的患者17例(耳),明显率为54.83%;提高10dB 以下的患者4例(耳),好转率为12.90%;无提高患者5例(耳),无效率16.13%。结论开放式乳突改良根治+鼓室成形术可彻底清除胆脂瘤中耳炎的病变,患者的听力效果恢复满意。

  4. 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

  5. Descrição histológica de colesteatomas adquiridos: comparação entre amostras de crianças e de adultos Histologic description of acquired cholesteatomas: comparison between children and adults

    Directory of Open Access Journals (Sweden)

    Cristina Dornelles

    2006-10-01

    Full Text Available O colesteatoma é constituído de matriz, perimatriz e conteúdo cístico. Alguns autores afirmam que, em crianças, seu comportamento clínico é mais agressivo do que em adultos. OBJETIVOS: Comparar histologicamente colesteatomas de crianças e adultos. METODOLOGIA: Foram analisados 74 colesteatomas, sendo 35 de pacientes pediátricos (18 anos. Foram avaliados o número de camadas celulares e hiperplasia na matriz; espessura, epitélio delimitante, fibrose, inflamação e granuloma na perimatriz. A análise estatística foi realizada com o programa SPSS 10.0, utilizando os coeficientes de Pearson e de Spearman, testes t e de qui-quadrado. O número de camadas celulares na matriz foi de 8,2±4,2. A hiperplasia aparece em 17%, a fibrose em 65%, o granuloma em 12% e o epitélio delimitante em 21%. A perimatriz apresentou uma mediana de 80 micrômetros (37 a 232, valor mínimo zero e valor máximo 1.926. O grau histológico de inflamação foi considerado de moderado a acentuado em 60%. Ao aplicarmos o coeficiente de Spearman entre o grau de inflamação e média de camadas celulares da matriz com as variáveis sumarizadoras da medida de espessura da perimatriz encontramos correlações, significativas, com magnitudes de moderadas a grandes (rs=0,5 e PCholesteatoma is constituted of matrix, perimatrix and cystic content. Some authors affirm that, in children, its clinical behavior is more aggressive of the than in adults. AIMS: Histologic compared cholesteatomas of children and adults. METHODOLOGY: 74 cholesteatomas been analyzed, being 35 of pediatrics patients (<18 years. The average number of cellular layers and hyperplasia in the matrix had been evaluated; thickness, delimitante epithelium, fibrosis, inflammation and granuloma in the perimatrix. The analysis statistics was carried through with program SPSS 10,0, using the coefficients of Pearson and Spearman, test of qui-square and t test. The number of cellular layers in the matrix was of 8

  6. Epitympanoplasty with Cartilage Obliteration in the Canal Wall Up Technique to the Middle Ear Cholesteatoma%保留外耳道后壁上鼓室切开软骨重建术治疗中耳胆脂瘤

    Institute of Scientific and Technical Information of China (English)

    赵丹珩; 刘阳; 孙建军; 林勇生

    2013-01-01

    Objective To report the curative effect of the epitympanoplasty with cartilage obliteration in the treatment of middle ear cholesteatoma .Methods This study retrospectively analysed 123 cases ,with middle ear cholesteatoma treated in our department from November 2009 to July 2012 .The operation included mastoidectomy with posterior canal wall preserved ,lateral wall of attic resected ,facial recess opened to the epitympanum ,epitym-panum obliterated with cartilage and mastoid cavity blocked with bone dust .All cases were followed up on complica-tions and hearing improvement .Results All cases were followed up 6~38 months .In 123 cases ,there were 2 ca-ses had cholesteatoma recurrence in the middle ear cavity ,6 cases had infection of post auricular incision after opera-tion ,3 cases had residual marginal tympanic membrane perforation ,2 cases had ossicular replacement prosthesis ex-clusion ,and 6 cases had canal wall skin swelling or defect .The rest cases acquired full -recovery after 2 or 3 wound dressing changes .Out of 123 cases ,83 cases had the whole hearing document ,the average AB gap at 0 .5 ,1 ,2 kHz reduced from 32 .2 ± 11 .2 dB pre-operation to 20 .7 ± 12 .4 dB post -operation .The AB gap of pre - and post -operation had significant difference (P<0 .001) .Conclusion The mastoidectomy with posterior canal wall preserved greatly shortened the healing time .The resection of lateral wall of epitympanum can exposed operating field more completely and remove lesions thoroughly .The cartilage obliteration in the attic can prevent the retraction pocket formation effectively .This technique provides alternative in treating middle ear cholesteatoma .%目的探讨在保持外耳道后壁完整的情况下,切除上鼓室外侧壁并软骨封闭治疗中耳胆脂瘤的疗效。方法2009年11月~2012年7月对123例(123耳)中耳胆脂瘤患者行保留外耳道后壁的乳突切开、上鼓室盾板切除及面神经隐窝向上鼓室开放,清除病

  7. 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

  8. Transmastoid approach treatment for facial paralysis complicated by otitis media cholesteatoma (75 cases report)%经乳突进路面神经减压术治疗中耳胆脂瘤并发面神经损害75例

    Institute of Scientific and Technical Information of China (English)

    刘骏; 赵宇; 邹剑; 秦学玲

    2013-01-01

    目的 探讨经乳突进路治疗中耳胆脂瘤导致的面神经损伤的最佳方法和疗效.方法 对由中耳胆脂瘤引起周围性面瘫的75例患者,采取经乳突进路面神经减压术.75例中累及垂直段13例,水平段及锥段36例;膝状神经节22例,膝状神经节及迷路段4例.结果 术后随访1~6个月,通过House-Beckmann面神经分级系统评分,结果为Ⅰ~Ⅴ级.结论 对由中耳胆脂瘤累及面神经所致周围性面瘫,及时采取经乳突进路施行面神经减压术治疗,可取得满意效果.%Objective To investigate the effect and method of transmastoid approach treatment for facial nerve paralysis complicated by otitis media cholesteatoma. Methods Clinical data of 75 peripheral facial paralysis patients caused by middle ear cholesteatoma were reviewed, including 13 cases involving the vertical segment, 36 cases involving the horizontal segment and cone segment, 22 cases involving the geniculate ganglion, and 4 cases involving the geniculate ganglion and labyrinth segment. Facial decompression surgery was performed through transmastoid apporach. Results In a 1 to 6-month follow-up, facial nerve function rehabilitated to Ⅰ ~ Ⅴ level based on House - Beckmann facial grading system score. Conclusion Transmastoid approach is a reliable method for facial nerve decompression in the treatment of peripheral facial paralysis caused by middle ear cholesteatoma.

  9. 慢性化脓性及胆脂瘤中耳炎患者行乳突根治加鼓室成形术治疗的临床疗效观察%Observation of Chronic Suppurative Otitis Media With Cholesteatoma and Underwent Radical Mastoidectomy and Tympanoplasty in Clinical Treatment

    Institute of Scientific and Technical Information of China (English)

    许亮

    2016-01-01

    目的:探讨乳突根治加鼓室成形术治疗慢性化脓性及胆脂瘤中耳炎的临床疗效。方法选择2013年3月~2014年3月我院收治的80例慢性化脓性及胆脂瘤中耳炎患者,均行乳突根治加鼓室成形术治疗,并术后随访6个月,观察患者术后干耳率、听力的情况。结果80例患者治疗后平均气骨导差及平均气导听阈与治疗前相比均有显著改善,差异有统计学意义(P<0.05);治疗后49例纯音听阈(500,1000,2000 Hz)平均气骨导差缩小达到15 dB及以上,听力提高总有效率为61.25%。患者干耳率为96.25%。结论乳突根治加鼓室成形术治疗慢性化脓性及胆脂瘤中耳炎可提高患者听力及术后干耳率,临床疗效确切。%Objective To investigate the clinical curative effect of radical mastoidectomy and tympanoplasty in chronic suppurative otitis media and cholesteatoma. Methods 80 cases of chronic suppurative and cholesteatoma otitis media patients were chosen from March 2013 to March 2014 in our hospital, underwent radical mastoidectomy and tympanoplasty in the treatment, and postoperative follow-up of 6 months were observed after surgery in patients with dry ear rate, listening. Results 80 cases of patients after treatment, the average air bone guide difference and the average air conduction threshold and treatment before have a significant decrease compared, the difference is statistically signiifcant (P<0.05). After the treatment of 49 speech frequency (500, 1 000, 2 000 Hz) average air bone conduction gap reached more than 15 dB and, hearing provided high total effective rate was 61.25%. The dry ear rate was 96.25%. Conclusion Radical mastoidectomy and tympanoplasty in the treatment of chronic suppurative and cholesteatoma otitis media can improve the hearing of patients and postoperative dry ear rate and clinical effcacy precise.

  10. 探讨完壁式乳突根治鼓室成形术治疗胆脂瘤中耳炎的临床效果%To Investigate the Clinical Effect of End Wall Mastoidectomy and Tympanoplasty in the Treatment of Cholesteatoma Otitis Media

    Institute of Scientific and Technical Information of China (English)

    吕金霞

    2016-01-01

    目的:研究分析完壁式乳突根治鼓室成形术治疗胆脂瘤中耳炎的疗效。方法选择我院2014年1月~2015年1月我院收治的66例胆脂瘤中耳炎患者,将其按照治疗方法分为对照组和观察组,对照组给予常规治疗,观察组给予完壁式乳突根治鼓室成形术治疗,对比两组患者的临床疗效。结果观察组、对照组手术成功例数分别为31例、27例,比较差异有统计学意义(P <0.05);且观察组手术时间低于对照组患者(P <0.05)。结论完壁式乳突根治鼓室成形术治疗胆脂瘤中耳炎的临床疗效显著。%Objective To study the curative effect analysis of end wall mastoidectomy and tympanoplasty in the treatment of cholesteatoma otitis media. Methods 66 cases of cholesteatoma otitis media patients in our hospital from January 2014 to January 2015, the according to the treatment methods, divided into the observation group and the control group, the control group was given conventional treatment, observation group given finished wall mastoidectomy and tympanoplasty therapy, compared two groups of patients with clinical curative effect. Results In observation group and control group, the number of successful cases were 31 cases and 27 cases respectively, and the difference was significant (P<0.05). The operation time of the observation group was significantly lower than that of the control group (P<0.05). Conclusion Wall mastoid radical tympanic forming operation in the treatment of cholesteatoma otitis media clinical curative effect is remarkable.

  11. 乳突根治术联合开放式鼓室成形术治疗胆脂瘤中耳炎的疗效观察%Effect of radical mastoidectomy combined with open tympanoplasty in the treatment of cholesteatoma otitis media were observed

    Institute of Scientific and Technical Information of China (English)

    丁志琴

    2015-01-01

    ObjectiveTo analyze the mastoidectomy open tympanoplasty combined clinical efficacy in the treatment of otitis media with cholesteatoma.MethodsSelected from our hospital in January 2010 to 2013 to December of cholesteatoma otitis media were 85 cases as the object of study, divided into observation group (45 cases) and control group (40 cases). The control group used radical mastoidectomy treatment, observation group were treated with radical mastoidectomy combined with open tympanoplasty treatment. The shape of the external auditory canal, the difference of the gas bone and the complications occurred in the two groups were compared.ResultsAfter two external auditory canal shape, the difference between the situation and the air-bone complications signifi cant difference in the case,the observation group was better than the control group,the difference was statistically significant(P<0.05).ConclusionCompared with mastoidectomy,mastoidectomy joint open tympanoplasty treatment cholesteatoma better effi cacy, fewer complications, higher clinical application value.%目的:分析乳突根治术联合开放式鼓室成形术治疗胆脂瘤中耳炎的疗效。方法选取我院2010年1月~2013年12月收治的胆脂瘤中耳炎患者85例为研究对象,将其分为对照组40例和观察组45例。对照组采用乳突根治术治疗,观察组采用乳突根治术联合开放式鼓室成形术治疗。比较两组患者术后外耳道形状、气骨导差值变化和并发症发生情况。结果观察组术后两组外耳道形状、气骨导差值和并发症发生情况明显优于对照组,差异有统计学意义(P<0.05)。结论与乳突根治术相比,乳突根治联合开放式鼓室成形术治疗胆脂瘤中耳炎的疗效更佳,且并发症更少,临床推广应用价值更高。

  12. 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

  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. 乳突根治联合开放式鼓室成形术治疗胆脂瘤中耳炎的疗效分析%Analysis of clinical efficacy of radical mastoidectomy combined with open mastoidectomy with tympanoplasty in the treatment of cholesteatoma otitis media

    Institute of Scientific and Technical Information of China (English)

    陈皓

    2014-01-01

    Objective:To analyze the clinical efficacy of radical mastoidectomy combined with open mastoidectomy with tympanoplasty in the treatment of cholesteatoma otitis media.Methods:84 patients with cholesteatoma otitis media were as the research objects.They were randomly divided into the control group and the observation group with 42 cases in each.The control group was given the routine operation treatment.The observation group was given radical mastoidectomy combined with open mastoidectomy with tympanoplasty on the basis of the conventional treatment.The clinical curative effects of two groups were compared.Results:The clinical efficacy of the observation group was better than that of the control group.The total effective rate of the observation group was 92.86%,it was significantly higher than 78.57% of the control group.The patients satisfaction rate of the observation group was 90.48%,it was significantly higher than 73.81% of the control group.The significant differences between the groups has statistical significance(P<0.05).Conclusion:Radical mastoidectomy combined with open mastoidectomy with tympanoplasty in the treatment of cholesteatoma otitis media can obtain the exact clinical curative effect.Its total effective rate is high.It is worth to promote the use.%目的:分析乳突根治联合开放式鼓室成形术治疗胆脂瘤中耳炎的临床疗效。方法:将84例胆脂瘤中耳炎患者作为研究对象,随机分为对照组、观察组,各42例。给予对照组常规手术治疗,观察组于常规治疗基础上接受乳突根治联合开放式鼓室成形术,对比两组临床疗效。结果:观察组临床疗效优于对照组,总有效率92.86%,显著高于对照组的78.57%;患者满意率90.48%,明显高于对照组的73.81%。组间差异具有统计学意义,P<0.05。结论:乳突根治联合开放式鼓室成形术治疗胆脂瘤中耳炎可获得确切临床疗效,总有效率高,值得推广应用。

  15. Clinical efficacy of open tympanoplasty combined radical mastoidectomy in treatment of chronic otitis media with cholesteatoma%开放式鼓室成形术联合乳突根治术治疗胆脂瘤型中耳炎的临床疗效

    Institute of Scientific and Technical Information of China (English)

    章洺; 黄秋红

    2014-01-01

    Objective To explore clinical efficacy of open tympanoplasty combined radical mastoidectomy in treatment of chronic otitis media with cholesteatoma. Methods Retrospectively analyzed the clinical data of 68 cases of cholesteatoma otitis media patients in our hospital from 2011 June to 2012 December ,and they were divided into con-trol group and observation group,each group 34 cases, the control group received simple mastoidectomy, the observa-tion group received the open-ended tympanoplasty with mastoidectomy treatment,follow-up of 1.5 years,the operation efficiency and improve the postoperative hearing, complications were compared. Results The observation group, the clinical total effective rate (94.12%) was significantly higher than that of the control group (73.53%), with statistical significance (P<0.05);The control group tympanic membrane healing rate of live,dry ear rate (73.53%, 76.47%) was signif-icantly lower than the observation group (91.18%,94.12%),the differences were statistically significant (P<0.05). Conclusion The radical mastoidectomy with tympanoplasty for cholesteatoma otitis media with the exact effect ,can effectively improve the patient's hearing,it is worthy of clinical application.%目的:探讨胆脂瘤型中耳炎治疗中开放式鼓室成形术联合乳突根治术治疗的应用效果。方法采用回顾性方法,选取我院2011年6月~2012年12月收治的68例胆脂瘤型中耳炎患者的临床资料,分为对照组及观察组各34例。对照组予单纯乳突根治术治疗,观察组予开放式鼓室成形术辅以乳突根治术治疗,随访1.5年,观察两组手术有效率及其术后听力提高、并发症情况。结果观察组临床总有效率(94.12%)明显高于对照组(73.53%),差异有统计学意义(P<0.05);对照组鼓膜愈合成活率、干耳率(73.53%、76.47%)明显低于观察组(91.18%、94.12%),差异有统计学意义(P<0.05)。结论采用乳突根治术联

  16. 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

  17. Comparative study of different frequency hearing reconstruction surgery in treating cholesteatoma otitis media%胆脂瘤型中耳炎行开放式鼓室成形术后不同频率听力重建效果的对比研究

    Institute of Scientific and Technical Information of China (English)

    陈建良; 钱小飞

    2013-01-01

    目的探讨胆脂瘤型中耳炎患者行开放式鼓室成形术后的听力重建效果。方法选择在该院进行开放式鼓室成形术的胆脂瘤型中耳炎患者作为研究对象,随机分为全听骨赝复物(TORP)组、听骨赝复物(PORP)组、未植入听骨赝复物(NONE)组,比较患者术后不同频率处的骨导听阈和纯音气导听阈。结果 TORP组患者术后2、1、0.5、0.25 kHz频率处的骨导听阈和纯音气导听阈均明显高于PORP组、NONE组;3、4 kHz的骨导听阈和纯音气导听阈均明显高于NONE组且与PORP组相比差异无统计学意义。结论全听骨赝复物植入开放式鼓室成形术能够有效改善患者的低中频听力,具有积极的临床价值。%Objective To investigate the effects of different frequency hearing reconstruction surgery in trea-ting cholesteatoma otitis media .Methods Cholesteatoma otitis media patients ,receiving open tympanoplasty ,were randomly divided into total ossicular replacement prosthesis (TORP) group ,partial ossicular replacement prosthesis (PORP) group and none ossicular replacement prosthesis (None) group .Different frequency of bone conduction threshold (BC) and air conduction threshold (AC) were observed .Results BC and AC at 2 ,1 ,0 .5 and 0 .25 kHz of TORP group were significantly higher than PORP group and None group ,and AB and AC at 3 and 4 kHz of TORP group were significantly higher than None group ,but was not different with PORP group .Conclusion TORP im-plantation might be effective to improve the low frequency hearing .

  18. HRCT常规重建与后处理对CSOM及中耳胆脂瘤诊断价值%The Diagnostic Value of HRCT Image Reconstruction and Post-processing Technology in Chronic Suppurative Otitis Media and Middle Ear Cholesteatoma

    Institute of Scientific and Technical Information of China (English)

    李必强; 王小铭; 黄显龙; 李朝军; 杨超; 唐茁月; 唐永存

    2015-01-01

    目的:探讨高分辨率CT扫描常规轴位、冠状位重建图像及图像后处理技术对慢性化脓性中耳炎及中耳胆脂瘤的诊断价值。方法对经手术病理证实并行64排螺旋CT容积扫描慢性化脓性中耳炎及中耳胆脂瘤共105例(107耳)进行回顾性分析。在常规轴位及冠状位重建图像基础上,综合运用图像后处理技术,根据主要CT表现:1、鼓室、鼓窦腔软组织密度影;2、听骨链骨质破坏情况;3、鼓室、鼓窦壁骨质破坏情况;进行术前分型,并将手术阳性结果与CT表现进行比较分析。结果慢性化脓性中耳炎59耳,其中单纯型8耳,肉芽型36耳,硬化灶肉芽型15耳;中耳胆脂瘤48耳,术前CT分型准确率为89%。对主要CT征象,常规轴位+冠状位显示率为88%,结合图像后处理技术,显示率为95%。对于所有可CT显示的术中阳性发现,均可以用多平面重组进行显示;容积再现及多平面容积再现对锤骨、砧骨破坏能较好显示,对镫骨破坏显示受到一定限制;曲面重组对面神经骨管破坏显示较满意,对听骨链骨质破坏也有一定的价值。结论 HRCT能对CSOM及中耳胆脂瘤进行较准确的术前分类、分型,常规轴位、冠状位重建图像能较全面、准确地对解剖和病变进行显示,各种图像后处理技术特别是MPR能提高CSOM及中耳胆脂瘤细微病变显示率和诊断准确率,具有很高的临床应用价值。%Objective To investigate the high resolution CT(HRCT) conventional axial scanning, coronal reconstruction images and image post-processing technology in the diagnosis of chronic suppurative otitis media(CSOM ) and middle ear choles⁃teatoma. Methods 107 ears(105 patients) were included who had been diagnosed CSOM or middle ear cholesteatoma by surgi⁃cal pathology, and been checked by 64 slices spiral CT volume scanning before surgery. The retrospectively analysis was applied to

  19. 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%.

  20. External auditory canal and middle ear cholesteatoma and osteonecrosis in bisphosphonate-treated osteoporosis patients

    DEFF Research Database (Denmark)

    Thorsteinsson, A-L; Vestergaard, P; Eiken, P

    2014-01-01

    reported in the world literature. Our aim was to describe the incidence of external auditory canal and middle ear diseases in Danish patients exposed to BPs in the treatment of osteoporosis. METHODS: This register-based nationwide cohort study was conducted on the Danish population of approximately 5......UNLABELLED: Long-term treatment with bisphosphonates against osteoporosis may cause atypical femur fractures and osteonecrosis of the jaw. Eight cases of bisphosphonate-associated osteonecrosis of the external auditory canal area are published. Based on Danish national registers, we report a time...

  1. 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...

  2. 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;

    , these findings may be susceptible to selection bias, as age at first VTI and time between VTIs, as well as the outcome variable, STMEC1, may all depend on the 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...

  3. 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.

  4. 单纯鼓室成形术后继发胆脂瘤——附5例报告%Second cholesteatoma of postoperative tympanoplasty-Report of 5 cases

    Institute of Scientific and Technical Information of China (English)

    戴海江; 赵守琴

    2001-01-01

    目的:探讨单纯鼓室成形术后发生胆脂瘤的原因并提出预防措施.方法:对5例单纯鼓室成形术后继发胆脂瘤患者的临床资料进行分析.结果:单纯鼓室成形术后胆脂瘤形成,多与角化鳞状上皮残留有关,而且局部解剖特点、鼓膜穿孔后表皮生长特点及术者的手术操作与角化鳞状上皮的残留关系密切.结论:只要术前仔细、全面的检查,术中认真操作,就会大大降低继发胆脂瘤的发生,确保手术成功.并提出术中操作的几点体会.

  5. 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...

  6. [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

  7. 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

  8. 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.

  9. 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.

  10. Detection of bacterial biofilms in different types of chronic otitis media.

    Science.gov (United States)

    Gu, Xingzhi; Keyoumu, Youlidusi; Long, Li; Zhang, Hua

    2014-11-01

    Biofilms are organized bacterial communities that may be homogeneous or heterogeneous. They play a significant role in the pathogenesis of chronic nasal sinusitis, chronic tonsillitis, cholesteatomas, and device-related infections. Despite this, few studies have been done that examine the presence of bacterial biofilms in tissues from patients with different types of COM or middle ear cholesteatomas. In the current study, we examined the presence of biofilms in surgical tissue specimens from humans with chronic ear infections using scanning electron microscopy (SEM). We hypothesize that bacterial biofilms present differently in patients with different types of chronic otitis media. Our results provide new insights regarding treatment of chronic otitis media. A prospective study was conducted in which middle ear tissues were obtained from 38 patients who underwent tympanoplasty and/or tympanomastoid surgery due to chronic ear infections. A total of 50 middle and mastoid tissue samples were processed for SEM analysis. In addition, 38 middle ear secretion specimens were obtained for routine bacterial culture analysis. Bacterial biofilms were present in 85 % (11 of 13) of patients with middle ear cholesteatoma, 92 % (12/13) of patients with chronic otitis suppurative media (CSOM), and 16 % of patients (2/12) with tympanic membrane perforation (TMP). Fungal biofilms were found in two cases of cholesteatoma. The positive coincidence rate between bacterial biofilms visualized by SEM and bacteria detected by culture was 82 %. Our findings suggest that bacterial biofilms are very common in CSOM and middle ear cholesteatomas. Positive bacterial cultures imply the presence of biofilm formation in CSOM and cholesteatomas. As such, our results provide new insights regarding treatment of chronic otitis media.

  11. [The mastoid osteoma, an incidental feature?].

    Science.gov (United States)

    Domínguez Pérez, Angel Daniel; Rodríguez Romero, Rafael; Domínguez Durán, Emilio; Riquelme Montaño, Pedro; Alcántara Bernal, Ricardo; Monreal Rodríguez, Carlos

    2011-01-01

    Osteoma in the mastoid is a rare benign osteogenic tumour that has been described in literature in only 137 cases. It usually appears in asymptomatic patients, although a few cases are described associated with clinical manifestations. We report three cases of mastoid osteoma: a pedunculated osteoma in the aditus ad antrum (associated with a cholesteatoma), a superficial osteoma of the mastoid surface and a sessile osteoma that progressed to the temporal lobe (associated with vertigo). A brief review of this rare entity is presented and a possible association between mastoid osteoma, cholesteatoma otitis and vertigo is posed.

  12. 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

  13. 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...

  14. 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.

  15. 显微镜下乳突根治术并 I期骨室成形术与听力重建的相关性分析%Radical mastoidectomy and primary tympanoplasty under microscopy correlation analysis of therapeutic efficiency of hearing reconstruction

    Institute of Scientific and Technical Information of China (English)

    王学林; 谢朝峰; 林怀洁; 余怀生; 黄娥贞; 陈影芳; 邱素辉; 许碧如

    2001-01-01

    Objective The aim of this article is to research the radical mastoidectomy and primary tympanoplasty to attain radical cure of the mastoid focus as well as rebuilding the sound- conducting structure of the tympanic cavity to improve the audition. Method The autobone and temporal fascia were taken as the transplants after the radical mastoidectomy under microscopy, and then to carry out the operation of Portmann` s tempanoplasty of 2nd and 3rd types of 2nd class.Result Non of the cholesteatoma was relapsed after follow- up for 1~ 4 years.The efficiency rate of tympanoplasty is of 89.47% .The average audition increased was 19 dB HL. Conclussion Radical operation for cholesteatoma should be associated with tympanoplasty if having condition. We recommend that the opening tympanoplasty should be used, and use autobone as a artificial auditory ossicles.

  16. 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.

  17. Case of Chronic Otitis Media with Intracranial Complication and Contralateral Extracranial Presentation

    Science.gov (United States)

    Lim, P. S.; Pua, K. C.

    2016-01-01

    Intracranial complications of chronic otitis media have been on the decline with advent of antibiotics. Septic thrombosis of the sigmoid sinus is rarer compared to commoner complications such as otogenic brain abscesses and meningitis. This patient presented with recurrent infection after left mastoidectomy secondary to cholesteatoma and a contralateral internal jugular vein thrombosis with parapharyngeal abscess, which was drained. He recovered well postoperatively with antibiotics. PMID:27668115

  18. Molecular confirmation of transmission route of Staphylococcus intermedius in mastoid cavity infection from dog saliva.

    Science.gov (United States)

    Kikuchi, Ken; Karasawa, Toshiko; Piao, Chuncheng; Itoda, Ichiro; Hidai, Hiroko; Yamaura, Hisashi; Totsuka, Kyoichi; Morikawa, Takayuki; Takayama, Mikiko

    2004-02-01

    We report a case of infection of a mastoid cavity after mastoidectomy had been performed for chronic otitis media with cholesteatoma. The infection was caused by Staphylococcus intermedius after a pet dog had licked the patient's ears. Bacterial strains from the dog's saliva and the otorrhea in the patient were confirmed to be identical by pulsed-field gel electrophoresis analysis. The possibility of an oral transmission route of S. intermedius from pets to humans should be noted.

  19. BAHA SYSTEM AND ITS USE

    Directory of Open Access Journals (Sweden)

    Slavcho CHADIEV

    2004-12-01

    Full Text Available People with impaired hearing wear hearing aids to compensate that failure. There is one category of persons with impaired hearing that are not able to use behind-the ear hearing aids (chronical ear infections, cholesteatoma. People with that kind of damage use behind-the ear hearing aids-prosthesis that are implanted by surgery in the mastoide bone, where the sound is transmitted to the cochlea. That is the BAHA sound processor, product of ENTIFIK Medical system.

  20. 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...

  1. 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...

  2. 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.

  3. High-resolution computed tomography of the middle ear and mastoid. Part III. Surgically altered anatomy and pathology

    Energy Technology Data Exchange (ETDEWEB)

    Swartz, J.D.; Goodman, R.S.; Russell, K.B.; Ladenheim, S.F.; Wolfson, R.J.

    1983-08-01

    High-resolution computed tomography (CT) provides an excellent method for examination of the surgically altered middle ear and mastoid. Closed-cavity and open-cavity types of mastoidectomy are illustrated. Recurrent cholesteatoma in the mastoid bowl is easily diagnosed. Different types of tympanoplasty are discussed and illustrated, as are tympanostomy tubes and various ossicular reconstructive procedures. Baseline high-resolution CT of the postoperative middle ear and mastoid is recommended at approximately 3 months following the surgical procedure.

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

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    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.

  5. Endoscopic Anatomy of the Protympanum.

    Science.gov (United States)

    Jufas, Nicholas; Marchioni, Daniele; Tarabichi, Muaaz; Patel, Nirmal

    2016-10-01

    The protympanum, a final common pathway between the tympanic cavity and external environment, is gaining relevance due to the ease and completeness of visualization with angled endoscopes. Two primary conformations are described, quadrangular and triangular, and new anatomic structures such as the protiniculum, subtensor recess, and protympanic spine are defined. Surgical relevance of the protympanum is described with respect to ventilation, cholesteatoma, cerebrospinal fluid leak, otic neuralgia, and surgical access to the eustachian tube. PMID:27565384

  6. Techniques of the tympanomastoidectomy with reconstruction of the posterior bone wall of the external auditory canal

    Directory of Open Access Journals (Sweden)

    Dankuc Dragan

    2015-01-01

    Full Text Available A combined tympanoplasty method, the mobile-bridge tympanoplasty, has been applied at the Clinic for Ear, Nose and Throat Diseases in Novi Sad since 1998. Mobile-bridge tympanoplasty is performed at our Clinic by applying Feldmann’s procedure utilizing a microsurgical oscillating saw. It is a combination of closed and open techniques for surgical treatment of middle ear diseases. In addition to this technique, a method for reconstruction of the posterior bone wall of the external auditory canal was introduced. This procedure is applied in cases of damage or impairment of the bony ear canal wall using mastoid cortical temporal bone graft or modeled cartilage of the concha. Maintenance of general anatomical relations in the middle ear enables good ventilation of pneumatic spaces of the middle ear and Eustachian tube permeability, thus providing good conditions for ossicular chain reconstruction. The incidence of recurrent cholesteatoma in combined mobile-bridge tympanoplasty and tympanoplasty with reconstruction of the posterior bone wall was 6% in total. The incidence values for the recurrent cholesteatoma in closed tympanoplasty and in cases of open techniques were 10%. Mobile-bridge tympanoplasty and reconstruction of the posterior bone wall of external auditory canal are methods of choice in surgical treatment of middle ear cholesteatoma that progressed to the attic space, sinus tympani and facial recess.

  7. 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.

  8. 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

  9. 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

  10. 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.

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

    Directory of Open Access Journals (Sweden)

    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.

  12. The clinical efficacy of 1 mm-slice CT of the middle ear

    Energy Technology Data Exchange (ETDEWEB)

    Noda, Kazuhiro; Noiri, Teruhisa [Kawanishi Municipal Hospital, Hyogo (Japan); Doi, Katsumi; Koizuka, Izumi; Tanaka, Hisashi; Mishiro, Yasuo; Okumura, Shin-ichi; Kubo, Takeshi

    2000-02-01

    The efficacy of the preoperative 1 mm-slice CT for evaluating the condition of the ossicular chain and the facial canal was assessed. CT findings were compared with the operative findings of middle ears in 120 cases of chronic otitis media or cholesteatoma that underwent tympanoplasty. The reliability of 1 mm-slice CT in detecting any defect of the ossicular chain was much superior to those of 2 mm-slice CT previously reported, and the difference between them is essential for preoperative information. On the other hand, thinner slice than 1 mm may be unnecessary, especially in routine use. (author)

  13. REVISION MASTOIDECTOMY AND ITS GOAL

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    Sampath Kumar Singh Katewad

    2016-06-01

    Full Text Available BACKGROUND The main aims in doing surgery for chronic otitis media are: 1. Complete clearance of progressive disease from its site and form dry and well-epithelialised cavity. 2. Prevention of recurrent and residual cholesteatoma achieved by modifying the anatomy of tympanomastoid compartments. 3. Hearing improvement by reconstructing the ossicles and tympanic membrane. The main indication for revision surgery is failure to achieve above said aims by previous surgeon. The aim of our study was to identify the causes of recurrent disease and the factors that helps in chronic otitis media surgery to minimise the revisions & report the results of revision mastoidectomy. MATERIALS AND METHODS In this study, thirty patients are selected and operated for revision mastoidectomy surgery at our institute during the period from May 2013 – Dec 2015. These cases were analysed retrospectively, patients who had discharging ear with the history of previous intact canal wall and canal down mastoidectomy surgeries were selected for this study. OBSERVATION AND RESULTS In this study, the common age group of patients who underwent revision surgery - 8-46 yrs. (mean 19 yrs.. Majority of patients are female, 16 cases (53.33%; and males 14 cases (46.66%. Revision mastoidectomies were applied to 12 cases (40% of previous canal wall up mastoidectomies and 18 cases (60% of prior canal down mastoidectomies. 60% of cases had residual/recurrent cholesteatoma which was the most common finding seen. While in 33.3% cases patient had only chronic granulations. The most frequent site of cholesteatoma was mastoid antrum/mastoid cavity seen in 73% followed by attic 42.3% and mesotympanum in 40% of cases. The common failure in primary surgery was inadequate clearance of diseased mastoid air cells - 48%, high facial bridge - 48%, stenotic meatoplasty - 40%, incomplete removal of buttress - 30%. Tympanic membrane perforation - 6.66% of cases with poor architecture of mastoidectomy

  14. 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

  15. Diffusion-weighted images of intracranial cyst-like lesions

    Energy Technology Data Exchange (ETDEWEB)

    Bergui, M.; Zhong, J.; Sales, S. [Dept. of Neuroradiology, University of Turin (Italy); Bradac, G.B. [Dept. of Neuroradiology, University of Turin (Italy); Neuroradiologia Universitaria, Ospedale S. G. Battista, Turin (Italy)

    2001-10-01

    Magnetic resonance sequences may be designed to evaluate the diffusion movements of the protons (diffusion-weighted images, DWI). In these images, a bright signal identifies a region where the diffusion along a spatial axis is restricted. The contents of a cystic lesion frequently have the signal intensities of a generic homogeneous hyperproteinic fluid (hypointensity in T1-, hyperintensity in T2-weighted images). DWI may give further information about the microscopic organisation of these fluids: a hyperintense signal indicates the presence of a restricted diffusion, due to some kind of microscopic organisation, at the cellular or macromolecular level. This may provide additional information useful for clinical purposes. We obtained DWI in 24 consecutive patients with intracranial cystic lesions, (19 intra-axial: five abscesses, five gliomas, six metastases, two demyelinating lesions, one neurocysticercosis; five extra-axial: two arachnoid cysts, two epidermoid cysts, one cholesteatoma). We found a strongly hyperintense signal, indicating restricted diffusion, in brain abscesses, epidermoid cysts and cholesteatoma; all the remaining lesions were hypointense or mildly hyperintense. We found these data useful in critical diagnoses, such as in differentiating abscesses from tumours, and in identifying elusive tumours such as epidermoid cysts. (orig.)

  16. Facial Canal Dehiscence in Patients with Chronic Otitis Surgery

    Directory of Open Access Journals (Sweden)

    Ahmet Uluat

    2016-04-01

    Full Text Available Aim: To examine facial canal status in patients with chronic otitis media (COM surgery and to detect the relation between facial canals dehiscence (FCD with middle ear pathology in these patients. Material and Method: The surgery data of patients who were subjected to tympanoplasty with or without mastoidectomy and radical mastoidectomy due to COM were analyzed retrospectively from January 2006 to December 2012. In addition to demonstrative data of the patients, status of facial canal and preoperative diagnoses of patients, type of the operation performed, status of middle ear, number of surgeries, existence of cholesteatoma, existence of ossicular chain defect, lateral canal defect and dura defect were assessed and the relation thereof with facial canal dehiscence (FCD was analyzed statistically. Results: Seven hundred ninety six patients were included in the study. FCD was detected in 10.05% of the patients. FCD was most frequently observed in the tympanic segment. It was found out that there was a statistically significant relationship of middle ear pathology, cholesteatoma, revision surgery, lateral semicircular canal and ossicular chain defect with FCD. Discussion: COM diagnosed patients may have defect in facial canal according to their preoperative diagnoses, middle ear pathologies, number of operations and ossicular chain defects. These patients should be applied a more careful surgery and closely followed up in postoperative periods.

  17. 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

  18. 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

  19. 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)

  20. Otoendoscopic treatment of hidden lesions in otomastoiditis

    Institute of Scientific and Technical Information of China (English)

    LIU Yang; SUN Jian-jun; LIN Yong-sheng; ZHAO Dan-heng; ZHAO Jing; LEI Fei

    2010-01-01

    Background Surgical treatments for chronic suppurative and cholesteatoma otitis media have been discussed for several decades, but recurrences still occur because of the complex dissection required and hidden lesions associated with otomastoiditis. This study investigated the technology and strategy behind the use of otoendoscopic-assisted otosurgery.Methods We reported on hidden lesions in 32 ears of patients with otomastoiditis between November 2006 and January 2009. All the patients were treated with the aid of an otoendoscope. The advantages of otoendoscopy, including multi-angle light scattering, aperture illumination, and magnification of the local operative field, were utilized in otologic microsurgery, and otoendoscopic operative techniques were introduced for operative sites such as the epitympanum, aditus of the antrum, facial recess, sinus tympani and the mastoid tip.Results All patients were followed up from 3 months to 2 years after surgery. All patients recovered well within 3 months following surgery, except for one case of epithelialization of the mastoid cavity occurring 6 months after surgery for cholesteatoma on the cerebellar surface and another case with Bezold's abscess, hyperplastic granulation tissue developed at the antrum.Conclusions Otoendoscopy can overcome the technical deficiency of rectilinearity of the visual axis associated with otomicroscopic illumination, which presents a problem when dealing with otomastoiditis lesions in hidden areas. This technique allows such lesions within the complex three-dimensional structure to be visualized and cleaned. Otoendoscopy thus has significant potential for improving the quality of surgery and reducing the risk of postoperative recurrence.

  1. [Criteria for the objective assessment of the dynamic state of the retraction pockets in the children presenting with excudative otitis media].

    Science.gov (United States)

    Karneeva, O V; Zelikovich, E I; Poliakov, D P

    2012-01-01

    This publication continues the preceding paper entitled "Early diagnostics of the retraction pockets in the tympanic membrane of the children". The objective of the present work was to develop the criteria for the objective estimation of the dynamic state of the retraction pockets (RP) in the children at different stages of excudative otitis media. The secondary objective was to develop an approach to the early diagnostics of cholesteatoma of the middle ear. A group of 138 children at the age varying from 1 to 17 years was placed under dynamic observation for the purpose of drawing up the individual "photo-roentgenological passport of the retraction pockets". Special attention was given to RP-semiotics of different forms of the syndrome and its severity in accordance with the classification universally accepted by foreign researchers. The results of the dynamic observations were used to develop the indications for the early preserving surgical treatment. It was given to 16 children six of which presented with cholesteatoma. The original illustrative materials for all variants of the retraction pockets are presented.

  2. 乳突根治联合开放式鼓室成形术治疗胆脂瘤中耳炎的疗效

    Institute of Scientific and Technical Information of China (English)

    李峰

    2013-01-01

    Objective To explore the curative effect of radical mastoidectomy with open tympanoplasty combined application for the treatment of cholesteatoma otitis media clinical effect. Methods 120 patients with cholesteatoma otitis media patients undergoing radical mastoidectomy, and at the same time assisted give line open tympanoplasty. Results After radical mastoidectomy+open treatment of patients was 3-5 years follow-up, patients with postoperative external auditory canal development is basic and normal femoral model, with good patient accounted for all 95.8%of the number of treatment of postoperative hearing test results, 35 patients with preoperative hearing listening improve≥30 dB, there were 53 cases of hearing in patients with a preoperative is improved by 20 to 29 dB, 20 patients with hearing is improved by 10 to 19 dB, only 12 of patients with hearing no significant improvement. Conclusion Radical mastoidectomy and tympanoplasty for cholesteatoma otitis media patients treatment has significant effect, can greatly increase hearing of the patients.%  目的探讨乳突根治联合开放式鼓室成形术治疗胆脂瘤中耳炎的效果。方法对120例胆脂瘤中耳炎患者进行乳突根治术,并同时辅助给予行开放式鼓室成形术。观察治疗效果。结果对接受乳突根治术+开放式治疗的患者进行3~5年的随访,术后患者的外耳道发育基本正常,鼓膜型带良好的患者占所有治疗人数的95.8%,术后进行听力测试结果显示,有35例患者的听力较术前听力提高≥30 dB,有53例患者的听力较术前提高了20~29 dB,有20例患者的听力提高了10~19 dB,仅有12例患者的听力未见明显好转。结论乳突根治术+开放式鼓室成形术对于胆脂瘤中耳炎患者的治疗具有显著的效果,能够提高患者的听力。

  3. 开放式乳突根治伴鼓室成型术治疗胆脂瘤型和骨疡型中耳炎的疗效观察%Evaluation of the curative effect of open mastoidectomy combined with tympanoplasty in the treatment of chronic suppurative otitis media

    Institute of Scientific and Technical Information of China (English)

    胡春梅; 陈德珍

    2013-01-01

    Objective The evaluate the therapeutic effects of open mastoidectomy combined with tympanoplasty in the treatment of chronic suppurative otitis media with cholesteatoma and/or granulation tissue. Methods Sixty patients suffered from chronic o-titis media with cholesteatoma and/or granulation tissue were treated with combination of tympanoplasty and open mastoidectomy. The patients were followed-up for 1 to 2 years. Results After operation,56 of 60 cases had dry ears. The pure tone test showed that 19 ears have been improved more than 20 db,20 ears improved from 10 to 19 db and 17 ears improved less than 10 db. Five cases had perforation , and 4 cases had cholesteatoma. Conclusions The open mastoidectomy can completely remove the lesion and control the infection. The autologous residual auditory ossicles can be used in reconstruction of ossieular chain. The open mastoidectomy combined with tympanoplasty may improve the hearing level and life quality.%目的 观察开放式乳突根治术并同期鼓室成型术治疗胆脂瘤型和骨疡型中耳炎的疗效,探讨自体残余听小骨在彻底清除中耳病变后重建听力的效果.方法 60例患者行开放式乳突根治术并同期鼓室成型术,随访1~2年,判定疗效.结果 术后干耳56例,纯音测听平均听阈提高20 db以上有19耳,提高10~19 dB有20耳,提高10 dB以内有17例;术后鼓膜穿孔5例,耳流脓4例,1例出现术后眩晕.干耳率93%,治愈率65%.结论 乳突根治术能彻底清除病灶,控制感染,自体残余听骨是很好的鼓室成型材料;同期鼓室成形能有效提高听阈,改善生活质量.

  4. 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.)

  5. Use of Pericranial Flap Coverage in Cochlear Implantation of the Radical Cavity: Rationale, Technique, and Experience.

    Science.gov (United States)

    Nieman, Carrie L; Weinreich, Heather M; Sharon, Jeffrey D; Chien, Wade W; Francis, Howard W

    2016-09-01

    Cochlear implant (CI) surgery in the setting of an open mastoid cavity is evolving. Two strategies are commonly pursued: a staged approach, clearing the disease, closing the meatus or the external auditory canal (EAC), and reevaluating in 3 to 6 months prior to implantation, or a single-stage procedure with mastoid obliteration without EAC closure. Meatal closure is often employed in the setting of an open mastoid cavity to reduce the risk of electrode extrusion and infection. An open cavity offers the advantages of being a single-stage procedure, permitting direct surveillance for recurrent cholesteatoma, and reducing the need for repeat computed tomography scans. We describe an approach to the coverage of a CI within a dry, open mastoid cavity using an anteriorly-based postauricular pericranial flap.

  6. Tympanosclerosis Presenting as Mass: Workup and Differential.

    Science.gov (United States)

    Barry, Jonnae Y; Reghunathan, Saranya; Jacob, Abraham

    2016-01-01

    Introduction. Tympanosclerosis is a commonly encountered entity within ENT clinics and primary care settings. Recognizing ear pathology is essential for correct management. Oftentimes the diagnosis is clear; however in certain cases further workup to rule out other more insidious disease processes is warranted. Case Report. We present a case of tympanosclerosis which presented as an ear mass without classic appearance of tympanosclerosis. Through imaging and biopsy the diagnosis of tympanosclerosis was made. The patient was treated surgically with good outcome. Discussion. Various ear pathologies, with different treatment algorithms, may present as clinically similar to one another. Differential diagnosis for this case included tympanosclerosis, cholesteatoma, or other middle ear masses. We review these entities and discuss their pathophysiology and implications on management. PMID:27656306

  7. Tympanomastoid obliteration for recalcitrant attico-antral chronic suppurative otitis media

    Directory of Open Access Journals (Sweden)

    C Preetam

    2011-01-01

    Full Text Available Though the standard canal wall up and canal wall down mastoidectomies provide for reliable disease removal and good functional outcome in most cases with atticoantral chronic suppurative otitis media (CSOM, few cases remain unresponsive to such treatment. This report describes the application of tympanomastoid obliteration with blind sac closure of the EAC as a surgical technique for recurrent CSOM persisting despite multiple previous surgical treatments. Though maximal conductive deafness is an inevitable consequence of this procedure, such morbidity may even otherwise be inevitable in this clinical situation, as scarring and destruction consequent to disease and previous surgical treatments often lead to clinical situations not amenable to tympanoplasty and hearing reconstruction. Further concerns of recurrent epithelial pearls and implantation cholesteatoma can be currently addressed by follow-up MR scanning.

  8. Graft Take-Rates After Tympanoplasty

    DEFF Research Database (Denmark)

    Andersen, Steven Arild Wuyts; Aabenhus, Kristine; Glad, Henrik;

    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...

  9. Effects of eustachian tube function in outcome of graft in tympanoplasty or tympanomastoidectomy for chronic otitis media

    Directory of Open Access Journals (Sweden)

    Malakooti B

    2001-07-01

    Full Text Available Chronic otitis media is a common disease which can lead to serious complications or even death. Betterment of eustachian tube function is effective on results of operations. The main goal of this study was to determine the effect of eustachian tube function on outcome of graft in tympanoplasty or tympanomastoidectomy for chronic otitis media. We prospectively studied 126 patients who underwent these operations in Amir Alam hospital in 1998. Eustachian tube function, technique of operation, use of silastic, age, sex, presence of cholesteatoma were evaluated in each patient and graft vascularization after 6 to 8 weeks of surgery was considered as successful outcome. Among 126 ears, 59 had good ETF and among those 59 ears 88.1% or 52 had successful outcome. Among 67 patients with poor ETF 46 or 68.7% got successful results. This significant difference shows the role of Eustachian tube function on the result of surgery.

  10. Effects of eustachian tube function in outcome of graft in tympanoplasty or tympanomastoidectomy for chronic otitis media1

    Directory of Open Access Journals (Sweden)

    Malakooti B

    2000-07-01

    Full Text Available Chronic otitis media is a common disease which can lead to serious complications or even death. Betterment of eustachian tube function is effective on results of operations. The main goal of this study was to determine the effect of eustachian tube function on outcome of graft in tympanoplasty or tympanomastoidectomy for chronic otitis media. We prospectively studied 126 patients who underwent these operations in Amir Alam hospital in 1998. Eustachian tube function, technique of operation, use of silastic, age, sex, presence of cholesteatoma were evaluated in each patient and graft vascularization after 6 to 8 weeks of surgery was considered as successful outcome. Among 126 ears, 59 had good ETF and among those 59 ears 88.1% or 52 had successful outcome. Among 67 patients with poor ETF 46 or 68.7% got successful results. This significant difference shows the role of Eustachian tube function on the result of surgery.

  11. 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

  12. 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

  13. 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

  14. 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

  15. Medical adventure in Nepal.

    Science.gov (United States)

    Boon, D A

    1980-12-01

    In 1977 a request for teaching of otologic surgery from a Nepalese doctor to a Canadian colleague resulted in Doctor David Boon and his wife, Joan, travelling to Nepal in February, 1979, as volunteers. They participated in the "Lions Club of Kathmandu First Free Ear Camp" sponsored jointly by the International Sound Foundation Society and the Lions Club of Kathmandu. Fifteen hundred patients were seen and otosclerosis was one of the commonest ear diseases encountered. Adhesive otitis media with attic cholesteatoma was prevalent and a few cases of childhood serous otitis media were diagnosed. Severe sensorineural hearing loss was also prevalent and related to heredity, post febrile illness, and ototoxic drugs. Seventy surgical procedures were performed consisting of mastoidectomy, stapes reconstruction, tympanoplasty and myringotomy.

  16. 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

  17. 完壁式乳突根治鼓室成形术的发展及应用%Development and Application of Canal Wall up Mastoid-tympanoplasty

    Institute of Scientific and Technical Information of China (English)

    宋昱(综述); 马芙蓉(审校)

    2015-01-01

    慢性化脓性中耳炎严重影响患者生活质量,伴胆脂瘤者可能因颅内外并发症危及生命,手术目的为彻底清除病灶,并尽可能保存和重建听力。手术方式主要包括开放式及完壁式乳突根治鼓室成形术,前者在清除病灶方面具有较为广阔的视野,后者术后胆脂瘤复发可能性较高,但因外耳道后壁的保存使患者术后有更高的生活质量。本文对完壁式乳突根治鼓室成形术的术式、手术疗效、术后复发率及手术适应证进行概述,旨在为该术式的选择提供参考。%[Summary] Chronic suppurative otitis media affects patients ’ quality of life, and is life-threatening in patients with cholesteatoma which causes intracranial or extracranial complications .The purpose of surgery is to clear up all the lesions and to reconstruct hearing function .Tympanoplasty is the main surgical method , which includes basically canal wall down ( CWD) and canal wall up (CWU) styles.CWD provides lager surgical field but impairs normal auditory canal structure ; CWU preserves the posterior wall of external auditory canal and provides better quality of life although it has higher possibility of recurrence of cholesteatoma .We reviewed the surgical methods , surgical effects , recurrence rates , and surgical indications of canal wall up mastoid-tympanoplasty , hoping to provide meaningful reference for clinical application .

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

    Directory of Open Access Journals (Sweden)

    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

  19. Osteomas of the middle ear

    Directory of Open Access Journals (Sweden)

    Sente Marko

    2004-01-01

    Full Text Available INTRODUCTION Osteomas of the middle ear are small, single, usually unilateral, peduncular growths, off-white in color, with smooth or multilobular surface, asymptomatic or causing functional disorders (progressive hearing loss, pathological appearance of the eardrum, vertigo and otorrhea, of unclear or unknown etiology. Fleury described three types of osteomas: massive, diffuse atticoantral and localized type. The therapy is surgical. Small and asymptomatic ones are followed-up. Cremers suggests surgical intervention in cases of progressive growth and increased hearing loss. Case description Discharge and pain in the left ear started twelve years ago, accompanied by impaired hearing and tinnitus. Four months ago the symptoms aggravated and discharge and pain increased. Otomicroscopic findings revealed: perforation in the posterior attic and a prominent polypous, clustered bright red formation. Schüller X-ray showed total absence of pneumocyte cells, with distinct sclerotic changes. Retroauricular access showed a biventricular bony formation in the cavum and partly in the antrum. A cholesteatoma extended from the cavum into the antrum, above the osteatoma. The bony formation was separated transmeatally from the grip in the posterior attic using a chisel, partially removing the bone wall of the exterior aural tube, removing it completely through the mastoid antrum. The removed bony mass, sized 5 x 8 x 8 mm, included also the incus. DISCUSSION Osteoma was discovered accidentally. Regarding clinical features, it belonged to the second group, due to progressive hearing loss, recurrent episodes of otorrhea, pain, biventricular shape and association with cholesteatoma. It was removed using a combined method. It was not possible to establish when the osteoma exactly started generating. It is possible that the initial complaints twelve years ago were the first signs of illness, and chronic otitis may have occurred as a consequence of the tumor.

  20. Improved retention experience mastoidecto-my tympanoplasty osteopontin treatment of otitis media%改良乳突切除术保留骨桥鼓室成形术治疗中耳乳突炎的体会

    Institute of Scientific and Technical Information of China (English)

    李翔宇; 孙海燕; 梁振; 王东海; 张刚

    2014-01-01

    AIM:To investigate the clinical efficiency of the treatment for chronic otitis mastoidea after intactbridge mastoitym-panoplasty (IBM).METHODS:The charts of 83 ears that suf-fered chronic otitis media (including patients with cholesteatoma, granulation type),which underwent the treatment of IBMwere re-viewed.RESULTS:83 cases were observed after 1 month to 4 years,and hearing improvement rate was 68.67%;no efficiency rate was 3 1 .32%,dry ear within 3 months.Hearing recovery ef-ficiency of chronic otitis mastoidea is 95 .65%,followed by chron-ic otitis media of 85 .7 1% and the worst, cholesteatoma, of 34.37%.CONCLUSION:Long-term repeated pus hearing pro-gressive declines in chronic suppurative otitis media patients should recieved modified mastoid bone bridge resection retaining undergoing tympanoplasty,and obtain dry ear,listening,to pre-vent hearing loss.On cholesteatoma,carious type otitis media pa-tients,should remove the lesion as soon as possible based on the retention of mastoid air cells and the bone bridge simultaneous tympanoplasty.%目的:研究改良乳突切除术保留骨桥鼓室成形术治疗中耳乳突炎治疗效果.方法:选取2013-01/2013-12来我院接受治疗的患有慢性化脓性中耳乳突炎的病患83例,对病患实行改良乳突切除保留骨桥同期鼓室成形术,首先对病患的耳部内侧进行切口,将外耳道的皮瓣和乳突进行暴露,之后使用电钻将乳突气房部分进行磨除,保留骨桥将乳突及鼓窦鼓室出现的病变组织进行清除.结果:病患听力得到改善的有效率为68.67%,治疗无效率为31.32%;病患在三个月内均获得干耳,慢性单纯型中耳乳突炎患者,有效率95.65%,骨疡型,有效率85.71%,最差为胆脂瘤型,有效率为34.37%.结论:对慢性化脓性中耳乳突炎病患尽早实行改良乳突切除保留骨桥鼓室成形术可以对病患的听力起到较好的治疗效果,值得在实际临床中进行推广.

  1. 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

  2. 不同病因的周围性面神经麻痹外科治疗分析%Surgical treatment to facial nerve paralysis of different pathogeny

    Institute of Scientific and Technical Information of China (English)

    伊海金; 刘丕楠; 郭泓; 王春红; 倪富强

    2011-01-01

    Objective:To evaluate the surgical treatment to facial nerve paralysis of different pathogeny. Method: Thirty-seven patients were reviewed, including Bell's Palsy(5 patients), temporal bone fracture ( 20 patients),media otitis(cholesteatoma) (4 patients), facial neuroma and cranio-maxilly-facial operation trauma(8 patients). All the patients were treated by different surgical methods according different pathogeny. Result: The mean percentage facial function improvement (House-Brackmann Grade Ⅰ - Ⅱ )was 80% to Bell's Palsy and temporal bone fracture,100% to media otitis(cholesteatoma). Facial function of three patients improved from House-Brackmann Grade Ⅳ to Ⅲ,two patients had no obvious improvement about facial neuroma; three patients improved from Grade Ⅴ to Ⅲ ,one improved to Ⅳ about cranio-maxilly-facial operation trauma. Conclusion:Patients of facial nerve paralysis got better curative effect if treated by proper surgical therapy according different pathogeny.%目的:探讨不同病因的周围性面神经麻痹患者外科治疗的相关问题.方法:面神经麻痹患者37例,病因包括:贝尔面瘫5例,颞骨骨折20例,中耳乳突炎4例,内耳道面神经肿瘤3例,颅脑颌面手术损伤5例,针对不同病因采取相应外科治疗方式.结果:H-B分级Ⅰ~Ⅱ级恢复率:贝尔面瘫80%,颞骨骨折80%,中耳乳突炎100%;内耳道面神经肿瘤术后1例由Ⅳ级改善至Ⅲ级,2例术后无明显变化;颅脑颌面手术损伤行面-舌吻合者4例由Ⅴ级改善至Ⅲ级3例,Ⅳ级1例,行瘢痕切除+面神经探查减压术者1例由Ⅴ级改善至Ⅳ级.结论:针对不同病因导致的面神经麻痹,选择合适的手术治疗方法,可以取得良好效果.

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

    Directory of Open Access Journals (Sweden)

    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.

  4. The experience of 35 cases with open tympanoplasty treatment%开放式鼓室成形术35例治疗分析

    Institute of Scientific and Technical Information of China (English)

    胡民; 刘刚

    2012-01-01

    目的 评价35例开放式乳突根治鼓室成形手术的治疗效果.方法 对35例行开放式鼓室成形术治疗的慢性中耳炎患者的手术方法及术后干耳率和听力改善情况进行回顾分析.结果:随访1~2年,35耳全部干耳,无胆脂瘤复发,无眩晕和面瘫并发症.30例移植筋膜成活,4例鼓膜再穿孔,1例鼓膜瘢痕内陷.术后纯音测听语言频率气导平均听阈,提高25~30 dBHL 5耳,提高15 ~20 dBHL 18耳,提高10 dBHL 8耳,无变化4耳.结论 对慢性中耳炎患者行开放式鼓室成形术,能根治病变,听力恢复效果好,复发率低,是一种较为实用的手术方法.%Objective: To investigate the effect of open tympanoplasty for patients with chronic otitis media of the middle ear. Methods: Thirty five ears with cholesteatoma were treated by open tympanoplasty. The rate of dry ear and hearing condition were analyzed retrospectively. Results:During a follow-up of one to two years,all had dry ears without relapse and vertigo or facial paralysis. Among them,30 cases had normal tympanic membranes,4 had reperforation, and 1 had a sunken tympanic membrane. Hearing was improved by 25 to 30 dBHL in 5 ears, 15 to 20 dBHL in 18 ears, 10 dBHL in 8 ears,and not improved in 4 ears. Conclusions:Open tympanoplasty should be carried out in treating otitis media with cholesteatoma to improve the hearing and decrease relapse. It is a valuable surgery.

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

    Energy Technology Data Exchange (ETDEWEB)

    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.

  6. 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。

  7. 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

  8. Clinical Research of 2 Kinds of Operation Approach in Open Radical Mastoidectomy%开放性乳突根治术两种手术进路的临床研究

    Institute of Scientific and Technical Information of China (English)

    刘振宇

    2012-01-01

      Objective:To approach effective that open radical mastoidectomy in two kinds of Operation Approach through behind the ears and in ears.Method:Treating sixty ears which were Cholesteatoma otitis media by mastoid contour through behind the ears approach+conchal cavity forming technique,and comparing with forty ears which were traditional radical mastoidectomy+skin graft in through in the ears.Visiting 6-24 months.Result:Dry ear rate was 90%in first method,Dry ear rate was 60%in second method,the first method was more than the second method.The fewer had complication and the low rate of return in the first method.Two methods had no significant difference in improving hearing situation after operation.Conclusion:Mastoid contour through behind the ears approach+conchal cavity forming technique is a safer,more reasonable and effective method to effect a radical cure of Cholesteatoma otitis media.%  目的:探讨经耳后及耳内两种进路下开放式乳突根治术的疗效.方法:以耳后进路乳突轮廓化+耳甲腔成型术治疗胆脂瘤型中耳炎60耳,并与同期行耳内进路传统乳突根治术+替氏植皮术的40耳进行疗效比较.随访时间6~24个月.结果:耳后组术后最后干耳率为90.0%,明显高于耳内组的60.0%,前者术时并发症发生率及术后复诊率较低.两组术后听力改善情况无明显差异.结论:耳后进路乳突根治术+耳甲腔成型术是一种更安全、合理、有效的根治胆脂瘤型中耳炎并获干洁自净术腔的方法.

  9. MicroRNAs in sensorineural diseases of the ear

    Directory of Open Access Journals (Sweden)

    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.

  10. 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.

  11. 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.

  12. The use of subtotal petrosectomy in cochlear implant candidates with chronic otitis media.

    Science.gov (United States)

    Szymański, Marcin; Ataide, Andre; Linder, Thomas

    2016-02-01

    Cochlear implants (CI) candidates with chronic otitis media require special attention and management. The need of opening of the inner ear creates potential routes of spread of infection to subarachnoid spaces and lead to meningitis. The aim of the study was to analyse the technique and complications of subtotal petrosectomy (SP) in cochlear implant candidates with chronic otitis media at three different CI centres. A retrospective study was carried out in three Territory Referral Hospitals. The centres follow Fisch's philosophy and surgical techniques of SP. The study group consisted of 19 patients, 4 men and 15 women, aged 12-82 years. All patients underwent SP with either primary or staged CI implantation. Indications for single or a staged management, difficulties during surgery and complications were analysed. Skin and muscle flap design in primary and revision cases as well as imaging follow-up strategy are discussed. In 14 patients implantation was performed in a single stage and in 5 cases in two stages. Follow-up ranged from 8 months to 10 years. All the patients use their implants and there were no major nor minor complications. The use of subtotal petrosectomy with cochlear implants is a safe and efficient technique when strict surgical steps and rules are applied. Closure of the external ear canal after previous meatoplasty can be challenging and extreme care dissecting the skin flaps is required. In patients with extensive cholesteatoma, active discharge from the ear with resistant bacteria or an "unstable" situation, the procedure can be staged.

  13. 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.)

  14. Application of autologous cartilage and Tos modified combined approach tympanoplasty in middle ear surgery%自体软骨和Tos改良联合进路鼓室成形术在中耳手术中的应用

    Institute of Scientific and Technical Information of China (English)

    张志钢; 陈穗俊; 郑亿庆; 杨海弟; 陈斌; 郭焕萍; 陈洽鑫

    2010-01-01

    Objective To explore the clinical application of autologous cartilage and Tos modified combined approach tympanoplaty in middle ear surgery. Methods Twenty-three patients with chronic otitis media with cholesteatoma received tympanoplasty with Tos modified combined approach. The lateral walls of epitympanum and posterior tympanum were removed and reconstructed with tragal cartilages. Type Ⅲ ossicular reconstruction was performed either with partial ossicular replacement prosthesis (PORP) or total ossicular replacement prosthesis (TORP), depending on the stapes situation. All the patients were followed up for 3-5 years. Results Four to six weeks after surgery, all the 23 patients experienced dry ear and wellhealed tympanic membranes with normal appearance. Depression of lateral walls of epitympanum and posterior tympanum after cartilage reconstruction was not seen in any case. One year after surgery, pure tone audiometry one showed that speech frequency (500, 1000, 2000, 3000, 4000 Hz), air conduction hearing threshold increased by at least 30 dB in 8 patients (34.78%), by 20-29 dB in 9 (39.13%), 10-19 dB in 4 (17.39%) and no improvement in 2 (8.69%). According to the first 3 years of follow-up, patients were with stable audition, and no cholesteatoma relapsed during follow-up of 5 years. Conclusions The tympanoplasty with Tos modified combined approach can be a good solution for surgical treatment of chronic otitis media with cholesteatoma since it can not only remove the lesions completely, but also keep the posterior wall of external tympanic meatus intact, with a satisfying postoperative hearing level obtained. The cartilage reconstruction of the lateral walls of epitympanum and posterior tympanum removed during surgery is effective to prevent depression of new tympanic membrane and formation of secondary cholesteatoma.%目的 探讨自体软骨和Tos改良联合进路鼓室成形术在中耳手术中的临床应用.方法 对23例胆脂瘤型中耳炎用Tos

  15. 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.

  16. Hearing Benefit in Allograft Tympanoplasty Using Tutoplast Processed Malleus

    Directory of Open Access Journals (Sweden)

    Anja Lieder

    2014-01-01

    Full Text Available Objectives. Tutoplast processed human cadaveric ossicular allografts are a safe alternative for ossicular reconstruction where there is insufficient material suitable for autograft ossiculoplasty. We present a series of 7 consecutive cases showing excellent air-bone gap closure following canal-wall-down mastoidectomy for cholesteatoma and reconstruction of the middle ear using Tutoplast processed malleus. Patients and Methods. Tympanoplasty with Tutoplast processed malleus was performed in seven patients to reconstruct the middle ear following canal-wall-down mastoidectomy in a tertiary ENT centre. Main Outcome Measures. Hearing improvement and recurrence-free period were assessed. Pre-and postoperative audiograms were performed. Results. The average pre operative hearing loss was 50 ± 13 dB, with an air-bone gap of 33 ± 7 dB. Post operative audiograms at 25 months demonstrated hearing thresholds of 29 ± 10 dB, with an air-bone gap of 14 ± 6 dB. No prosthesis extrusion was observed, which compares favourably to other commercially available prostheses. Conclusions. Tutoplast processed allografts restore conductive hearing loss in patients undergoing mastoidectomy and provide an excellent alternative when there is insufficient material suitable for autograft ossiculoplasty.

  17. 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

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

    Directory of Open Access Journals (Sweden)

    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.

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

    Directory of Open Access Journals (Sweden)

    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.

  20. The Dehiscent Facial Nerve Canal

    Directory of Open Access Journals (Sweden)

    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.

  1. Petrous apex lesions outcome in 21 cases

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    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.

  2. 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.

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

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    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.

  4. Diagnosis of Bell palsy with gadolinium magnetic resonance imaging.

    Science.gov (United States)

    Becelli, R; Perugini, M; Carboni, A; Renzi, G

    2003-01-01

    Bell palsy is a condition resulting from a peripheral edematous compression on the nervous fibers of the facial nerve. This pathological condition often has clinical characteristics of no importance and spontaneously disappears in a short time in a high percentage of cases. Facial palsy concerning cranial nerve VII can also be caused by other conditions such as mastoid fracture, acoustic neurinoma, tumor spread to the temporal lobe (e.g., cholesteatoma), neoformation of the parotid gland, Melkersson-Rosenthal syndrome, and Ramsay-Hunt syndrome. Therefore, it is important to adopt an accurate diagnostic technique allowing the rapid detection of Bell palsy and the exclusion of causes of facial paralysis requiring surgical treatment. Magnetic resonance imaging (MRI) with medium contrast of the skull shows a marked increase in revealing lesions, even of small dimensions, inside the temporal bone and at the cerebellopontine angle. The authors present a clinical case to show the important role played by gadolinium MRI in reaching a diagnosis of Bell palsy in the differential diagnosis of the various conditions that determine paralysis of the facial nerve and in selecting the most suitable treatment or surgery to be adopted.

  5. Tumors of the skull base in children: review of tumor types and management strategies.

    Science.gov (United States)

    Tsai, Eve C; Santoreneos, Stephen; Rutka, James T

    2002-05-15

    Although many treatment strategies for skull base tumors in adults have been reported, relatively little has been reported regarding such therapies in the pediatric population. Skull base tumors in children present a therapeutic challenge because of their unique pathological composition, the constraints of the maturing skull and brain, and the small size of the patients. In this review, the authors examine the pediatric skull base lesions that occur in the anterior, middle, and posterior cranial base, focusing on unique pediatric tumors such as encepahalocele, fibrous dysplasia, esthesioneuroblastoma, craniopharyngioma, juvenile nasopharyngeal angiofibroma, cholesteatoma, chordoma, chondrosarcoma, and Ewing sarcoma. They review management strategies that include radio- and chemotherapy, as well as surgical approaches with emphasis on the modifications and complications associated with the procedures as they apply in children. Evidence for the advantages and limitations of radiotherapy, chemotherapy, and surgery as it pertains to the pediatric population will be examined. With a working knowledge of skull base anatomy and special considerations of the developing craniofacial skeleton, neurosurgeons can treat skull base lesions in children with acceptable morbidity and mortality rates. Outcomes in this population may be better than those in adults, in part because of the benign histopathology that frequently affects the pediatric skull base, as well as the plasticity of the maturing nervous system.

  6. 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.

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

    Directory of Open Access Journals (Sweden)

    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.

  8. 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)

  9. 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.

  10. Otologic disorders causing dizziness, including surgery for vestibular disorders.

    Science.gov (United States)

    Bertholon, P; Karkas, A

    2016-01-01

    This chapter will focus on vertigo/dizziness due to inner-ear malformations, labyrinthine fistula, otosclerosis, infectious processes, and autoimmune inner-ear disorders. Inner-ear malformation due to dehiscence of the superior semicircular canal is the most recently described inner-ear malformation. Vertigo/dizziness is typically induced by sound and pressure stimuli and can be associated with auditory symptoms (conductive or mixed hearing loss). Labyrinthine fistula, except after surgery for otosclerosis, in the context of trauma or chronic otitis media with cholesteatoma, still remains a challenging disorder due to multiple uncertainties regarding diagnostic and management strategies. Otosclerosis typically manifests with auditory symptoms and conductive or mixed hearing loss on audiometry. Vertigo/dizziness is rare in nonoperated otosclerosis and should draw clinical attention to an inner-ear malformation. Computed tomography scan confirms otosclerosis in most cases and should rule out an inner-ear malformation, avoiding needless middle-ear surgical exploration. Labyrinth involvement after an infectious process is unilateral when it complicates a middle-ear infection but can be bilateral after meningitis. Labyrinth involvement due to an inflammatory disease is a challenging issue, particularly when restricted to the inner ear. The diagnosis relies on the bilateral and rapid aggravation of audiovestibular symptoms that will not respond to conventional therapy but to immunosuppressive drugs. PMID:27638078

  11. Has mastoid pneumatization any bearing on tympanoplasty?

    Directory of Open Access Journals (Sweden)

    Chander Mohan

    2015-01-01

    Full Text Available Aims: The importance of the mastoid in determining the success or failure of tympanic membrane reconstruction has been a topic of debate since long. A decrease in the mastoid air cell volume has been shown to be related to atelectatic ear diseases, cholesteatoma, and chronic otitis media with effusion. The aim of this study was to see the surgical outcome in cases of type I tympanoplasty in well-pneumatized and sclerotic mastoids. Materials and Methods: Eighty patients undergoing type I tympanoplasty were randomly selected. X-ray of the mastoid (Schullers' view was advised in all the patients. The patients were divided into two groups. Group I having fully pneumatized mastoid and group II having sclerotic mastoid. These cases were followed up for a period of 1-year for the graft uptake. Results: It was seen that the graft uptake rate was better in well-pneumatized mastoid as compared to sclerotic mastoid. The results were analyzed and were found to be statistically significant with Chi-square value 3.94 and P = 0.047. Conclusion: As per the study, it can be concluded that graft uptake rate in cases of tubo tympanic chronic suppurative otitis media was better in well-pneumatized mastoids as compared to sclerotic mastoid.

  12. Chloramphenicol and acute esophagitis in the emergency department

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    Chad T Andicochea

    2015-01-01

    Full Text Available Even with its broad spectrum and low cost, concern over chloramphenicol′s adverse effects limited its use in the United States during the 1980s. Reports from United Kingdom and China in the 1990s demonstrated a low incidence of blood dyscrasias with the topical preparation of chloramphenicol, and showed continued good efficacy and low cost. Today, topical chloramphenicol is being used by some groups within otolaryngology and ophthalmology in the United States. As a result, emergency physicians are once again considering chloramphenicol-induced side effects in patients presenting to the emergency department. To date, there have been no published reports associating chest pain, dyspnea with chloramphenicol use, and there has only been one report of fungal esophagitis associated with topical chloramphenicol. We present a 31-year-old woman, 4 months status post tympanoplasty with a modified radical canal wall down mastoidectomy due to a cholesteatoma involving the epitympanum who had a residual tympanic membrane defect. She presented to the emergency department with chest "burning", with no other symptoms shortly after starting treatment with an insufflated combination antibiotic containing chloramphenicol. After ruling out cardiopulmonary or vascular etiology, she was treated successfully with a gastrointestinal cocktail cocktail for presumed esophagitis secondary to newly prescribed chloramphenicol.

  13. Diagnostic Performance of Endoscopic and Microscopic Procedures for Identifying Different Middle Ear Structures and Remaining Disease in Patients with Chronic Otitis Media: A Prospective Cohort Study.

    Directory of Open Access Journals (Sweden)

    Farhad Farahani

    Full Text Available The diagnostic performance of endoscopic and microscopic procedures for detecting diseases of the middle ear in patients with chronic otitis media (COM has rarely been investigated. This study was conducted to compare the performance of these procedures for identifying middle ear structures and their associated diseases in COM patients.In this prospective cohort study, 58 patients with chronic COM, who were candidates for tympanoplasty with or without a mastoidectomy, were enrolled. Before the surgical intervention, the middle ear was examined via an operating microscope and then through an endoscope to identify the middle ear structures as well as diseases associated with the middle ear.The patients were 15 years of age or older. The anatomical parts of the middle ear - the epitympanic, posterior mesotympanic, and hypotympanic structures - were more visible through an endoscope than through a microscope. In addition, the various segments of the mesotympanum, oval window, round window, and Eustachian tube were more visible via endoscopy. The post-operative endoscopic reevaluation of the middle ear revealed that a cholesteatoma had remained in four of 13 patients after surgery.According to the results of this study, in cases in which there is poor visibility with the operating microscope or the surgeon suspects remaining disease within the middle ear, endoscopy could be utilized to improve the evaluation of more hidden middle ear pits and structures, particularly if there is a potentially recrudescent pathology.

  14. Preparation and placement of cartilage island graft in tympanoplasty

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    Veysel Yurttas

    2014-12-01

    Full Text Available Introduction: Cartilage graft tympanoplasty has a better success rate in the treatment of chronic otitis media if regularly prepared and placed. Objective: To prepare cartilage island material and evaluate its effect on the success rate of tympanoplasty. Methods: The medical records of 87 patients (48 males and 39 females; mean age, 27.3 ±11.2 years; range, 14–43 years with chronic otitis media without cholesteatoma who underwent intact canal-wall-up tympanoplasty and revision surgery between December of 2007 and October of 2011 were retrospectively evaluated. Surgery was performed under general anesthesia via a retroauricular approach. Results: The overall success rate of this technique was 93% in terms of perforation closure. No graft lateralization or displacement into the middle ear occurred. The overall average preoperative air bone gap was 37.27 ± 12.35 dB, and the postoperative air bone gap was 27.58 ± 9.84 dB. The mean postoperative follow-up period was 15.3 months (range: 7–21 months. Conclusion: If cartilage graft is properly prepared and placed, cartilage graft tympanoplasty appears to provide better success rates and hearing results.

  15. EXPERIENCE WITH OVERLAY TYMPANOPLASTY IN 83 CHINESE PATIENTS

    Institute of Scientific and Technical Information of China (English)

    PENG Bengang; MIAO Xutao; WANG Xin; ZHU Sixiang; SUN Yiqing

    2014-01-01

    Background In many European and American hospitals, represented by the House Ear Clinic (HEC), the overlay tympanoplasty is used with rare exception, with simultaneous canal wall up or down mastoidectomy being taken if needed. In China, underlay tympanoplasty is used across the country, but the overlay tech-nique is used rarely. The aim of the current study was to report the authors’experience with overlay tympa-noplasty in 83 Chinese patients and study its value. Methods Eight-three patients (86 ears) underwent over-lay tympanoplasty in accordance to the standard of the HEC. The patients were followed up and conditions of the external auditory canal, tympanic membrane and hearing were reviewed and analyzed. Results All patients gained stage I incision healing. The size of external auditory canal and tympanic membrane mor-phology were satisfactory. Hearing either remained unchanged or improved. There were no hearing deterio-ration or serious complications. Conclusions Overlay tympanoplasty carries positive value in treating chron-ic otitis media and cholesteatoma with the merits of procedure standardization, adequate operative exposure, thorough disease elimination and extensive adaptation.

  16. A three-dimensional reconstruction of the temporal bone by the helical scanning CT and its clinical application

    Energy Technology Data Exchange (ETDEWEB)

    Yonekawa, Hiroyuki; Ohashi, Masami; Miyashita, Souji; Gotoh, Mizuho; Nemoto, Satohiko; Kikuchi, Hideki (Azabu Triology Hospital, Sapporo (Japan)); Sakai, Noboru; Inuyama, Yukio

    1993-09-01

    The current availability of 3 dimensional (3-D) imaging from Computed Tomography (CT) has yielded new anatomical information and pre- and postoperative evaluations. However, little discussion as to the 3-D structural image of the temporal bone has been reported because conventional CT does provide sufficient data to produce such images. The helical scanning CT gathers continuous and multiple slice image data since it consists of an X-ray tube that continuously rotates around the patient while the patient moves continuously into the CT scanner. Thus, application of the helical scanning CT has made it possible to reconstruct 3-D images of the minute and complicated structure of the temporal bone. We evaluated 3-D images from 9 typical cases, examined from February to October 1992. As a result, we found that the 3-D images reconstructed with this system are useful for evaluation of the postoperative state of tympanoplasty, the diagnosis of anomalies of the bony labyrinth, and examining the extent of bone destruction induced by trauma, cholesteatoma, etc. (author).

  17. [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

  18. [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

  19. 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

  20. CT of temporal bone II. OMPC

    Energy Technology Data Exchange (ETDEWEB)

    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.

  1. Audiometry and ossicular condition in chronic otitis media

    Directory of Open Access Journals (Sweden)

    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.

  2. 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.

  3. Hematologic, serologic, and histologic profile of aged Siberian hamsters (Phodopus sungorus).

    Science.gov (United States)

    McKeon, Gabriel P; Nagamine, Claude M; Ruby, Norman F; Luong, Richard H

    2011-05-01

    Biologic samples from 18 (12 female, 6 male) Siberian hamsters (Phodopus sungorus) representing an aged colony (17 to 27 mo) were examined. Values for CBC and serum biochemical parameters were determined, and macroscopic and microscopic pathologic evaluations were performed. Blood urea nitrogen levels were significantly higher in male (54.2 ± 14 mg/dL) compared with female (35.3 ± 22 mg/dL) hamsters and correlated histologically with a higher incidence of chronic glomerulonephropathy in males (5 of 6 males; 0 of 12 females). All 18 hamsters had histologic evidence of follicular mite infestation. Half (6 of 12) of the female hamsters showed cystic rete ovarii. Other histologic findings included thymic or thyroid branchial cysts (3 of 18), focal enteritis (2 of 18), and single cases of hepatic hemangiosarcoma, renal adenoma, subcutaneous mast cell tumor, cutaneous sebaceous adenoma, cutaneous trichofolliculoma, squamous papilloma of the nonglandular stomach, epididymal cholesteatoma, pyometra, and pituitary craniopharyngeal cyst. This study is the first published report of hematologic and serum chemical values for any population of Siberian hamsters and the first published report showing a potential male predisposition for chronic progressive glomerulonephropathy and a potential female predisposition for cystic rete ovarii.

  4. Iatrogenic facial nerve palsy "Prevention is better than cure": Analysis of four cases

    Directory of Open Access Journals (Sweden)

    Rakesh Kumar

    2011-01-01

    Full Text Available Iatrogenic facial nerve palsy in mastoid surgery is considered a crime or a taboo in the present scenario of medical science. But one has to accept the fact that every otologist encounters this entity at some point in his/her career. Hence it is of prime importance to be equipped to detect and to manage these cases. The obvious and disfiguring facial deformity it causes makes this a dreaded complication. Our article here discusses our experience in managing four cases of iatrogenic facial palsy. The etiology in all the cases was mastoidectomy for cholesteatoma. The detection of the site and repair was performed by the same surgeon in all cases. The facial nerve was transected completely in three cases, and in one case there was partial loss (>50% of fibers. Cable nerve grafting was utilized in three patients. There was grade 4 improvement in three patients who underwent cable nerve grafting, and one patient had grade 2 recovery after end-to-end anastomosis. A good anatomical knowledge and experience with temporal bone dissection is of great importance in preventing facial nerve injury. If facial nerve injury is detected, it should be managed as early as possible. An end-to-end anastomosis provides better results in final recovery as opposed to cable nerve grafting for facial nerve repair.

  5. Inflammation and tumors of the temporal bone; Entzuendungen und Tumoren des Schlaefenbeins

    Energy Technology Data Exchange (ETDEWEB)

    Burian, M. [Universitaetsklinik fuer Hals-, Nasen- und Ohrenkrankheiten, Allgemeines Krankenhaus, Wien (Austria)

    1997-12-01

    The term `inflammation of the middle ear` covers a couple of deseases which range from the acute otitis media to the middle ear cholesteatoma. However, a clear characterization of a certain pathology is essential for any further treatment. Therefore this article presents a short overview about the different types of infections and their clinical manifestation. The tumors of the temporal bone show a great variety in their incidence. Even if tumors like the acoustic neurinoma or the paraganglioma are compareable common, the chondroblastoma of the temporal bone is absolutely rare. In spite of these differences the individual temporal bone neoplasias are shortly mentioned herein. (orig.) [Deutsch] Der Begriff Mittelohrentzuendung umfasst ein weites Spektrum von Krankheiten welches von der akuten Mittelohrentzuendung bis hin zum Cholesteatom reicht. Es soll in diesem Artikel eine kurze Uebersicht ueber die verschiedenen Entzuendungen gegeben werden, wobei vor allem auf eine klare Begriffsdefinition der einzelnen Entzuendungsformen und deren klinisches Erscheinungsbild geachtet wurde. Bei den Tumoren des Schlaefenbeins ist ein grosser Unterschied in der Inzidenz der einzelnen Tumoren gegeben. Waehrend Neubildungen wie das Akustikusneurinom oder das Paragangliom vergleichsweise haeufig im klinischen Alltag zu sehen sind, stellen Veraenderungen wie das Chondroblastom eine Raritaet dar. Trotz dieses Unterschieds im Vorkommen der verschiedenen Tumoren, wurde versucht, einen kurzen Gesamtueberblick ueber die Tumore des Mittel- und Innenohres zu geben. (orig.)

  6. DISCHARGING MASTOID CAVITY: A CLINICAL ANALYSIS

    Directory of Open Access Journals (Sweden)

    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 .

  7. Influence of middle ear mucosal condition on post-tympanoplasty audiologic outcome.

    Science.gov (United States)

    Song, Chan Il; Hong, Hye Ran; Yoon, Tae Hyun

    2016-03-01

    In this study, the association between the middle ear mucosal condition and post-tympanoplasty audiologic outcome was investigated in patients with chronic otitis media without cholesteatoma. One hundred and forty-three patients with chronic otitis media were collected in the Department of Otorhinolaryngology-Head and Neck Surgery at Asan Medical Center between January, 2009 and December, 2011. In the course of tympanoplasty, the status of the middle ear mucosa was divided into normal or abnormal by one surgeon. Pure tone audiometry was performed preoperatively and postoperatively, and post-tympanoplasty tympanogram was also conducted to estimate the condition of middle ear cavity. Of the 143 patients, there were 73 patients with normal middle ear mucosa and 70 patients with abnormal middle ear mucosa around Eustachian tube opening. The mean ABG of subjects with normal middle ear mucosa was 20.1 dB preoperatively, and 9.7 dB postoperatively (p ear mucosa group (p = 0.137). Postoperative ABGs for 500 and 1000 Hz (7.1, 7.7 dB) in normal middle ear mucosa patients were significantly lower than those (17.2, 19.4 dB) in abnormal middle ear mucosa patients (p ear mucosa status and post-tympanoplasty audiologic outcomes. The better condition of middle ear ventilation, the better postoperative hearing thresholds revealed after tympanoplasty.

  8. 慢性中耳乳突炎性疾病不同手术方式的疗效分析%Curative Effects of Different Surgical Procedures for Chronic Middle Ear and Mastoid Inflammatory Lesions

    Institute of Scientific and Technical Information of China (English)

    阿依恒·曲库尔汗; 王远强; 木拉提·阿地力; 冯娟

    2015-01-01

    Objective To study the curative effects of microscopic surgery for inflammatory lesions in the middle ear and mastoid by using different surgical procedures . Methods There were 110 cases of inflammatory lesions in the middle ear and mastoid from January 2009 to October 2013, including middle ear cholesteatoma and chronic suppurative otitis media .According to the scope of the lesions , either canal wall up mastoidectomy with or without tympanoplasty or open mastoidotympanectomy was carried out . Postoperative ear recovery , complications , recurrence , and hearing improvement were observed . Results The canal wall up mastoidectomy was performed in 51 cases, 46 of which received tympanoplasty simultaneously and 6 of which underwent a secondary artificial prosthesis implantation .Two patients with middle ear cholesteatoma experienced recurrence 1 year after surgery , and were given a secondary open operation .Postoperatively, hearing improvement was achieved >25 dB in 27 cases, >15 dB in 16 cases, and hearing loss was seen in 1 case.There were 59 cases of open mastoidectomy , including 31 cases of small tympanic cavity plasty .After open surgery, dry ear was not achieved in 1 case, which was cured after 2 months of dressing changes .The dry ear was achieved in all the remaining cases, with hearing improvement >15 dB in 3 cases and hearing loss in 3 cases. Conclusion According to different lesions in the middle ear and mastoid , different operative methods can be used to obtain satisfactory clinical curative effects .%目的:探讨慢性中耳乳突炎性疾病的不同显微手术方式的疗效。方法2009年1月~2013年10对110例慢性中耳乳突炎性病变,包括中耳胆脂瘤和慢性化脓性中耳炎,根据病变范围显微镜下分别施行完壁式乳突根治或同时鼓室成形术和开放式乳突根治术,观察术后干耳恢复情况、并发症、复发以及术后听力改善程度等。结果完壁式乳突根治术51例,其中46

  9. Experience in overlay tympanoplasty%筋膜外植法鼓室成形术的手术体会

    Institute of Scientific and Technical Information of China (English)

    彭本刚; 苗旭涛; 王欣; 孙轶青; 刘志莹; 李永新

    2009-01-01

    Objective To explore the experience and value of overlay tympanoplasty. Methods Sixty-three ears with overlay tympanoplasty were reviewed and followed up for the external auditory canal, tympanic membrane and hearing. Results The diseases of the patients included middle ear cholesteatoma in 25 ears and chronic suppurative otitis media in 38 ears. The surgical techniques involved three kinds: overlay tympanoplasty, overlay tympanoplasty with canal wall up mastoidectomy and overlay tympanoplasty with canal wall down mastoidectomy. In middle ear cholesteatoma and suppurative otitis media patients, the case received the three techniques are 4, 17, 4 ears and 19, 18, 1 ears respectively. All patients gained stage Ⅰ incision cure. Followed up for 0.5 to 3.5 years respectively, the external auditory canal was wide and tympanic membrane gained a good shape. The hearing in all case kept intact or increased while hearing decrease did not occur. Complications were free in patients with punctual visit. Conclusions Overlay tympanoplasty has positive significance in treating the chronic otitis media with the merits of standard procedure, sufficient operative field and thorough erosion elimination.%目的 探讨筋膜外植法在鼓室成形术中的应用及价值.方法 回顾分析筋膜外植法鼓室成形术63耳,随访观察患者的外耳道宽敞度、鼓膜形态及听力恢复情况.结果 本组病例包括中耳胆脂瘤25耳,慢性化脓性中耳炎38耳.手术方式分别为筋膜外植法鼓室成形术、筋膜外植法鼓窜成形术+完肇式乳突根治术和筋膜外植法鼓室成形术+开放式乳突根治术三种类型,中耳胆脂瘤和慢性化脓性中耳炎患者实施三种手术的数最分别为4、17、4耳和19、18、1耳.术后切口全部Ⅰ期愈合.随访0.5~3.5年,外耳道宽敞,鼓膜形态良好,听力提高或维持术前水平,未有听力下降者.按时随访者未发现有明显并发症.结论 筋膜外植法鼓室成形术

  10. Effect analysis of wall radical mastoidectomy and tympanoplasty in treat-ing cholesteatomatous tympanitis%完壁式乳突根治并鼓室成形术治疗胆脂瘤型中耳炎的效果分析

    Institute of Scientific and Technical Information of China (English)

    施芳

    2015-01-01

    目的:分析完壁式乳突根治并鼓室成形术治疗胆脂瘤型中耳炎的效果。方法将本院于2013年2月~2015年3月接收的60例胆脂瘤型中耳炎患者做为研究对象,以随机数字表法将其分成实验组和对照组,每组30例。对照组患者采取常规传统开放式手术进行治疗;实验组患者采取完壁式乳突根治并鼓室成形术治疗,观察比较两组患者手术成功情况、平均手术时间、术后听力恢复和并发症发生情况。结果实验组手术成功率(93.3%)高于对照组(80.0%),术后并发症发生率(10.0%)低于对照组(26.7%),术后患者听力恢复情况优于对照组,平均手术时间[(52.37±12.63)min]短于对照组[(75.69±13.26)min],组间数据比较,差异有统计学意义(P<0.05)。结论完壁式乳突根治并鼓室成形术治疗胆脂瘤型中耳炎安全有效,恢复快且并发症少,具有临床应用和推广价值。%Objective To study the effect of wall radical mastoidectomy and tympanoplasty in treating cholesteatoma-tous tympanitis. Methods 60 patients with cholesteatomatous tympanitis from February 2013 to March 2015 of our hospital were selected as study object.Patients were divided into experimental group and control group by random num-ber table,and each group was 30 cases.Patients in control group were treated with conventional traditional open surgery. Patients in experimental group were treated with wall radical mastoidectomy and tympanoplasty in treating cholesteatoma-tous tympanitis.The operation situation,mean operation time,postoperative hearing restored and incidence of complica-tions were observed and compared. Results The operation success rate of experimental group (93.3%) was higher than 80.0% in control group,the postoperative complications incidence (10.0%) was lower than 26.7% in control group,post-operative hearing restored obvious was better than control group,mean operation time [(52.37±12.63)min] was shorter than

  11. 软壁外耳道重建的鼓室成形术%Tympanoplasty with soft-wall reconstruction of ear canal

    Institute of Scientific and Technical Information of China (English)

    孙开; 管国芳; 金春顺; 刘瑶; 张德军; 都延茹; 娄玮; 史平; 孙丽丽

    2011-01-01

    目的:观察软壁外耳道重建的鼓室成形术治疗胆脂瘤中耳炎的疗效.方法:73例(76耳)胆脂瘤中耳炎患者行开放式乳突病变切除鼓室成形术,以耳后肌骨膜瓣行软壁外耳道重建,不做耳甲腔成形术,应用自体乳突皮质骨或砧骨雕刻后行听骨链重建.观察术后外耳道的形态和功能、术后听力以及有无并发症.结果:本组平均干耳时间为术后(21.1士3.1)d.术后外耳道形态基本正常,保持了正常的功能.随访6~24个月,术后气导听力平均改善(14.5士6.1) dB HL.结论:应用耳后肌骨膜瓣行软壁外耳道重建的鼓室成形术能使外耳道的形态和功能基本恢复正常,无需行耳甲腔成形术,听力改善满意.%Objective:To observe the therapeutic effect of tympanoplasty with soft-wall reconstruction of ear canal for chronic otitis media with cholesteatoma. Method: Seventy-three patients(76 ears) suffering from chronic otitis media with cholesteatoma were treated with canal wall down mastoidectomy with tympanoplasty. Postauricu-lar myo-periosteal flap was used to the soft-wall reconstruction of ear canal, and the cavityplasty of auricular con-cha was not performed. The auricular bone prosthesis was made of the autogeneic mastoid cortical bone or residual incus. The postoperative modality and the function of external auditory canal and the postoperative hearing and the postoperative complications were observed. Result:The mean dry ear time was(21. 1±3. 1) days after surgery in this study. The postoperative modality of external auditory canal was normal on the whole. The patients were fol-lowed up between 6 months and 24 months after surgery. The postoperative average air conduction hearing was improved by (14. 5±6. DdB HL. Conclusion: Tympanoplasty with soft-wall reconstruction of ear canal using the postauricular myo-periosteal flap can recover the modality and function of external auditory canal on the whole, and the cavityplasty of auricular

  12. Canal-wall-down mastoidectomy and tympanoplasty surgery preserving chorda tympani nerve integrality%保留鼓索神经的开放式乳突根治鼓室成形术

    Institute of Scientific and Technical Information of China (English)

    王林娥; 张汝祥; 张道行

    2012-01-01

    目的:报告开放式乳突根治鼓室成形术中寻找鼓索神经的方法和保留鼓索神经的意义.方法:66例慢性化脓性中耳炎或中耳胆脂瘤患者,术中以砧骨短突为标志,磨低外耳道后壁,沿面神经垂直段找到鼓索嵴(鼓索神经出骨管处),沿鼓索嵴找到游离于鼓室内的鼓索神经,仔细清理鼓索神经表面的病变组织,保持其完整性.结果:24例中耳胆脂瘤患者和42例慢性化脓性中耳炎患者鼓索神经表面胆脂瘤上皮及肉芽彻底清理,无一例鼓索神经断裂,患者术后味觉无明显变化.结论:开放式乳突根治鼓室成形术中彻底清理病变的同时保持鼓索神经的完整性,保留了鼓索神经的结构和功能,可以减低移植于镫骨头上的听小骨膺复物脱落的危险,且可对移植筋膜起支架作用.%Objective:To report the way for searching the chorda tympani nerve and the significance for preserving the chorda tympani nerve during canal'wall-down mastoidectomy and tympanoplasty surgery. Method:Sixty-six cases with chronic suppurative otitis media underwent canal-wall-down mastoidectomy and tympanoplasty surgery. According to the marker of the short crus of incus, the posterior wall of auditory canal was lowered and crista of the chorda tympani nerve was found through tracing the facial nerve contour. The chorda tympani nerve was preserved after clearing the surrounding tissue. Result: Among the 66 cases, 24 cases had middle ear chol-esteatoma,42 cases had granulation in middle ear. The cholesteatoma and granulation on the surface of the chorda tympani nerve were cleared thoroughly. No neurotmesis or obvious change of taste occurred after operation. Conclu sion: Canal-wall-down mastoidectomy and tympanoplasty surgery preserving chorda tympani nerve integrality may preserve the structure and function of the chorda tympani nerve , reduce the risk of ossicle extrusion above the head of stapes and serve as a frame for transplanting

  13. 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

  14. Patología del hueso temporal en pediatría: hallazgos tomográficos característicos Pediatric pathology of temporal bone: characteristic tomographic findings

    Directory of Open Access Journals (Sweden)

    Paola Berra

    2012-06-01

    Pediatric Hospital Pedro Elizalde. The classification of diseases was: inflammatory (infectious and noninfectious, congenital, histiocytosis, tumor infiltration and traumatic. Results. Males: 64%, age range: 1 month to 14 years (mean: 6.1 years. We found 53% inflammatory infectious conditions, 36% inflammatory noninfectious, 4.6% congenital, 1.5% histiocytosis, 3% tumor infiltration, and 1.5% traumatic. Infections disease was the most prevalent pathology in children under 5 years (otomastoiditis 43.6%. Cholesteatoma constituted the major non-infectious inflammatory condition in the age range from 6 to 14 (36%. Neoplasms were represented by secondary infiltration of nasopharyngeal angiofibroma or neuroblastoma metastasis. Conclusion. Acute otomastoiditis and cholesteatoma were the most common otologic pathology in the pediatric population and require CT. In the cases reviewed, CT diagnosis was consistent with clinical, surgical and / or pathology findings.

  15. Minimally invasive keyhole approaches for removal of tumors of the third ventricle

    Institute of Scientific and Technical Information of China (English)

    LAN Qing; DONG Jun; HUANG Qiang

    2006-01-01

    Background In recent years, keyhole microsurgery has become an important subject of modem minimally invasive neurosurgery. In this study, minimally invasive techniques avoiding unnecessary tissue injuries were applied to refine traditional approaches for the removal of third ventricular tumors within a limited operative filed.Methods Individualized keyhole approaches were designed according to the characteristics of third ventricular tumors and their growth patterns. A series of keyhole approaches such as supraorbital subfrontal approach,infratentorial supracerebellar approach, interhemispheric transcallosal approach, pterional approach were taken to enter the third ventricle anteriorly, posteriorly, superiorly or laterally, respectively. A total of 34 removed tumors in or extended into the third ventricle included 11 craniopharyngiomas, 10 pituitary adenomas, 2 pinealomas, 1cholesteatoma, 3 germinomas, and 7 gliomas.Results Total tumor resection was done in 27 (79.4%) of the patients, and subtotal resection in 7 patients (20.6%). Residual tumor was due to tight adherence of germinoma to the vein of Galen (1 patient),craniopharyngioma to the pituitary stalk (3), supratentorial extension of pineal region gliomas (1), suprasellar extension of gliomas (1) and giant pituitary adenoma (1). Complications such as brain contusion, postoperative hemorrhage and infection were not associated with keyhole approaches. Extended incision or enlarged bone flap was not made because of episode during operation or inadequate exposure.Conclusions Keyhole approaches are safe, effective and minimally invasive in the surgical treatment of tumors deeply seated in the third ventricle. Individualized keyhole approach ensures a successful treatment. Tumors in the upper middle part of the third ventricle can be exposed by the interhemispheric transcallosal keyhole approach. Tumors of the posterior third ventricle may be well exposed by the infratentorial supracerebellar keyhole approach

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

    Energy Technology Data Exchange (ETDEWEB)

    Edamatsu, Hideo; Yamashita, Koichi [Kanazawa Medical Univ., Uchinada, Ishikawa (Japan)

    1995-02-01

    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).

  17. Middle ear risk index as a prognostic factor in pediatric ossicular reconstruction

    Directory of Open Access Journals (Sweden)

    Khalid Almazrou

    2013-01-01

    Full Text Available Objectives: To study the hearing results in children following ossicular reconstruction and to determine if the middle ear risk index (MERI is a useful tool for predicting the outcome of surgery. Design: A retrospective case series. Setting: A tertiary academic center. Patients: Forty-four children underwent ossicular reconstruction using autologous or alloplastic prostheses from January 1995 to January 2005. Materials and Methods: Patients′ audiograms were evaluated preoperatively and postoperatively for pure-tone average (PTA and air-bone gap (ABG. Each ear was scored using the MERI and a total index was calculated. Results: 23 boys and 21 girls were included in the study. The mean preoperative ABG was 38 dB, and the mean postoperative ABG was 25.3 dB. The mean MERI was 3.40 for excellent results (0-10 dB postoperative ABG, 4.42 for good results (11-20 dB postoperative ABG, 4.45 for fair results (21-30 dB postoperative ABG, and 4.06 for poor results (ABG > 30 dB. The complications included perforation of tympanic membrane (13.6%, worsening of the conductive hearing loss (6.8%, retraction pockets (9.1%, recurrent or residual cholesteatoma (6.8%, high-frequency sensorineural hearing loss (4.45%, and prosthesis extrusion (2.3%. The mean follow-up period was 14 months. Conclusion: Children have poorer hearing outcome following ossicular reconstruction in comparison to the published adults′ results. The MERI was not a reliable tool for predicting the hearing results of ossicular reconstruction in children.

  18. Masseteric nerve for reanimation of the smile in short-term facial paralysis.

    Science.gov (United States)

    Hontanilla, Bernardo; Marre, Diego; Cabello, Alvaro

    2014-02-01

    Our aim was to describe our experience with the masseteric nerve in the reanimation of short term facial paralysis. We present our outcomes using a quantitative measurement system and discuss its advantages and disadvantages. Between 2000 and 2012, 23 patients had their facial paralysis reanimated by masseteric-facial coaptation. All patients are presented with complete unilateral paralysis. Their background, the aetiology of the paralysis, and the surgical details were recorded. A retrospective study of movement analysis was made using an automatic optical system (Facial Clima). Commissural excursion and commissural contraction velocity were also recorded. The mean age at reanimation was 43(8) years. The aetiology of the facial paralysis included acoustic neurinoma, fracture of the skull base, schwannoma of the facial nerve, resection of a cholesteatoma, and varicella zoster infection. The mean time duration of facial paralysis was 16(5) months. Follow-up was more than 2 years in all patients except 1 in whom it was 12 months. The mean duration to recovery of tone (as reported by the patient) was 67(11) days. Postoperative commissural excursion was 8(4)mm for the reanimated side and 8(3)mm for the healthy side (p=0.4). Likewise, commissural contraction velocity was 38(10)mm/s for the reanimated side and 43(12)mm/s for the healthy side (p=0.23). Mean percentage of recovery was 92(5)mm for commissural excursion and 79(15)mm/s for commissural contraction velocity. Masseteric nerve transposition is a reliable and reproducible option for the reanimation of short term facial paralysis with reduced donor site morbidity and good symmetry with the opposite healthy side.

  19. 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 .

  20. 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

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

    Directory of Open Access Journals (Sweden)

    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.

  2. Does Malleolus non-Lifting Tympanoplasty have any Advantage Over Malleus Lifting Technique?

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    Mohammad Reza Vahidi

    2016-01-01

    Full Text Available Introduction: In order to achieve a higher success rate for tympanoplasty, different techniques have been developed, and a wide variety of grafting materials have been developed. One of the techniques currently receiving considerable attention involves not lifting the remaining of eardrum from the malleus and embedding the graft underneath in order to repair the eardrum correctly in its original position, as well as minimizing graft lateralization leading to progression of hearing rehabilitation. We compared the effects of tympanoplasty with and without malleus lifting on hearing loss in patients with chronic otitis media.   Materials and Methods: In this study, 30 consecutive patients diagnosed as having chronic otitis media without cholesteatoma were randomly assigned to two tympanoplasty groups; with or without malleus lifting. Air and bone conduction thresholds were recorded before and 45 days after the intervention.   Results: In groups, except for 8000 Hz, the air conduction was significantly improved following surgery. According to air conduction there was no difference between the groups before surgery at different frequencies, although it was improved to a greater degree in the group without lifting at 250 Hz postoperatively. The average post-operative air-bone gap (ABG gain was significantly higher in all study frequencies in the target group. One of the effects of this technique is inner-ear protection from physical trauma to the ossicular chain, and prevention of damage to bone conduction.   Conclusion:  A higher hearing threshold and also higher ABG gain can be achieved by not lifting the remaining eardrum from the malleus and embedding the graft undereath it, especially at lower frequencies.

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

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    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

  4. 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.

  5. 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.

  6. 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.)

  7. 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

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    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.

  8. 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.

  9. Epidemiology of Intratemporal Complications of Otitis Media

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    Maranhão, André

    2014-01-01

    Full Text Available Introduction Despite the advent of antibiotics and immunizations in the last century, complications of otitis media remain quite frequent, have high morbidity and mortality rates, and pose a challenge to the otorhinolaryngologist. Objective To establish the annual incidence of intratemporal complications of otitis media and prospectively evaluate patients via an analysis of epidemiologic and clinical aspects. Methods Prospective, observational study. Between February 2010 and January 2011, patients admitted to a tertiary care, university-based otology practice with diagnosis of otitis media and an associated intratemporal complication (ITC were included in the study. The following data were evaluated: age, sex, type of ITC, treatment, imaging tests findings, type and degree of hearing loss, and clinical outcome. The overall incidence of all complications and of each complication individually was determined. Results A total of 1,816 patients were diagnosed with otitis media. For 592 (33% individuals, the diagnosis was chronic otitis media; for 1,224 (67%, the diagnosis was acute otitis media. ITCs of otitis media were diagnosed in 15 patients; thus, the annual incidence of intratemporal complications was 0.8%. We identified 19 ITC diagnoses in 15 patients (3 patients had more than one diagnosis. Labyrinthine fistulae were diagnosed in 7 (36.8% individuals, mastoiditis in 5 (26.3%, facial palsy in 4 (21.1%, and labyrinthitis in 3 (15.8%. Conclusion The incidence of intratemporal complications in Brazil remains significant when compared with developed countries. Chronic otitis media with cholesteatoma is the most frequent etiology of intratemporal complications. Labyrinthine fistula is the most common intratemporal complication.

  10. 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

  11. The use of total ossicular replacement prosthesis after radical tympanomastoidectomy

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    Rančić Dejan

    2013-01-01

    Full Text Available Background/Aim. This paper presents our operative method for hearing recovery after the previous radical tympanomastoidectomy, radical trepanation of the temporal bone (trepanatio radicalis ossis temporalis - TROT in eight patients submitted to operations for giant cholesteatotoma. Methods. All the patients were admitted to our clinic after TROT. There were no signs of cholesteatoma or infection. The patients refused any stent implantations or any hearing aids due to possible aesthetic problems. The described procedure developed in two steps. The first one was to restore the destroyed cavum tympany and to covert with chondroperichondral new membrane with a pin-like “guide” as collumela. The second step was to insert a TORP (total ossicular replacement prosthesis after guide excision. Results. After the first operation (stage one there were no infections in the operated area nor chondroperichondral graft rejection. Postoperative audiometry (6 to 8 weeks was done to demonstrate the improvement of air conduction. Three months following the first, the second (stage two operation was performed and 2.5 to 3 months after this operation even greater audiometry revealed hearing improvement in air- and bone-conduction. The patients were dismissed from the hospital 2 days after each procedure without any complications. They did not experience any dizziness, vomiting nor a severe pain. Three months after the second operative stage, otoscopic findings were very good. The audiometry findings after a 3-months period (after stage one and 3 months after final TORP insertion was done for each of the patients. After one year, the audiometric curve was the same. Clinical and audiometry follow up demonstrated a hearing recovery and closure of air bone gap (ABG to values of 5 to 15 dB. Conclusion. The use of TORP after radical tympanomastoidectomy is feasible. The first step of the procedure is the fixation of a neomembrane. A stabilized neomembrane is essential

  12. 面神经减压治疗周围性面瘫的临床分析%Facial Nerve Decompression for Peripheral Facial Paralysis

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    聂智樱; 毛弈韬; 彭安全; 谢鼎华; 伍伟景

    2014-01-01

    目的:总结各种原因所致周围性面瘫行面神经减压术的经验和疗效。方法回顾分析37例周围性面瘫的临床资料、面神经减压的手术方式及疗效。结果37例中,包括颞骨骨折、中耳乳突手术后、中耳乳突炎、面神经瘤、听神经瘤及中耳癌等不同原因。术后随访3月至4年,其中25例面神经功能恢复至House-BrackmannⅠ、Ⅱ级(68%)。面瘫病程2月者。结论面神经减压术是治疗周围性面瘫的有效手段,对保守治疗恢复不满意、有手术指征的患者,应尽早行面神经减压术。%Objective To report efficacy of facial nerve decompression in treating peripheral facial paralysis of differ-ent causes. Methods The clinical data of 37 cases of peripheral facial paralysis, and surgical approaches as well as efficacy of facial nerve decompression were retrospectively analyzed. Results Causes of facial paralyhsis included temporal bone fracture, post-operative infection, middle ear cholesteatoma, facial neuroma, acoustic neuroma and middle ear carcinoma, etc. Among the 37 cases, 25 demonstrated satisfactory facial nerve recovery of House-Brackmann grade I-II during the fol-low-up period of three months to four years. The facial nerve recovery after decompression in patients with facial paralysis duration of less than two months was obviously better than in patients with facial paralysis duration of greater than two months. Conclusions Facial nerve decompression is an effective method for peripheral facial paralysis. Early decompression in patients with dissatisfied recovery during observation is recommended.

  13. 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

  14. 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

  15. The Application of Multi-slice Spiral CT and MRI in Diagnosis of Facial Paralysis%CT、MRI在周围性面瘫诊断中的应用

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    汪建华; 田建明; 左长京; 马小龙; 王志锋; 曾新力

    2011-01-01

    目的 探讨多层螺旋CT与MRI技术在周围性面瘫的定位及病因诊断中的价值.方法 回顾性分析68例周围性面瘫患者的CT、MRI资料,分析总结影像学在周围性面瘫的定位、定性诊断中的意义.结果 本组68例周围性面瘫中影像学能明确定位45例(66.2%).病因分别是耳部先天畸形时伴面神经管异常2例,外伤性面瘫25例,慢性中耳乳突炎合并胆脂瘤10例,肿瘤11例及Bell's面瘫20例.除Bell's面瘫影像学无异常发现外,其他均准确发现病变并提示诊断.结论 合理运用CT、MRI技术,对耳部先天性发育畸形、脑外伤、慢性中耳乳突炎及肿瘤所致的周围性面瘫具有重要的诊断意义.%Objective To investigate the value of multi-slice spiral CT and MRI in diagnosis of pcripheral facial paralysis . Methods Imaging data of 68 patients with peripheral facial paralysis were analyzed retrospectively. The values of CT and MRI in localizing and qualitative diagnosing peripheral facial paralysis were summarized. Results In present study,45 of 68 cases(66. 2% ) of peripheral facial paralysis could be evaluated accurately in the etiology by CT and MRI,including congenital malformations of ear ( n= 2 ) ,traumatic facial paralysis ( n= 25) , chronic tympanitis with cholestcatoma( n= 10) and tumors( n= 11 ) , but Bell ' s facial paralysis ( n=20) was no of positive imaging findings . Conclusion CT and MRI are of significance for congenital ear deformities, traumaticbrain injury, chronic tympanitis with cholesteatomas , and tumors-induced peripheral facial paralysis.

  16. 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

  17. Study of simultaneous audition reconstruction to chronic suppurative otitis media in the period of infection%活动期慢性化脓性中耳炎Ⅰ期听力重建的研究

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    高雄辉; 谢景华; 吴晓钟; 黄顺德; 宋江顺; 孟庆翔; 李鹏

    2008-01-01

    目的 探讨活动期慢性化脓性中耳炎Ⅰ期鼓室成形术的可行性和疗效.方法 48例活动期(48耳)慢性化脓性中耳炎患者(胆脂瘤型31例,骨疡型17例)在彻底清除病变(经典或改良乳突根治术)同时进行Wullstein Ⅱ型和Ⅲ型鼓室成形术.结果 全部4~10周,平均7周干耳.术后1年纯音听力测试:气骨导差10 dB以内者11例,15~20 dB者25例,25~30 dB者9例,无变化甚至更差者3例.结论 慢性化脓性中耳炎活动期不是鼓室成形术的绝对禁忌证.术中彻底清除所有病变、重建乳突-鼓室-咽鼓管引流通气系统后,进行Wullstein Ⅲ型+乳突腔填充+耳甲腔成形术是可取的方法,同时咽鼓管是否通畅是手术成败的主要原因.%Objective To investigate the possibility and surgical effect of simultaneous tympanoplasty to chronic suppurative otitis media in the period of infection. Methods Forty-eight cases (48 ears) with chronic suppurative otitis media in the period of infection (31 with cholesteatoma, 17 with caries) were underwent simultaneous Wullstein Ⅱ and Ⅲ tympanoplasty on the complete elimination of the lesions (typical or modified mastoidectomy). Results All eases had dry ears within 4-10 weeks with average of 7 weeks. The air-bone gap within 10 dB was in 11 eases, 15 to 20 dB in 25 cases, 25 to 30 dB in 9 eases, no change or worse in 3 eases. Conclusions Infection is not the absolute eontraindication to the tympanoplasty in treating chronic suppurative otitis media, Wullstein Ⅲ tympanoplasty plus mastoid cavity obliteration and eonchaplasty is a suitable choice to treating chronic suppurative otitis media on the complete elimination of lesions and reconstruction of the ventilation system among mastoid cavity, tympanum and eustachian. The malfunction of eustachian is the main eanse to failure of surgery.

  18. Timpanoplastias: resultados cirúrgicos e análise dos fatores que podem interferir no seu sucesso Tympanoplasty: surgical results and a comparison of the factors that may interfere in their success

    Directory of Open Access Journals (Sweden)

    Ilana Fukuchi

    2006-04-01

    Full Text Available A otite média crônica continua muito prevalente em nosso meio e permanece um desafio aos otorrinolaringologistas quanto ao seu tratamento. OBJETIVO: Demonstrar os fatores que podem interferir no sucesso das timpanoplastias e os resultados cirúrgicos obtidos durante o ano de 2002. FORMA DE ESTUDO: Clínico prospectivo. CASUÍSTICA E MÉTODOS: Incluiu-se 37 pacientes portadores de otite média crônica não-colesteatomatosa (OMCNC submetidos a timpanoplastia (in-lay ou underlay, com enxerto homólogo. Os pacientes passaram por protocolo de avaliação pré e pós-operatória que consistiu em anamnese, exame físico específico, nasofibroscopia e audiometria. RESULTADO: Fatores como idade, localização e tamanho da perfuração; estado da mucosa da orelha média; número de infecções/ano; tabagismo; história familiar de otorréia e disacusia; história pessoal de cirurgia otológica prévia; renda familiar mensal; enxerto, técnica e via de acesso utilizada; não apresentaram relevância estatística quanto ao fechamento da perfuração. A taxa de sucesso foi de 65% para o fechamento da membrana timpânica e 100% para o ganho audiométrico. CONCLUSÃO: As timpanoplastias devem ser consideradas no tratamento das OMCNC.Chronic otitis media has a high prevalence on the population and their treatment continuous to be a challenge for the otorhinolaryngologists. AIM: To demonstrate the factors that could interfere in the tympanoplasty success and the surgical results during 2002. STUDY DESIGN: Clinical prospective. MATERIAL AND METHOD: were included 37 patients with chronic otitis media non cholesteatoma (COMNC undergo to tympanoplasty (in lay or underlay, with homologous graft. All the patients were submitted to a survey pre and postoperative include clinical, physical examinations, flexible nasal endoscope and audiometry. RESULTS: The age, the dimension and localization of the tympanic membrane perforation; the condition of middle ear mucosa

  19. Clinical application of pedicle retroauricular flap in canal wall-down tympanoplasty%耳后带蒂皮瓣在开放式鼓室成形术中的应用

    Institute of Scientific and Technical Information of China (English)

    黄永久; 鲍学礼

    2011-01-01

    Objective To explore the practical restorative procedure for tissue defect in canal wall-down (CWD) tympanoplasty based on a clinical trial. Methods Included in this study were 26 cases, among them 22 cases with cholesteatoma in the middle ear cleft and 4 with chronic suppurative otitis media, all treated by CWD type of tympanoplasty with pedicle retroauricular flap transplanting to repair the tissue defect in the operative cavity. Then, all these cases were followed up for 1 to 15 years to observe the therapeutic outcomes for evaluating the restorative effect on these cases. Results All the flaps were survived among these cases, with their operative cavities all clearing and dried in a period of one month and no granulation growing. During the following up period, it was found that the operated mastoid cavity were almost vanished in all of them, with a slightly wider external auditory meatus present when compared with that of the opposite side, covered with smooth and clear skin on the reconstructed posterior canal wall, and improved postoperative hearing level at different degrees. Conclusions The tissue defect in the operative cavity, met during CWD type of tympanoplasty, can be repaired with a pedicle retroauricular flap in a simple and convenient way to improve the survival rate of the flap to a higher level and to shorten the period of ear drying for avoiding granulation growing in the operative cavity.%目的 探讨开放式鼓室成形术中上皮缺损的有效修复方法.方法 26例开放式鼓室成形术患者,应用耳后带蒂皮瓣一期修复术腔上皮缺损,系统观察修复效果.结果 所有患者皮瓣全部成活,均在1月内干耳,术腔无肉芽生长.术后随访1~16年,全部患者乳突术腔基本消失,外耳道略宽,后壁皮肤光滑、洁净,术后听力均有不同程度提高.结论 对于开放式鼓室成形术中出现的上皮缺损,耳后带蒂皮瓣修复法简单方便,成活率高,有利于缩短干耳时间.

  20. 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.

  1. Analysis of 285 cases with infratentorial lessions operated by minimally invasive keyhole approach of ;craniotomy%微创锁孔幕下手术285例分析

    Institute of Scientific and Technical Information of China (English)

    周明卫; 傅震; 朱风仪; 赵春生; 曹胜武; 骆慧; 刘宁

    2015-01-01

    目的总结微创锁孔开颅幕下手术的临床效果。方法285例幕下病变在微创锁孔显微镜及神经内镜下完成。皮肤切口3‐5 cm ,骨瓣直径1‐3 cm。小脑半球病变共4例采用锁孔中线入路;桥小脑角区手术281例采用锁孔枕下乙状窦后入路。结果成功实施了肿瘤切除152例;其中,听神经瘤96例,脑膜瘤23例,胆脂瘤17例,三叉神经鞘瘤12例(全切除8例,4例跨中颅窝的为次全切除)。成功完成微血管减压术129例、畸形血管切除3例和巨大蛛网膜囊肿切除1例。结论显微镜下神经内镜微创锁孔入路在幕下手术中能获得有效的操作空间,具有创伤小、并发症少、恢复快等优点,可应用于小脑、桥小脑角区病变的手术。%Objective To summary the outcomes of minimally invasive keyhole approach of craniotomy for infratentorial lesions .Methods The minimally invasive keyhole approach of craniotomy was performed in 285 cases with infratentorial lesions .The skin incision was 3‐5 cm in length and the bone flap was 1‐3 cm in diameter .The post‐middle line keyhole approach was used in 4 cases with cerebellar hemisphere lesions and the suboccipital retrosigmoid keyhole approach was used in 281 cases with the lesions in cerebellopontine angle area .Results Tumor resection surgeries were performed successfully in 152 cases ,of whom 96 cases were with acoustic neurinoma ,23 cases with meningioma ,17 cases with cholesteatoma ,and 12 cases with trigeminal neurinoma(total resection in 8 cases and partial resection in 4 cases due to extending to the middle cranial fossa) .The cranial neural micro‐vascular decompression was performed in 129 cases ,and the resections of three deformed vessels and one large arachnoid cyst were carried out ,which were all successful .Conclusion Asisted by microscope and endoscope ,the minimally invasive keyhole approach of craniotomy has the advantages of providing effective space

  2. 自体听骨与人工听骨在听骨链重建术中远期疗效的对比观察%Contradistinction of Long-term Effect between Self-incus and Partial Ossicular Replacement Prosthesis in Reconstruction of Ossicular Chain

    Institute of Scientific and Technical Information of China (English)

    张社江; 习国平; 马喆; 郝艳芳; 蔡爱军

    2011-01-01

    Objective To observe long-term effect of self-incus and partial ossicular replacement prosthesis( PORP ) in reconstruction of ossicular chain, to seek preferable materials of reconstruction of ossicular chain. Methods The efficacy of ossicular reconstruction with PORP and self-incus were retrospectively summed up in 58 ears and 69 ears. All patients were followed up for six months to 3 years. All patients were examined by audiometric measurement( the average hearing threshold at 0.5,1.0,2.0 kHz ) before and after reconstruction of ossicular chain. We also compared the influence of different inserts. Results Hearing improvement between two different inserts had no statistical difference( P > 0.05 ). All patients healed well at one month. 6 ears were discovered prolapsed auricular bone in PORP group at 3 month to 3 year, while no patients were discovered bone resorption or prolapse in self-incus group. Only 1 case of eardrum reperfotation occurred in self-incus group( cholesteatoma tympanitis ). Conclusion Self-incus could be a useful and ideal materials in reconstruction of ossicular chain. with an advantage over PORP.%目的 通过自体听骨与人工听骨在听骨链重建术中远期疗效的对比观察,寻求听骨链重建术更好的材料.方法 对接受人工听骨(PORP)植入进行陈旧性中耳炎听骨链重建的患者及接受自体听骨植入进听骨链重建的患者,随访半年以上、资料完整的病例进行回顾性总结,进行疗效对比分析.计算语言频率(分别为0.5、1、2 kHz)平均听力,比较PORP植入及自体听骨植入的疗效.结果 两组植入物鼓膜修补术后纯音测听语言频率,听力提高情况间差异无统计学意义(P>0.05).1个月复查所有患者均愈合良好,术后3个月至3年PORP植入组发现6例听骨脱出,自体听骨植入组未发现听骨吸收及排出现象,仅1例鼓膜再穿孔(胆脂瘤型中耳炎).结论 自体听骨是听骨链重建中理想的材料,优于PORP.

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

    Directory of Open Access Journals (Sweden)

    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

  4. 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

  5. 射频消融术治疗肝癌术中并发症的观察与护理%Care for Complications in Treatment of Liver Cancer by Radiofrequency Ablation

    Institute of Scientific and Technical Information of China (English)

    王春华; 郑加生; 孙健; 刘莉

    2009-01-01

    目的 针对射频消融术(radiofrequency ablation,RFA)对原发性肝细胞性肝癌治疗中出现的不同并发症,探讨护理规范和体会.方法 采用RFA对肝癌患者实施治疗,观察总结术中出现的各种并发症及术中护理配合要点.结果 对348例原发性肝癌患者,行RFA治疗733例次,术中共出现14种并发症172例次,最常见的并发症为恶心、呕吐,发生率为8.4%(62/172);头晕、头痛发生率为3.7%;右肩疼痛3.5%;肝被膜下出血2.9%;气胸1.2%;心绞痛1.0%;血压升高或下降0.8%;心率失常、胆汁瘤、低血糖发生率分别为0.4%;心包填塞、肠痿、皮肤灼伤、细电极断裂发生率分别占0.1%.由于护士对术中可能出现的并发症有充分认识,术中施以及时有效的护理配合,协助医师及早发现、预防和治疗,控制了术中并发症的进展.结论 护士及时有效的护理配合及护士的预见性,能更好地协助医师工作,99%的术中并发症都能得到及时的控制,减轻了患者的痛苦.%Objective To discuss the nursing norm of various complications in treatment of primary hepatocellular carcinoma (HCC) by radiofrequency ablation (RFA).Methods Totally 348 patients with HCC were treated by RFA,and various complications arising while performing RFA were observed and suitable nursing measures were summarized.Results RFA treatment for 348 HCC patients was applied for 733 case times,among which 14 types of complications developed for 172 case times.The most common complications were nausea and vomit with an incidence of 8.4%(62/172).The incidence for dizziness and headache was 3.7%; for right shoulder pain 3.5%; for subcapsular hemorrhage of liver 2.9%; for pneumothorax 1.2%; for angina pectoris 1.0%; for fluctuation of blood pressure 0.8%; for arrhythmia,cholesteatoma,and hypoglycemia 0.4%; and for pericardial tamponade,intestinal fistula,skin burning,breakdown of micro-electrode 0.1%.However,the nurses fully knew the possible complications

  6. 前壁外耳道-鼓膜瓣应用于开放式鼓室成形术31例%Application of anterior wall of external auditory canal ardrum flap for open tympanoplasty in 31 patients

    Institute of Scientific and Technical Information of China (English)

    陈泽; 钟兆棠; 梁敏志

    2014-01-01

    目的:探讨前壁外耳道-鼓膜瓣应用于开放式鼓室成形术中,能否提高鼓膜修补成功率和手术疗效。方法对慢性化脓性中耳炎及中耳胆脂瘤伴中、下鼓室自行封闭患者66例(66耳),予开放式鼓室成形术治疗,其中31例术中应用前壁外耳道-鼓膜瓣内植法鼓室成形(前瓣组),35例应用软骨和筋膜内植法鼓室成形(软骨组),测定术前及术后6个月气导(AC)、气骨导差(ABG),比较两组的临床疗效。结果前瓣组成功率为96.8%(30/31),软骨组88.6%(31/35),两组比较差异无统计学意义(P >0.05);前瓣组有效率为88.46%,软骨组为65.52%,两组比较差异有统计学意义(P <0.05),即前瓣组优于软骨组。结论伴有中、下鼓室封闭的慢性中耳炎患者,行开放式鼓室成形术中应用前壁外耳道-鼓膜瓣鼓室成形能提高筋膜成活率,术后鼓膜穿孔率低,较好成形鼓室,并能同期听力重建,提高听力。%Objective To investigate the application of anterior wall of external auditory canal-eardrum flap in open tympanoplasty to improve tympanic molding.Methods 66 patients (66 ears)with chronic suppurative otitis media or middle ear cholesteatoma accompanied with self sealing of mesotympanum and hypotympanum underwent open tympan-oplasty.31 cases were applied with anterior wall of external auditory meatus-eardrum flap (Anterior flap group)and 35 cases were treated with cartilage and fascia inner-transplanted method (Cartilage group).Air conduction (AC)and air bone gap (ABG)were performed six months before and after surgery.The clinical effect of the two groups were Com-pared.Results The success rates were 96.8%(30 /31)and 88.6%(31 /35)in anterior flap group and cartilage group respectively (P >0.05 ),while the effective rates were 88.46% and 65.52% correspondingly in the two groups (P <0.05).Conclusion For the patients

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

    Directory of Open Access Journals (Sweden)

    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

  8. 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.

  9. 桥小脑角区小型占位致继发性三叉神经痛的手术疗效分析%Surgical outcome after resection of small cerebellopontine angle lesions resulted in secondary trigeminal neuralgia

    Institute of Scientific and Technical Information of China (English)

    陶传元; 魏攀; 庄进学; 陈登奎; 程宏炜; 宋朝理; 李海龙; 薛峰; 张炜; 郑小强

    2011-01-01

    目的 评估桥小脑角区(CPA)小型占位致继发性三叉神经痛的手术疗效.方法 回顾分析我科自2005年1月~2010年12月期间该类患者的临床资料,包括年龄、症状及体征、影像学表现、手术方式、疗效及并发症.结果 6年期间手术治疗三叉神经痛372例,其中CPA区小型病变(最大直径<3cm)致继发性三叉神经痛23例,约占6.2%;病种包括胆脂瘤12例、神经鞘瘤6例、脑膜瘤3例、蛛网膜囊肿2例;所有患者行乙状窦后入路显微镜下切除病变,3例另行三叉神经感觉根部分切断术;术后疼痛消失20例,面部麻木3例;术后并发症包括无菌性脑膜炎、脑脊液漏、颅内感染、短暂耳鸣及面瘫,均恢复,无死亡.随访1~5年,无疼痛复发.结论 CPA区小型占位所致继发性三叉神经痛患者由于病变小、易于全切,加之镜下暴露充分,手术疗效满意;术中若发现病变与三叉神经无确切关系,则需行微血管减压或三叉神经部分感觉根切断术.%Objective To evaluate the surgical outcome after resection of small cerebel-lopontine angle lesions resulted in secondary trigeminal neuralgia (TN). Methods Clinical data including age, symptom and sign, image manifestation, surgical modality, surgical outcome and complications in patients diagnosed secondary TN resulted from small cerebellopontine angle lesions are analyzed retrospectively between 2005. 1 and 2010. 12. Results Of 6 years duration, 372 cases of TN underwent operations. There were 23 cases of such kind (the largest diameter less than 3cm) accounting for 6. 2% among them which involved 12 cholesteatomas, 6 schwanno-mas, 3 meningiomas and 2 arachnoid cysts. All lesions were resected under microscope through retrosigmoid approach and additional partial sensory rhizotomy was performed in 3 cases. After operation, 20 cases got complete pain relief and the rest had facial numbness. Postoperative complications included aseptic

  10. 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.

  11. 不同原因耳聋患者耳鸣的发生率调查%The Incidence of Tinnitus and Hearing Loss with Different Diseases

    Institute of Scientific and Technical Information of China (English)

    刘蓬; 阮紫娟; 龚慧涵; 郭恩钦; 安玲玲

    2011-01-01

    Objective To provide clinic data to study the pathogenesis of tinnitus and the incidence and correlation of tinnitus and hearing loss with different diseases. Methods The clinic investigation was conducted for 376 hearing loss with different diseases consisting of 120 cases of sudden deafness, 21 cases of Meniere diseases, 10 cases of noise deafness, 10 cases of presbycusis, 70 cases of unknown causes sensorineural deafness, 70 cases of suppurative otitis media, 45 cases of secretory otitis media, 10 cases of otosclerosis, 2 cases of ossicular chain malformations, 4 cases of traumatic tympanic membrane perforation, 4 cases of external auditory canal cholesteatoma, 10 cases of impacted cerumen. Each patient was interviewed in detail regarding tinnitus onset and the degree of correlation about tinnitus and hearing loss was determined for the time and location. Results In 376 cases of deafness, the incidence of tinnitus are 51.3% ,and the incidence of tinnitus related deafness is 43.6%. The incidence of tinnitus is different in different diseases: sudden deafness and Meniere's disease are higher 90%, 85.7% respectively, while noise deafness may also be higher. The other diseases are very lower with an average of 13.3%. Conclusion No tinnitus has been noted in more than half of deaf cases, further research is warranted.%目的 对不同疾病致聋患者耳鸣的发生率及耳鸣与所患耳疾的有关与否进行调查,为进一步研究耳鸣的发病机理提供临床资料.方法 对376例不同原因导致的耳聋患者进行临床调查,包括突发性聋120例,梅尼埃病21例,噪声性聋10例,老年性聋10例,不明原因感音神经性聋70例,化脓性中耳炎70例,分泌性中耳炎45例,耳硬化10例,听骨链畸形2例,外伤性鼓膜穿孔4例,外耳道胆脂瘤4例,耵聍栓塞10例.对每例患者详细询问是否出现耳鸣,并根据耳鸣与耳聋发生的时间先后及部位等判定二者的相关程度.结果 376例耳聋患

  12. 鼓室成形术治疗慢性化脓性中耳炎的疗效分析%The clinical observations of tympanoplasty in treatment of chronic otitis suppurative media

    Institute of Scientific and Technical Information of China (English)

    秦江波; 侯世东

    2009-01-01

    Objective To discuss the feasibility and curative effect of tympanoplasty for chronic suppurative otitis media. Methods Thirty-three cases of chronic suppurative otitis media in the period of infection had infected tissue removed and the Eustachian tube restored during tympanoplasty. The short-and long-term curative effects were observed by follow-up visit. Results Among the 33 cases, 3 cases are found tinnitus during tamponading the cavity during operation and normal state resumeed after the tampons were taken out. 2 weeks after operation, tampons were taken out of the acoustic duct and the transplants in 27cases showed normal color and growth. 4 cases had low Blood-supply. 2 cases showed bottom margin crevices. All the transplants were maintained after therapy. The follow-up showed that the tympanums in 28 cases grew well(85% ). Perforation of ear drum recurred in 2 cases 6 months after-wards. 1 case with the transplanted tympanum perforated and suppurated again. The transplant invaginated in 1 case but get better after inflating the eustachian tube. 1 case had relative severe tympanum invaginating and didn't show acoustic sensibility recovery. 1 year after operation, the tympanic membranes of 28 ears were normal. Among 33 ca-ses, the air bone gap in 9 patients was improved 10dB HL. 14 ears were improved from 15 to 20 dB HL, 6 ears were improved from 25 to 30 dB HL. 4 cases showed no change. Conclusion Tympanoplasty can be performed in pa-tients with chronic suppurative otitis media in the period of infection. The complete removal of diseased tissue, pla-cing the transplant precisely, preventing formation of cholesteatoma and restoring the eustachian tube function are key factors to successful operation%目的 探讨慢性化脓性中耳炎鼓室成形术的可行性和疗效.方法 对33例单侧慢性化脓性中耳炎患者在恢复咽鼓管功能、清除病变的同时行鼓室成形术,随访观察近期及远期疗效.结果 33例患者中,3例术腔填

  13. 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.

  14. 耳源性面神经麻痹的手术治疗%Surgical treatment in otogenic facial nerve palsy

    Institute of Scientific and Technical Information of China (English)

    冯国栋; 高志强; 翟梦瑶; 吕威; 亓放; 姜鸿; 查洋; 沈鹏

    2008-01-01

    objective To study the character of facial nerve palsy due to four difierent auris diseases including chronic otitis media,Hunt syndrome,tumor and physical or chemical factors,and to discuss the principles of the surgical management of otogenic facial nerve palsy.Methods The clinical charaeters of 24 patients with otogenic facial nerve palsy because of the four different auris diseases were retrospectively analyzed,all the cases were performed surgical management from October 1991 to March 2007.Facial nerve function Was evaluated with House-Brackmann(HB) grading system.Results The 24 patients including 10 males and 14 females were analysised,of whom 12 cases due to cholesteatoma,3 cases due to chronic otitis media,3 cases due to Hunt syndrome,2 cases resulted from acute otitis media,2 cases due to Dhysical or chemical factors and 2 cases due to tumor.All cases were treated with operations included facial nerve decompression,lesion resection with facial nerve decompression and lesion resection without facial nerve decompression,I patient'S facial nerve was resected because of the tumor.According to HB grade system,I degree recovery was attained in 4 cases,while Ⅱ degree in 10 cases,Ⅲ degree in 6 cases,Ⅳ degree in 2 cases,V degree in 2 cases and Ⅵ degree in 1 case.Conclusions Removing the lesions completely Was the basic factor to the surgery of otogenie facial palsy,moreover,it was important to have facial nerve decompression soon after lesion removal.%目的 总结由于中耳炎、Hunt综合征、肿瘤及理化损伤4种常见耳源性疾病导致的面神经麻痹手术治疗的经验,增加对手术治疗耳源性面神经麻痹的认识.方法 回顾性分析1991年10月至2007年3月间由于上述4种耳部疾病导致面神经麻痹的24例患者的临床资料.面神经功能评估采用House-Brackman分级.结果 24例患者中男10例,女14例;年龄14~82岁,平均44.5岁.耳部病变包括:胆脂瘤中耳炎12例(其中合并Hunt综合征1

  15. 可吸收固定系统在开颅骨瓣复位固定手术中的初步应用%PRELIMINARY APPLICATION OF ABSORBABLE FIXATION SYSTEM ON CRANIAL BONE FLAP REPOSITION AND FIXATION AFTER CRANIOTOMY

    Institute of Scientific and Technical Information of China (English)

    邓跃飞; 郑眉光; 吴锦铨

    2012-01-01

    years). The disease duration ranged from 3 months to 6 years (median, 25 months). Forty-one lesions were located at supratentorial and 26 at subtentorial, including at the frontotemporal site in 13 cases, at the frontoparietal site in 12 cases, at the temporal oprietal site in 8 cases, at the temporooccipital site in 5 cases, at the occipitoparietal site in 4 cases, and at the posterior cranial fossa in 25 cases. The diagnosis results were glioma in 15 cases, cerebral vascular diseases (aneurysm, arteriovenous malformation, and cavernous angioma) in 8 cases, meningioma in 7 cases, arachnoid cyst in 7 cases, acoustic neurinoma in 5 cases, cholesteatoma in 3 cases, primary trigeminal neuralgia in 5 cases, cerebral abscess in 3 cases, hypophysoma in 2 cases, craniopharyngioma in 2 cases, metastatic tumor in 2 cases, radiation encephalopathy in 2 cases, medulloblastoma in 1 case, ependymocytoma in 1 case, germinoma in 1 case, atypical teratoma/rhabdoid tumor in 1 case, facial spasm in 1 case, and subdural hematoma in 1 case. Intracranial lesion size ranged from 3 cm x 2 cm to 7 cm x 5 cm. The changes of local incision and general condition were observed. Results Subcutaneous effusion occurred in 2 supratentorial lesions and 3 subtentorial lesions, which was cured at 2 weeks after puncture and aspiration. All incisions healed primarily and no redness or swelling occurred. CT scans showed good reposition of the cranial bone flap and smooth inner and outer surfaces of the skull at 2 weeks after operation. All 67 patients were followed up 3-20 months (mean, 10.3 months). During follow-up, the skull had satisfactory appearance without discomfort, local depression, or effusion. Moreover, regular CT and MRI scans showed no subside, or displacement of the cranial bone flap or artifacts. Conclusion Absorbable fixation system for reposition and fixation of the cranial bone flap not only is simple, safe, and reliable, but also can eliminate the postoperative CT or MRI artifact caused

  16. 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

    Institute of Scientific and Technical Information of China (English)

    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