Skull base osteomyelitis following a mastoidectomy

Skull base osteomyelitis is a rare but life-threatening condition that is characterized by osteitis of the temporal bone and skull base. Although skull base osteomyelitis is recognized as a rare complication of malignant external otitis or middle ear infection, it may also occur following a mastoidectomy. We present a case of an 81-year-old woman who suffered severe otalgia with normal-looking EAC and tympanic membrane that developed six weeks following a canal wall up mastoidectomy. Otalgia was the only abnormal feature to suspect occurrence of skull base osteomyelitis.     

Rhabdomyosarcoma of the middle ear and mastoid: a case report and review of the literature

We report a case of rhabdomyosarcoma of the middle ear and mastoid in a 3-year-old boy. The patient was treated according to Intergroup Rhabdomyosarcoma Study IV protocol (chemo- and radiotherapy), and he experienced a complete remission. However 7 months after the completion of treatment, he experienced a recurrence at the primary site that spread to the brain. Despite treatment, the patient died of progressive metastasis to the lung 4 months later.     

外耳道胆脂瘤侵犯中耳乳突11例临床分析

目的总结外耳道胆脂瘤侵犯中耳的临床表现、诊断及治疗方法.方法回顾分析1987至2001年收入院治疗的11例侵犯中耳乳突的外耳道胆脂瘤的临床资料.结果侵入中耳乳突的部位多为鼓膜松弛部,其余依次为外耳道后壁、紧张部.乳突片表现为乳突密度升高,4例有较明显的骨性外耳道扩大.4例进行了颞骨CT检查,示外耳道有软组织影及外耳道骨质破坏现象.手术清理胆脂瘤上皮、肉芽及坏死骨质,修补外耳道后壁及鼓膜.术后均未见复发.结论病变侵入中耳乳突的部位多为鼓膜松弛部.颞骨CT检查和仔细询问病史在诊断外耳道胆脂瘤侵犯中耳乳突中十分重要.合理选择术式对最大限度的保存听力、预防复发同样关键.     

Cost-effectiveness of intraoperative facial nerve monitoring in middle ear or mastoid surgery

OBJECTIVES: Despite the utility of intraoperative facial nerve monitoring in reducing the risk of iatrogenic facial nerve injury during neurotologic surgery, its routine use during primary or revision surgery remains controversial. One of the major barriers to its acceptance is cost. This study evaluates the cost-effectiveness of intraoperative facial nerve monitoring during middle ear or mastoid surgery. RESEARCH DESIGN/METHODS: A simple decision analytic cost-effectiveness model and a societal approach were used to evaluate three cohorts of individuals who received (1) intraoperative facial nerve monitoring for both primary and revision middle ear or mastoid surgeries, or (2) facial nerve monitoring for revision surgeries only, or (3) no monitoring for any middle ear or mastoid surgeries. RESULTS: Our results strongly favored the use of intraoperative facial nerve monitoring in all patients undergoing middle ear or mastoid surgery, adding about $222.73 to $528.00 US dollars to the total cost. The strategy to monitor primary and revision surgeries had the greatest effectiveness and lowest cost, with an average quality-adjusted life-year (QALY) of 45.68 at an average cost of $238 US dollars. Facial nerve monitoring in revision patients only had similar QALYs (45.67) and higher costs ($292.1). Finally, the strategy not to monitor had the lowest QALY (45.65) and highest cost ($449.8). The analysis was robust across a wide range of changes in both costs and probabilities. CONCLUSIONS: Facial nerve monitoring is cost-effective, and its routine use should be adopted to reduce the risk of iatrogenic facial nerve injury during otologic surgery.     

Adenomatous tumors of the middle ear and mastoid

Three cases of middle ear and mastoid neoplasms are reported as “adenomatous tumors” since in their search of the literature the authors did not find any previously described lesions with a similar histologic appearance and benign biologic behavior. Microscopically, all three tumors are similarly composed of solid cords and nests of closely-packed small cells having an epithelial appearance. Two distinct cell types are present: cuboidal cells, arranged in a rudimentary gland-like pattern, and angular cells forming irregular nests with no distinct pattern. All three tumors developed in patients in their 20′s, over a period of months with minimal symptoms; yet in all of the lesions the tympanic membrane was intact at the time of initial examination. None of the neoplasms was diagnosed preoperatively, and, once removed, all three tumors were pathologic enigmas and therapeutic problems in view of the initial and subsequent consultant pathologic opinions; nevertheless, total local excision with preservation of the tympanic membrane would appear to be safe treatment in these cases. The term “adenomatous tumor” is applied to these three neoplasms because: 1. a true glandular epithelial origin warranting the term adenoma or adenocarcinoma cannot be proven; and 2. the biologic behavior and prognosis is not necessarily reflected by the histologic appearance. A more specific term reflecting the origin and behavior of these tumors does not appear possible without the study of further cases.     

Aeration of the middle ear and mastoid in tympanoplasty

In order to achieve a good hearing result following tympanoplasty it is necessary to maintain an aerated middle ear space. Poor Eustachian tube function is most commonly blamed in cases of failure to obtain an adequately aerated middle ear following tympanoplasty. Although this may be the true etiology in some cases, middle ear adhesions, loss of support of the posterior canal wall and inadvertent blockage of the Eustachian tube orifice by graft material may be contributing factors. Aeration of the mastoidectomy cavity is also important to prevent collapse of the posterior canal wall, retraction pockets and to insure an adequate air reserve. Surgical techniques for prevention of these complications and a means of bypassing the totally blocked Eustachian tube are discussed.     

Adenomatous tumors of the middle ear and mastoid

Adenomatous tumors of the middle ear and mastoid have been called adenoma or adenocarcinoma. The clinical and pathologic distinction between the two has been difficult. The resultant pathologic ambiguity makes it difficult to decide whether conservative or radical management is appropriate. The Otologic Medical Group's (OMG) experience with glandular tumors of the middle ear and mastoid over the past 27 years was reviewed. Thirteen cases were found and analyzed with respect to signs and symptoms at presentation. Extensive histopathologic review with light and electron microscopy was performed on tumor specimens. Two distinctive histopathologic and clinical patterns were identified. The mixed type of tumor was always confined to the middle ear and mastoid, was commonly misdiagnosed as chronic otitis media, and rarely demonstrated otic capsule or facial nerve involvement. The papillary pattern always had extension to the petrous apex and frequently involved the middle and/or posterior cranial fossa. Papillary tumors were more frequent in females and usually involved the facial nerve. On the basis of the findings in this review as well as information from the literature, we have come to the following conclusions: 1. The correct general pathologic heading be Adenomatous Tumors of the Middle ear and Mastoid with each tumor then being subclassified into Mixed or Papillary tumor and adenocarcinoma when warranted by histology. 2. There is a high rate of local recurrence. 3. Long-term follow-up (at least 10 years) for all adenomatous tumors is necessary. 4. Primary surgical treatment is required.     

Embryonal rhabdosarcoma of the middle ear and mastoid

Two cases of embryonal rhabdomyosarcoma, arising from the middle ear, are described. It is a rare mesenchymal tumour of childhood, with a very poor prognosis. The literature is briefly reviewed and the difficulties encountered in diagnosis are outlined.     

Epidemiology of middle ear and mastoid cholesteatomas. Study of 1146 cases

Middle ear cholesteatoma is an important and relatively common disorder which may have serious consequences.AimThe purpose was to conduct a retrospective study of the statistics of 1,146 middle ear surgical procedures for middle ear cholesteatoma in adults and children of low income living in distant areas from our city.MethodsFrom 1962 to 1988 there were 1,146 surgeries for unilateral or bilateral cholesteatomas in children and adults, which were reviewed for the following criteria: total number of surgeries, sex, onset of the first symptoms, duration of the disease, the site of perforation, the cholesteatoma site, changes in the ossicular chain, the contralateral ear, bilateral cholesteatomas, the site of residual cholesteatoma, and complications.ResultsResults are shown graphically on a pie chart.ConclusionThe etiology of cholesteatomas remains unknown. Epidemiological and statistical data, surgical reports, and conclusions of experimental studies are welcome, as they may provide support for clarifying the pathogenesis of cholesteatoma. Our results were compared with internationally published papers. We found no published papers on the epidemiology of cholesteatoma in the Brazilian literature.