CSF otorrhea complicating temporal bone osteoradionecrosis in a patient with nasopharyngeal carcinoma

A 44-year-old Chinese man with a history of nasopharyngeal carcinoma that was treated with radiotherapy presented with fluid in the middle ear. We performed a myringotomy and subsequently made a diagnosis of cerebrospinal fluid (CSF) leakage secondary to osteoradionecrosis of the temporal bone. To the best of our knowledge, this is only the second reported case of an otogenic CSF leak resulting from osteoradionecrosis of the temporal bone. This case highlights the controversial role of myringotomy in the management of CSF otorrhea.     

Anomalies of the auditory organ in trisomy 18 syndrome: human temporal bone histopathological study

The purpose of this study was to define the histopathological changes in the temporal bone of a fetus with trisomy 18 syndrome, a stillborn due to perosplanchnia. Several anomalies were found including malformation of the auditory ossicles, residual mesenchyme in the middle ear, aberrant tensor tympani muscle, absence of stapedial tendon, aberrant lateral ampullary nerve and wide endolymphatic sinus. The incus body was deformed and separated from the long process by connective tissue and monocrural stapes was noted in the right ear. Three-dimensional reconstruction images provided a clear view of the auditory ossicle malformation. The abnormal findings in our case indicate that ear anomalies in this syndrome might be derived from the component around the first and second branchial arches.     

Osteoradionecrosis of the temporal bone in nasopharyngeal carcinoma after radiotherapy: a case report

Osteoradionecrosis of the temporal bone after external-beam radiotherapy for nasopharyngeal carcinoma is not uncommon following a long posttreatment interval. We describe the case of a man who had experienced this complication 13 years after he had undergone such radiotherapy. His condition resolved after removal of dead bone from the external auditory canal, followed by antibiotic therapy and periodic aural toileting.     

Frequency and localization of congenital anomalies of the middle and inner ears: a human temporal bone histopathological study

This study investigated congenital anomalies occurring in the middle and the inner ears, with particular attention to their features, localizations, and frequencies. One hundred human temporal bones obtained from 73 individuals, aged 31 gestational weeks to 39 years, each of whom had anomalies of the middle ear and/or inner ear, were used for this study. The temporal bones had been removed at autopsy, fixed, dehydrated, embedded in celloidin, and sectioned horizontally or vertically at 20 microns. Every 10th horizontal section or every 20th vertical section was stained with hematoxylin and eosin, mounted and studied under a light microscope. In the middle ear the structure most often found to be anomalous was the facial nerve; in the inner ear it was the lateral semicircular canal. The implications of the anomalies observed are discussed as they relate to fetal development, dysfunction of the ear, and clinical interpretation of diagnostic radiological studies.     

颞骨次全切除术治疗鼻咽癌放疗后 放射性颞骨坏死临床分析

摘要：目的分析颞骨次全切除术治疗放射性颞骨坏死的疗效。方法回顾性分析诊治的71例Ⅲ、Ⅳ型鼻咽癌放疗后放射性颞骨坏死患者,按随机抽样法分为两组,观察组（35例）行颞骨次全切除术治疗,对照组（36例）行保守治疗。比较两组治疗效果和患者术后行为状态、生活质量。结果观察组显效29例、有效2例、无效4例,总有效率89.16%;治疗效果明显好于对照组（P<0.05）。KPS评分、躯体功能、心理功能、社会功能、认知功能和总体生活质量评分明显高于对照组（P<0.05）。结论颞骨次全切除术对于放射性颞骨坏死具有积极的治疗意义,应在临床中推广。     

Metastatic tumours of the temporal bone. A histopathological report

Metastatic tumours of the temporal bone seem to be more common than is recognized. Most of these tumours are microscopic and asymptomatic in nature. Microscopic examination of 22 temporal bones belonging to 13 cases of metastatic tumours is reported. The commonest site of involvement in the temporal bone was the petrous apex followed by the tegmen tympani, mastoid bone and internal auditory canal. Primary tumours were most commonly located in the breast. Other sites of primary tumours included the thyroid gland, brain, lungs, prostate and blood (leukaemia). Two cases had undetermined sites of origin. Full neurotologic evaluation is indicated in every case suspected of having a temporal bone metastasis. All three modalities (of surgery, radiotherapy and chemotherapy) are used in combination for the treatment of these tumours.     

鼻咽癌放疗后颞骨放射性骨坏死的诊治

目的总结鼻咽癌放射性颞骨坏死的临床资料,为今后的诊断和治疗提供经验。方法根据骨坏死的范围是否局限,分为局限性和广泛性的放射性颞骨坏死,对1995～2002年期间收治的13例鼻咽癌放射性颞骨坏死的患者进行回顾性分析,9例局限性骨坏死采用手术清除死骨8例,对症治疗1例;4例广泛性骨坏死采用手术治疗3例,保守治疗1例。结果9例局限性骨坏死,经手术一次性治愈7例,1例再次手术治愈;1例保守治疗,经历4年后死骨脱落,无新死骨形成;4例广泛性骨坏死除了保守治疗1例死于鼻咽大出血外,另3例经手术治愈。结论手术治疗是有效的治疗手段,广泛性的骨坏死可引起危及生命的并发症。     

Osteoradionecrosis of the temporal bone: a surgical technique of treatment

Osteoradionecrosis of the temporal bone is a well-documented complication of radiotherapy to the ear, with potentially lethal complications. Three cases of advanced disease, treated surgically, are presented. In two of these, subtotal petrosectomy with blind-sac closure of the external auditory canal was carried out via an anterior approach. The enclosed space was obliterated with pedicled temporalis muscle. Primary healing took place. One case was similarly obliterated using a prolonged posterior incision. The wound broke down, requiring a microvascular free flap for closure. Radiotherapy jeopardizes the viability of skin flaps. An anterior incision bases the flap behind on the occipital and postauricular arteries. When radiotherapy has been used, this incision has theoretical and practical advantages over a standard posterior incision.     

鼻咽癌放疗后颞骨放射性骨坏死的诊治

目的：探讨鼻咽癌放疗后颞骨放射性骨坏死的诊断和治疗。方法：21例（22耳）鼻咽癌放疗后颞骨放射性骨坏死患者，经耳镜及影像学检查16例17耳局限型，5例5耳弥漫型。17耳局限型及1耳弥漫型予耳内镜下死骨刮除术，4耳弥漫型行乳突根治加耳周带蒂筋膜转移填塞术。结果：局限型17耳中，12耳（70．6％）创面完全上皮化，无游离死骨形成而治愈；4耳（23．5％）好转，创面未完全上皮化，但随访无死骨形成；1耳（5．9％）未愈，呈进行性死骨发展。弥漫型5耳中，1耳行有限度的死骨刮除术，创面完全上皮化而治愈；乳突根治4耳中，治愈3耳，1耳死骨形成再次手术，仍有耳漏。结论：耳内镜及颞骨CT为该病提供不同特点的诊断价值，对局限型行局部死骨刮除术能获得较好的疗效，提高患者的生活质量；弥漫型手术选择应慎重，本病有进行性缓慢发展的可能，需定期随访。     

Intratemporal facial nerve anastomosis: a temporal bone study

The temporal bone findings in a patient who suffered a transverse temporal bone fracture and subsequently underwent intratemporal facial nerve anastomosis are presented. The patient returned a year after surgery with otorrhea and partial return of facial function that was documented clinically, and by electromyograph 12 days before death. The temporal bone shows breakdown of the posterior external canal wall and infection of the surgical cavity. At the facial nerve anastomosis, there is a fibrosis and lack of myelination in the few regenerating nerve fibers. These results demonstrate a seldom-mentioned complication of the translabyrinthine approach, and suggest changes in the technique of facial nerve anastomosis to improve the results.     

Aminoglycoside ototoxicity: a human temporal bone study.

OBJECTIVE: Hearing loss after aminoglycoside administration has been thought to result primarily from hair cell injury. The purpose of the study was to determine the potential for direct injury of spiral ganglion cells and hair cells in cases of documented human aminoglycoside ototoxicity. STUDY DESIGN: Retrospective case review. METHODS: The clinical course of two individuals with aminoglycoside ototoxicity are documented, including the details of administration of tobramycin and other ototoxic medication and serial audiograms. The temporal bones were processed, and the cochlear elements quantified. RESULTS: Histopathological study of the temporal bones from the individuals in the study demonstrated reduction of both ganglion cell and hair cell populations. Spiral ganglion cell loss was not necessarily subadjacent to areas of hair cell loss in cases of aminoglycoside ototoxicity. Instead, spiral ganglion cell reduction may be present in segments of the cochlea with normal-appearing hair cells. CONCLUSIONS: The study suggests that aminoglycoside antibiotics can injure spiral ganglion cells directly, as well as hair cells. Thus, the characteristic hearing loss of ototoxicity can result from degeneration of either cochlear element.     

The navigation-controlled drill in temporal bone surgery: a feasibility study

Background: This study examines the feasibility of a navigation‐controlled (NC) drill for surgery on the petrosal bone in an experimental environment. According to the principle of NC, the drill is to be switched off automatically once the borders of the workspace are exceeded during a mastoidectomy. Materials and Methods: The registration is based on an optical navigation system with navigation software (MiMed). As surgery engine, the Unidrive‐system (Karl Storz GmbH & CO. Kg, Tuttlingen, Germany) was integrated. The definition of the workspace was performed manually in axial computed tomography (CT) slices of the petrosal bone phantom. The mastoidectomy on the model was accomplished in three runs with 10 trial surgeons altogether (5 experienced [exp.] in otologic (ear) surgery, 5 inexperienced [nonexp.]). During each run, the following were logged: the total length of time for the procedure as well as the number and extent of injuries to the risk structures (facial nerve, horizontal semicircular canal, sigmoid sinus). The resultant petrosal bone cavities were measured on the CT. Results: The time for the segmentation of the workspace for the mastoidectomy amounted to 17 minutes. The mean value of the drilling (e.g., milling) performance ranges from 6.61 mm³/s (group 1 [nonexp. + NC]), 9.62 mm³/s (group 2 [exp. w/o NC]), to 10.08 mm³/s (group 3 [exp. + NC]). The relative deviation to the segmented volume amounts to +7.4% (794.3 mm³) for group 1, –39.9% for group 2, and –34% (3,647.0 mm³) for group 3. In the groups with NC guidance of the drill, no damage to a risk structure could be logged. In the group of exp. ear surgeons without NC assistance, one injury to the facial nerve in the petrosal bone phantom occurred. Discussion: The results that follow prove the fundamental feasibility of an NC drill for surgery of the petrosal bone using the example of the simple mastoidectomy in the laboratory test. When using NC, tissue resection is faster, more precise, and has fewer related complications than the same procedure without. The results offer a very promising basis for the introduction of a newly conceived system to the procedure of NC surgery on the petrosal bone. The device configuration used here was originally conceived for NC guidance of a shaver in functional endoscopic sinus surgery. Individual errors will have to be mitigated through the new version of the control unit presently in development.     

Trends of temporal bone cancer: SEER database

ObjectiveThis retrospective review aims to analyze epidemiological trends related to temporal bone cancer, and primarily of the squamous cell subtype. Potential trends analyzed included age, gender, and geographical location.Data sourcesThis retrospective review analyzed data found in the National Cancer Institute's SEER Database for cases of carcinomas of the middle ear. Cases were selected between 1975 and 2016 and using the primary site of Middle Ear (Site code C30.1), and then narrowed using additional variables, which included age, sex, and state-county. Languages covered included English.Data extractionThe extracted data was entered into an Excel spreadsheet for further analysis in SPSS Version 25.Data synthesisAn Analysis of Covariance (ANCOVA) and a Bonferroni correction were applied to the data for further analysis of significant trends. The data was then placed into tables outlining the distribution of cases among select patient characteristics of age and sex, and significant age group pairwise comparisons.ConclusionsAge at diagnosis of temporal bone cancer is strongly associated with the prevalence of temporal bone cancer. We urge providers to consider subtypes of temporal bone cancer, including squamous cell carcinoma, when evaluating older adults with risk factors for temporal bone cancer and an abnormal physical exam.     

Bilateral cochlear implantation in a patient with bilateral temporal bone fractures

With the emphasis on bilateral hearing nowadays, bilateral cochlear implantation has been tried out for bilateral aural rehabilitation. Bilateral sensorineural hearing loss caused by head trauma can get help from cochlear implantation. We present the case of a 44-year-old man with bilateral otic capsule violating temporal bone fractures due to head trauma. The patient demonstrated much improved audiometric and psychoacoustic performance after bilateral cochlear implantation. We believe bilateral cochlear implantation in such patient can be a very effective tool for rehabilitation.