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Teoh T, Abdullah A, Kumarasamy G. Finding the Silver Bullet for Persistent Foramen Hushke. Cureus 2024; 16:e52791. [PMID: 38389601 PMCID: PMC10883106 DOI: 10.7759/cureus.52791] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/22/2024] [Indexed: 02/24/2024] Open
Abstract
We report a case of persistent foramen Hushke and embark on a literature search from 1990 to 2021. The search was done using electronic databases of PubMed and Google Scholar using the MESH words 'TMJ herniation', 'persistent foramen Hushke', 'TMJ prolapse', 'EAC dehiscence', and 'ear canal mass'. A total of 37 other case reports were included after excluding duplicates and non-English publications. The most common presentations, treatment modalities, complications, and outcomes were discussed. Common presentations include otalgia, tinnitus, otorrhea, and aural fullness. Surgical intervention shows a good outcome, whereas conservative treatment shows a mixed response. Despite the overwhelming success of surgical interventions in treating symptomatic persistent foramen of Hushke, it is still early to establish a guideline to manage these patients, as this condition is rare and presents with variable symptoms. More high-quality studies and a long-term follow-up of the patients may be essential to observe and compare the outcome and recurrence rate of temporomandibular joint (TMJ) herniation.
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Affiliation(s)
- Theresa Teoh
- Otorhinolaryngology, University Kebangsaan Malaysia, Kuala Lumpur, MYS
| | - Asma Abdullah
- Otolaryngology, Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, MYS
| | - Guhan Kumarasamy
- Otorhinolaryngology and Head and Neck Surgery, Hospital Raja Permaisuri Bainun, Perak, MYS
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Hasani M, Haghnegahdar A, Khojastepour L, Golbahar Haghighi MJ. Determining the existence of the foramen of Huschke in patients with temporomandibular joint disorders using cone beam computed tomography: retrospective cohort study. BMC Med Imaging 2022; 22:145. [PMID: 35963990 PMCID: PMC9375943 DOI: 10.1186/s12880-022-00850-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Accepted: 07/04/2022] [Indexed: 11/10/2022] Open
Abstract
Background Foramen of Huschke has been presented as an unusual developmental defect in anteroinferior aspect of external auditory canal. It can be associated with significant otologic complications. The purpose of this study was to determine the association between existence of foramen of Huschke and temporomandibular joint disorders in Cone Beam Computed Tomography (CBCT) images. Methods Of an initial sample of 465 patients, we retrospectively evaluated the CBCT images of 118 individuals with clinical signs and symptoms of temporomandibular joint disorders as case group and 256 individuals as control group. The presence, size and localization of foramen of Huschke were assessed in the axial and corrected sagittal images. The sex and age distribution were determined. Fisher’s exact test, T-test and Pearson’s Chi-square were applied to assess the relationship between foramen of Huschke and temporomandibular joint disorders in the case and control groups considering age and sex. Results The foramen of Huschke prevalence was slightly higher in patients with temporomandibular joint disorders (3.4%) than patients without temporomandibular joint disorders (0.8%). However, the difference was not statistically significant (P = 0.082). foramen of Huschke was found in five females and one male. There was no significant difference between case and control groups considering the age of patients with foramen of Huschke (P = 0.683). There was no significant difference between the case and control groups, considering the right and left ears in distribution of foramen of Huschke (P = 0.099) (P = 0.183). Conclusions Higher prevalence of foramen of Huschke in patients with temporomandibular joint disorders may suggest possible mechanism for temporomandibular joint disorders development that can be affected by presence of foramen of Huschke.
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Affiliation(s)
- Mahvash Hasani
- Department of Oral and Maxillofacial Radiology, School of Dentistry, Shiraz University of Medical Science, Shiraz, Iran
| | - Abdolaziz Haghnegahdar
- Department of Oral and Maxillofacial Radiology, School of Dentistry, Shiraz University of Medical Science, Shiraz, Iran
| | - Leila Khojastepour
- Department of Oral and Maxillofacial Radiology, School of Dentistry, Shiraz University of Medical Science, Shiraz, Iran
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Macielak RJ, Nassiri AM, Fillmore WJ, Lane JI, Driscoll CLW, Carlson ML. Persistent foramen of Huschke: Presentation, evaluation, and management. Laryngoscope Investig Otolaryngol 2022; 7:237-241. [PMID: 35155803 PMCID: PMC8823160 DOI: 10.1002/lio2.725] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Revised: 12/16/2021] [Accepted: 12/21/2021] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVE Describe the presentation and management strategy for patients with symptomatic foramen of Huschke (FH). PATIENTS Adults with persistent FH confirmed on imaging. INTERVENTIONS Diagnosis and management of symptomatic persistent FH. MAIN OUTCOME MEASURE Resolution of otologic symptoms. RESULTS A total of four patients with symptomatic, radiographically-confirmed persistent FH were included. The majority of patients endorsed otalgia (n = 4) and otorrhea (n = 3), and only one patient was noted to have a conductive hearing loss. All patients were noted to have dynamic movement of an external auditory canal mass with mandible manipulation on examination, and all patients had an identifiable fistula on imaging. Patients underwent surgical intervention, including both preauricular (n = 2) and transcanal (n = 2) approaches, and all endorsed symptomatic resolution after convalescence. CONCLUSIONS Persistent FH remains an uncommon and potentially underrecognized cause of otologic symptoms. Diagnosis requires a high index of suspicion, and one must rely on both key examination findings and imaging to confirm this diagnosis. In appropriately selected patients, surgical intervention can provide durable symptomatic resolution. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Robert J. Macielak
- Department of Otolaryngology‐Head and Neck SurgeryMayo ClinicRochesterMinnesotaUSA
| | - Ashley M. Nassiri
- Department of Otolaryngology‐Head and Neck SurgeryMayo ClinicRochesterMinnesotaUSA
| | - W. Jonathan Fillmore
- Division of Oral and Maxillofacial Surgery, Department of SurgeryMayo ClinicRochesterMinnesotaUSA
| | - John I. Lane
- Department of RadiologyMayo ClinicRochesterMNUSA
| | - Colin L. W. Driscoll
- Department of Otolaryngology‐Head and Neck SurgeryMayo ClinicRochesterMinnesotaUSA
- Department of Neurologic SurgeryMayo ClinicRochesterMinnesotaUnited States
| | - Matthew L. Carlson
- Department of Otolaryngology‐Head and Neck SurgeryMayo ClinicRochesterMinnesotaUSA
- Department of Neurologic SurgeryMayo ClinicRochesterMinnesotaUnited States
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Simoes JP, Daoud E, Shabbir M, Amanat S, Assouly K, Biswas R, Casolani C, Dode A, Enzler F, Jacquemin L, Joergensen M, Kok T, Liyanage N, Lourenco M, Makani P, Mehdi M, Ramadhani AL, Riha C, Santacruz JL, Schiller A, Schoisswohl S, Trpchevska N, Genitsaridi E. Multidisciplinary Tinnitus Research: Challenges and Future Directions From the Perspective of Early Stage Researchers. Front Aging Neurosci 2021; 13:647285. [PMID: 34177549 PMCID: PMC8225955 DOI: 10.3389/fnagi.2021.647285] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Accepted: 03/19/2021] [Indexed: 12/15/2022] Open
Abstract
Tinnitus can be a burdensome condition on both individual and societal levels. Many aspects of this condition remain elusive, including its underlying mechanisms, ultimately hindering the development of a cure. Interdisciplinary approaches are required to overcome long-established research challenges. This review summarizes current knowledge in various tinnitus-relevant research fields including tinnitus generating mechanisms, heterogeneity, epidemiology, assessment, and treatment development, in an effort to highlight the main challenges and provide suggestions for future research to overcome them. Four common themes across different areas were identified as future research direction: (1) Further establishment of multicenter and multidisciplinary collaborations; (2) Systematic reviews and syntheses of existing knowledge; (3) Standardization of research methods including tinnitus assessment, data acquisition, and data analysis protocols; (4) The design of studies with large sample sizes and the creation of large tinnitus-specific databases that would allow in-depth exploration of tinnitus heterogeneity.
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Affiliation(s)
- Jorge Piano Simoes
- Department of Psychiatry and Psychotherapy, University of Regensburg, Regensburg, Germany
| | - Elza Daoud
- Centre National de la Recherche Scientifique, Aix-Marseille University, Marseille, France
| | - Maryam Shabbir
- Hearing Sciences, Mental Health and Clinical Neurosciences, School of Medicine, University of Nottingham, Nottingham, United Kingdom
| | - Sana Amanat
- Otology & Neurotology Group CTS 495, Department of Genomic Medicine, GENYO - Centre for Genomics and Oncological Research Pfizer/University of Granada/Junta de Andalucía, PTS, Granada, Spain
| | - Kelly Assouly
- Department of Otorhinolaryngology and Head & Neck Surgery, University Medical Center Utrecht, Utrecht, Netherlands
- Department of Clinical and Experimental Neuroscience, University Medical Center Utrecht Brain Center, Utrecht University, Utrecht, Netherlands
- Cochlear Technology Centre, Mechelen, Belgium
| | - Roshni Biswas
- Hearing Sciences, Mental Health and Clinical Neurosciences, School of Medicine, University of Nottingham, Nottingham, United Kingdom
- Laboratory of Lifestyle Epidemiology, Department of Environmental Health Sciences, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
| | - Chiara Casolani
- Hearing Systems, Department of Health Technology, Technical University of Denmark, Lyngby, Denmark
- Oticon A/S, Smoerum, Denmark
- Interacoustics Research Unit, Lyngby, Denmark
| | - Albi Dode
- Institute of Databases and Information Systems, Ulm University, Ulm, Germany
| | - Falco Enzler
- Centre National de la Recherche Scientifique, Aix-Marseille University, Marseille, France
| | - Laure Jacquemin
- Department of Otorhinolaryngology Head and Neck Surgery, Antwerp University Hospital, Edegem, Belgium
- Department of Translational Neurosciences, Faculty of Medicine and Health Sciences, Antwerp University, Wilrijk, Belgium
| | - Mie Joergensen
- Hearing Systems, Department of Health Technology, Technical University of Denmark, Lyngby, Denmark
- WS Audiology, Lynge, Denmark
| | - Tori Kok
- Ear Institute, University College London, London, United Kingdom
| | - Nuwan Liyanage
- University of Zurich, Zurich, Switzerland
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Zurich, Zurich, Switzerland
| | - Matheus Lourenco
- Experimental Health Psychology, Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, Netherlands
- Health Psychology Research Group, Faculty of Psychology and Educational Sciences, University of Leuven, Leuven, Belgium
| | - Punitkumar Makani
- Department of Otorhinolaryngology, Head and Neck Surgery, University of Groningen, University Medical Center Groningen, Groningen, Netherlands
- Graduate School of Medical Sciences (Research School of Behavioral and Cognitive Neurosciences), University of Groningen, Groningen, Netherlands
| | - Muntazir Mehdi
- Institute of Distributed Systems, Ulm University, Ulm, Germany
| | - Anissa L. Ramadhani
- Radiological Sciences, Mental Health and Clinical Neurosciences, School of Medicine, University of Nottingham, Nottingham, United Kingdom
- Sir Peter Mansfield Imaging Centre, School of Medicine, University of Nottingham, Nottingham, United Kingdom
| | - Constanze Riha
- Chair of Neuropsychology, Department of Psychology, University of Zurich, Zurich, Switzerland
| | - Jose Lopez Santacruz
- Department of Otorhinolaryngology, Head and Neck Surgery, University of Groningen, University Medical Center Groningen, Groningen, Netherlands
- Graduate School of Medical Sciences (Research School of Behavioral and Cognitive Neurosciences), University of Groningen, Groningen, Netherlands
| | - Axel Schiller
- Department of Psychiatry and Psychotherapy, University of Regensburg, Regensburg, Germany
| | - Stefan Schoisswohl
- Department of Psychiatry and Psychotherapy, University of Regensburg, Regensburg, Germany
| | - Natalia Trpchevska
- Department of Physiology and Pharmacology, Experimental Audiology Laboratory, Karolinska Institutet, Stockholm, Sweden
| | - Eleni Genitsaridi
- Hearing Sciences, Mental Health and Clinical Neurosciences, School of Medicine, University of Nottingham, Nottingham, United Kingdom
- Nottingham Biomedical Research Centre, National Institute for Health Research, Nottingham, United Kingdom
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Liu JH, Huang WH, Xu JH, Liu Y, Sha Y. Otoscopy and imaging features of spontaneous temporomandibular joint herniation into the external auditory canal. BJR Open 2020; 2:20200005. [PMID: 33178972 PMCID: PMC7594893 DOI: 10.1259/bjro.20200005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Revised: 04/20/2020] [Accepted: 04/25/2020] [Indexed: 11/23/2022] Open
Abstract
Objective: To explore the otoscopy, CT and MRI features of spontaneous temporomandibular joint(TMJ)herniation(STMJH) into the external auditory canal (EAC) through the persistent foramen of Huschke (PFH). Methods: 15 cases diagnosed STMJH were collected. The otoscopy, CT data of 15 cases and MRI data of 6 cases were retrospectively reviewed. Results: Otoscopy revealed a mass located in the anterior wall of the bony EAC that moved forwards and backwards during mouth opening and closing, respectively. CT showed a soft mass with bony defect in the anterior wall of the EAC, with no enhancement; the bony defect margin was well defined in all cases. The bone adjacent to the PFH was pressed and partially wrapped around the soft mass, as if “holding a ball,” in seven cases. Pseudobone shell around the soft mass was observed in eight cases. Six cases included MRI scans, which showed TMJ soft tissue herniated into the EAC. Conclusion: STMJHs have unique otoscopic, CT and MRI features. The examination strategy recommended is dynamic otoscopy and conventional CT, MRI can be chosen when the herniation is complicated by infection or otitis externa or when the patient has TMJ dysfunction; conservative management and follow-up observations are the main treatment strategy recommended. Advances in knowledge: Mechanical stress of TMJ on the EAC is thought to cause herniation and the special CT features, the location and size of the PFH, especially the location, are the major risk factors for TMJ herniation in patients with FH.
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Affiliation(s)
- Jun-Hua Liu
- Department of Radiology, Eye and ENT, Hospital of Fudan University, Shanghai 200031, China
| | - Wen-Hu Huang
- Department of Radiology, Eye and ENT, Hospital of Fudan University, Shanghai 200031, China
| | - Jiang Hong Xu
- Department of Otolaryngology, Eye and ENT, Hospital of Fudan University, Shanghai 200031, China
| | - Yin Liu
- Department of Otolaryngology, Eye and ENT, Hospital of Fudan University, Shanghai 200031, China
| | - Yan Sha
- Department of Radiology, Eye and ENT, Hospital of Fudan University, Shanghai 200031, China
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