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Trakimas DR, Knoll RM, Castillo-Bustamante M, Kozin ED, Remenschneider AK. Otopathologic Analysis of Patterns of Postmeningitis Labyrinthitis Ossificans. Otolaryngol Head Neck Surg 2020; 164:175-181. [PMID: 32600100 DOI: 10.1177/0194599820934748] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE Labyrinthitis ossificans (LO) may occur following meningitis and, in cases where cochlear implantation is indicated, complicate electrode insertion. LO is critical to identify for successful cochlear implantation, and histopathology is more sensitive than imaging for identification of LO. Herein we utilize otopathologic techniques to study the timing and location of intracochlear tissue formation following meningitic labyrinthitis (ML). STUDY DESIGN Retrospective review. SETTING Academic institution. METHODS Temporal bone specimens with a history of bacterial ML were histologically evaluated. The location and extent of intracochlear tissue formation within the scala tympani (ST) and scala vestibuli (SV) were graded, and spiral ganglion neurons were counted. RESULTS Fifty-one temporal bones were identified: 32 with no intracochlear tissue formation, 9 with fibrosis alone, and 10 with LO. Fibrosis was identified as early as 1.5 weeks after ML, while ossification was found only in specimens that survived multiple years after ML. All LO cases showed ossification of the ST at the round window membrane (RWM) with continuous extension throughout the basal turn. Extent of SV ossification correlated with that in the ST but showed frequent isolated distal involvement of the cochlea. Spiral ganglion neuron counts were lower than those in age-matched controls. CONCLUSION In this human temporal bone study, we found that postmeningitic LO results in ossification at the RWM with continuous extension into the ST of the basal turn and variable involvement of the SV. Identification of a patent basal turn beyond RWM ossification of the ST should permit full electrode insertion. LEVEL OF EVIDENCE Retrospective review.
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Affiliation(s)
- Danielle R Trakimas
- Department of Otolaryngology, Johns Hopkins Medical School, Baltimore, Maryland, USA
| | - Renata M Knoll
- Department of Otolaryngology, Harvard Medical School, Boston, Massachusetts, USA
| | | | - Elliott D Kozin
- Department of Otolaryngology, Harvard Medical School, Boston, Massachusetts, USA
| | - Aaron K Remenschneider
- Department of Otolaryngology, Harvard Medical School, Boston, Massachusetts, USA
- Department of Otolaryngology, UMass Memorial Medical Center, Worcester, Massachusetts, USA
- Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, USA
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Abstract
OBJECTIVES To demonstrate the clinical, radiologic, and pathologic findings of actinomycosis of the temporal bone. STUDY DESIGN Case report and literature review. METHODS Analysis of a case through medical records and literature review. RESULTS Actinomycosis is a rare cause of subacute-chronic suppurative infection of the temporal bone. We present an 11-year-old male with a history of ciliary dyskinesia presenting with a 6-week history of right-sided otorrhea, otalgia, and a 1-week history of progressive facial weakness. Final histopathology revealed a diagnosis of actinomycosis. A review of the literature showed 25 cases of temporal bone actinomycosis. This is the first reported case of actinomycosis causing facial nerve palsy and labyrinthine invasion. Effective treatment includes aggressive surgical debridement followed by long-term administration of appropriate antibiotic. CONCLUSIONS Actinomycosis can be a cause for bone erosive lesions of the temporal bone and can result in significant morbidities. Prompt tissue diagnosis with suspicion for nonmalignant causes of bone erosive disease can help in implementing appropriate treatment.
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Affiliation(s)
- Deepak Mehta
- Department of Pediatric Otolaryngology, Cincinnati Children's Hospital and Medical Center, Cincinnati, OH 45229, USA.
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3
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Mani R, Belcadhi M, Ben Said M, Bouzouita K. Aspergillus mastoiditis with intact tympanic membrane in immunocompetent host. B-ENT 2008; 4:39-43. [PMID: 18500021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023] Open
Abstract
Aspergillus mastoiditis is a very rare condition usually observed in immunocompromised patients. Masked mastoiditis is defined as a subclinical infectious inflammatory process of the mucosal lining and bony structures of the mastoid air cells with intact tympanic membranes. To our knowledge, our report of a masked Aspergillus mastoiditis occurring in a 71-year-old diabetic woman is only the second case of masked mastoiditis in the literature. Aggressive medical and surgical management are necessary to avoid a fatal outcome from this invasive infection.
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Affiliation(s)
- R Mani
- *Department of Otolaryngology, Head and Neck Surgery, Farhat Hached University Hospital, Sousse, Tunisia.
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4
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Abstract
OBJECTIVE To identify biofilm formation within a case of temporal bone osteoradionecrosis. PATIENT Single-case patient presenting with temporal bone osteoradionecrosis. INTERVENTION(S) Antibiotic therapy and then surgical debridement of the temporal bone. MAIN OUTCOME MEASURE(S) Histologic identification of biofilm formation within the affected temporal bone specimen. RESULTS Positive identification of biofilm formation in multiple sections of the temporal bone specimen removed from a patient affected by osteoradionecrosis. CONCLUSION This is the first evidence that temporal bone osteoradionecrosis involves biofilm formation. Such a pathogenic mechanism may explain the recalcitrance of this disease process and offer new strategies in formulating therapeutic interventions.
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Affiliation(s)
- Robert Nason
- Department of Otolaryngology, Washington University School of Medicine, St. Louis, Missouri 63110, USA
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Affiliation(s)
- Fred H Linthicum
- Temporal Bone Laboratory, House Ear Institute, Los Angeles, CA, USA.
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6
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Abstract
Although invasive fungal infections of the paranasal sinuses have been well described in immunocompromised patients, those affecting the ear and temporal bone are rare. Described is the case of invasive aspergillosis of the temporal bones after bone marrow transplant in an 8-year-old girl. The diagnosis and treatment of such infections are discussed.
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Affiliation(s)
- James L Connolly
- Department of Otolaryngology and Communicative Sciences, University of Mississippi School of Medicine, Jackson, MS 39216, USA
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7
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Trinidad A, Ramírez-Camacho R, García-Berrocal JR, Verdaguer JM, Vicente J, Daza R. Tissular changes induced by Pseudomonas aeruginosa in an otitis media rat model with tubal obstruction. Acta Otolaryngol 2007; 127:132-7. [PMID: 17364343 DOI: 10.1080/00016480600749994] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
CONCLUSIONS This is a suitable model for the study of different features of middle ear inflammation. This model allows manipulations inside the middle ear while preserving relevant structures such as the tympanic membrane, and provides a useful model for the study of interactions between bacterial infection and eustachian tube dysfunction. OBJECTIVES Analysis of early and late histological features in an experimental model of Pseudomonas aeruginosa middle ear inoculation in the rat designed for the study of middle ear procedures. MATERIALS AND METHODS Thirty Wistar rats were inoculated with Pseudomonas aeruginosa in the tympanic bulla followed by the cauterization of the eustachian tube. Culturing of middle ear effusion was carried out at 7 days follow-up and at sacrifice. Processing of the temporal bones for light microscopy was performed at 7, 14, 30 and 60 days. RESULTS Early cultures were positive in most cases, thus proving that middle ear inflammation was due to the presence of inoculated Pseudomona aeruginosa. Mucoperiosteal inflammatory changes similar to those observed in human middle ear infection were seen. Acute inflammatory cell infiltration was seen at 7 and 14 days, gradually decreasing to chronic inflammatory changes with fibroplasia at 60 days. Bone resorption was observed at 7 and 14 days, changing to a bony deposition at 30 and 60 days.
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Affiliation(s)
- Almudena Trinidad
- Department of Otorhinolaryngology, Hospital Universitario Puerta de Hierro, Madrid, Spain.
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8
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Abstract
A goat with neurologic signs had multifocal abscesses containing sulfur granules in the right brain and temporal bone. Histologically, the lesions consisted of pyogranulomas with several radiating bacterial colonies of various sizes. A tangled mass of filamentous and gram-positive bacteria was recognized in the central part of the colony. Actinomyces naeslundii antigen was detected in the colonies of bacteria in the brain and neighboring bone tissue by immunohistochemistry. Actinomycosis involving the central nervous system (CNS) and temporal bone is rare in animals. Cerebral infection with A. naeslundii may have resulted from direct extension from cervicofacial regions because the CNS lesions were distributed asymmetrically and were continuous with the right temporal bone.
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Affiliation(s)
- Takuya Hirai
- Nippon Institute for Biological Science, Shinmachi, Ome, Tokyo
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Alapatt JP, Kutty RK, Gopi PP, Challissery J. Middle and posterior fossa aspergilloma. ACTA ACUST UNITED AC 2006; 66:75-8; discussion 78-9. [PMID: 16793449 DOI: 10.1016/j.surneu.2005.11.061] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2005] [Accepted: 11/29/2005] [Indexed: 11/15/2022]
Abstract
BACKGROUND Aspergilloma of the brain is a rare disease. Among its varied presentations, a solitary intracranial mass is very uncommon. A preoperative diagnosis of it is very difficult, but a perioperative squash smear/frozen section can identify the pathology. Because of its rarity in immunocompetent patients and the difficulty in preoperative diagnosis, we have illustrated this case and its presentation and management. METHODS A 27-year-old man presented with an h/o right-sided weakness along with headache and ear discharge. A computed tomographic (CT) scan showed a large irregular, space-occupying lesion in the middle and posterior cranial fossa. He had a mastoidectomy done 3 years before for chronic suppurative otitis media. After a symptom-free interval of 1 year, he was investigated for severe earache on the same side. A CT scan at that time showed a space occupying mass in the right temporal bone and right inferior temporal lobe. A biopsy and histopathology of the lesion revealed a chronic granulomatous mass. He was started on antituberculous drugs and was on it for 7 months at the time of presentation. RESULTS He underwent a suboccipital craniectomy and total excision of the mass. Postoperatively, his consciousness improved but began to deteriorate on the third postoperative day. A repeat CT scan showed hydrocephalus and total removal of the mass. An external ventricular drain was put and he was ventilated, but he died on the fourth postoperative day. Histopathology report came as aspergilloma. CONCLUSION This report highlights the rare presentation of aspergilloma in an immunocompetent patient. It emphasizes the importance of suspecting this disease in such patients and the role of intraoperative squash smear preparations or frozen section in the diagnosis as routine diagnostic procedures that will help in early pharmacotherapeutic interventions in adjunct to surgery.
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Affiliation(s)
- Jacob P Alapatt
- Department of Neurosurgery, Medical College Hospital, Thrissur, Kerala 680001, India
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Mohindra S, Gupta SK, Mohindra S, Gupta R. Unusual presentations of craniovertebral junction tuberculosis: a report of 2 cases and literature review. ACTA ACUST UNITED AC 2006; 66:94-9; discussion 99. [PMID: 16793457 DOI: 10.1016/j.surneu.2005.11.020] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2005] [Accepted: 11/02/2005] [Indexed: 10/24/2022]
Abstract
BACKGROUND CVJ tuberculosis is a described entity requiring challenging ways of management. Severe neck pain, causing restricted neck movements and torticollis, is a characteristic presentation of neurologically asymptomatic suboccipital Pott's disease. CASE DESCRIPTION Two patients with unusual CVJ tuberculosis form the basis for the present communication. The first patient presented with tubercular otitis media, causing progressive erosion of the petrous part of temporal bone, and destruction of the occipital condyle, along with the lateral mass of atlas, leading to CVJ instability. This is a first report of such a presentation, according to our knowledge. Detailed bony architectural destruction demonstrable on CT scan has been described. The second patient, with CVJ tuberculosis, presented with skull base syndrome and with multiple cranial nerve palsies. Both patients were managed without surgical intervention and showed clinical and radiological recovery. CONCLUSION In such patients with unusual clinical presentations, histopathologic examination is necessary to arrive at a correct diagnosis. The management of patients with tubercular involvement of CVJ remains controversial. In the present communication, both the patients were managed successfully with full dose of antitubercular drugs and immobilization.
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MESH Headings
- Adult
- Axis, Cervical Vertebra/diagnostic imaging
- Axis, Cervical Vertebra/microbiology
- Axis, Cervical Vertebra/pathology
- Cervical Atlas/diagnostic imaging
- Cervical Atlas/microbiology
- Cervical Atlas/pathology
- Cranial Nerve Diseases/diagnosis
- Cranial Nerve Diseases/microbiology
- Cranial Nerve Diseases/physiopathology
- Disease Progression
- Ear, Middle/diagnostic imaging
- Ear, Middle/microbiology
- Ear, Middle/pathology
- Early Diagnosis
- Female
- Humans
- Hypoglossal Nerve/microbiology
- Hypoglossal Nerve/pathology
- Hypoglossal Nerve/physiopathology
- India
- Male
- Middle Aged
- Neck Pain/diagnosis
- Neck Pain/microbiology
- Neck Pain/physiopathology
- Occipital Bone/diagnostic imaging
- Occipital Bone/microbiology
- Occipital Bone/pathology
- Otitis Media/complications
- Otitis Media/diagnosis
- Otitis Media/microbiology
- Skull Base/diagnostic imaging
- Skull Base/microbiology
- Skull Base/pathology
- Temporal Bone/diagnostic imaging
- Temporal Bone/microbiology
- Temporal Bone/pathology
- Tomography, X-Ray Computed
- Tuberculosis, Spinal/diagnosis
- Tuberculosis, Spinal/physiopathology
- Tuberculosis, Spinal/therapy
- Vagus Nerve/microbiology
- Vagus Nerve/pathology
- Vagus Nerve/physiopathology
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Affiliation(s)
- Sandeep Mohindra
- Department of Neurosurgery, Postgraduate Institute of Medical Education and Research, Chandigarh 160012, India.
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11
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Tall A, Ba MC, Essalki I, Diallo BK, Ndiaye M, Loum B, Ndiaye IC, Diouf R, Diop EM. [Cranioencephalic complications of middle ear cholesteatoma: report of 4 cases]. Dakar Med 2006; 51:5-9. [PMID: 16924842] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
Abstract
INTRODUCTION Cranial and intracranial complications can be observed during middle ear cholesteatoma's evolution. We report our experience of management of infectious cholesteatoma's cranioencephalic complications. MATERIAL AND METHODS In a three year period, we had consecutively admitted 4 patients with cranioencephalic complications of middle ear cholesteatoma, in the Ear Nose and Throat (ENT) department of the university teaching hospital of Dakar. After preoperative investigations with computed tomography scan (CT scan) of brain and temporal bone. The patients had been operated after paraclinic assessment. RESULTS The finding showed one case of temporal bone otogenic extensive osteomyelitis with multifocal extradural empyema, 3 cases of brain abscess associated with subdural empyema and meningitis in 1 case. For 3 patients (75%), neurosurgical drainage and mastoidectomy were performed, associated with antibiotic treatment. The mastaidectomy was performed in the same time of the surgical procedure or delayed. One patient, with brain abscess, died before surgical intervention. With a follow up of 15 months, we have noticed stable mastoidectomies cavities and no neurological recurrence symptoms. CONCLUSION These complications can be prevented by early treatment of chronic otitis media diseases. The appropriated management of these complications necessitate collaboration between otorhinolaryngologists and neuro surgeons.
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Affiliation(s)
- A Tall
- Clinique ORL et de Chirurgie Cervico-Faciale du Centre Hospitalo-Universitaire de Dakar.
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12
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Trinidad A, Ramírez-Camacho R, García-Berrocal JR, Verdaguer JM, Vicente J, Pinilla MT. Pseudomonas aeruginosa infection in the hypoventilated middle ear: an experimental model. Acta Otolaryngol 2005; 125:266-9. [PMID: 15966695 DOI: 10.1080/00016480410022804] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
CONCLUSION This is a suitable model for studying different aspects of the pathophysiology of chronic suppurative otitis media. OBJECTIVE To analyze the methodological features of an animal model of chronic suppurative otitis media induced by intratympanic inoculation of Pseudomonas aeruginosa. MATERIAL AND METHODS Otitis media was induced by inoculation of P. aeruginosa through the inferior aspect of the rat bulla and cauterization of the Eustachian tube via a transpalatal approach. Inspection of the tympanic membrane, culturing of middle ear effusion and processing of the temporal bones for light microscopy were performed. RESULTS Abnormal otomicroscopic findings and persistence of infection were correlated with the histopathological changes found in middle ear tissues.
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Affiliation(s)
- Almudena Trinidad
- Department of Otorhinolaryngology, Hospital Puerta de Hierro, Madrid, Spain.
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13
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Pitcher R, Thandar MA. Bilateral tuberculous mastoiditis and facial palsy. S Afr Med J 2004; 94:893-4. [PMID: 15587447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/01/2023] Open
Affiliation(s)
- Richard Pitcher
- Division of Paediatric Radiology at Red Cross War Memorial Children's Hospital
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Heller F, Hsu CM, Chuang CC, Wei KC, Wei FC. Anterolateral thigh fasciocutaneous flap for simultaneous reconstruction of refractory scalp and dural defects. J Neurosurg 2004; 100:1094-7. [PMID: 15200129 DOI: 10.3171/jns.2004.100.6.1094] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
✓ Infected full-thickness defects of the calvaria including the scalp, cranial bone, and dura mater, are often refractory to treatment and pose a difficult and urgent therapeutic problem for reconstructive surgeons. The authors report two cases in which successful reconstruction was achieved in one stage by using an anterolateral thigh fasciocutaneous flap. The well-vascularized fascia components were used to repair the infected dural defects. The skin flaps were used for coverage reconstruction.
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Affiliation(s)
- Frank Heller
- Department of Plastic Surgery, Chang Gung Memorial Hospital, Taipei, Taiwan
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Abstract
HYPOTHESIS Histopathologic study of the tissue seal and biologic response around cochlear implant electrodes in patients who had received a cochlear implant during life could provide clues concerning the pathogenesis of meningitis after cochlear implantation. BACKGROUND Bacterial meningitis has been reported as an infrequent complication of cochlear implantation using a variety of electrode designs. The cause of meningitis in cochlear implant recipients has not been firmly established. In an analogous surgical situation, namely stapedectomy, delayed meningitis could occur as a complication of ipsilateral acute suppurative otitis media in which there was open communication between the middle ear and perilymph. METHODS Twenty-one temporal bones from 20 individuals who had undergone cochlear implantation during life were studied by light microscopy. All sections passing through the cochleostomy site and electrode track were examined to evaluate the tissue seal at the cochleostomy, the presence or absence of an extracochlear electrode sheath, and finally, to seek evidence of a cellular inflammatory response near the electrode. These data were compared with clinical data, including electrode system used, the number of years between implantation and death, type of tissue used at surgery, and the age and sex of the patients. RESULTS The 21 specimens included cases implanted with the Symbion Ineraid, Cochlear Corporation Nucleus 22-channel, Cochlear Corporation Nucleus 24-channel, a Cochlear Corporation Nucleus single channel, and Advanced Bionics Clarion C1 devices. At the cochleostomy site, and just within the cochlea, there was a robust fibrous and bony tissue response in all 21 ears and in most cases, there was a fibrous sheath surrounding the electrode in the middle ear. No recognizable open communication or potential communication between the middle ear and the inner ear was seen in any of the 21 ears. An inflammatory cellular response, including mononuclear leukocytes, histiocytes, and foreign body giant cells, were present in 12 of the 21 temporal bones (57%) and was most intense at the cochleostomy site. No statistically significant relationship was found between the presence or absence of inflammatory cells and the type of tissue graft used at surgery. CONCLUSIONS The histologic evidence presented in this study does not support open communication between the middle and the inner ear as part of the pathogenesis of bacterial meningitis as a late complication after cochlear implantation. Rather, the finding of a cellular inflammatory response in 12 of 21 temporal bones suggests that late hematogenous contamination and colonization of the implant is a much more likely pathogenic mechanism. This putative mechanism has implications for possible strategies to prevent meningitis after cochlear implantation.
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Affiliation(s)
- Joseph B Nadol
- Department of Otology & Laryngology, Harvard Medical School, Boston, Massachusetts, USA.
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Abstract
OBJECTIVE To discuss the clinical aspects and management of nontuberculous mycobacteriosis of the temporal bone. STUDY DESIGN Case report and review of the literature. SETTING University hospital, tertiary referral center. PATIENT, INTERVENTION, AND RESULTS The authors describe an uncommon case of nontuberculous mycobacteriosis of the temporal bone in an immunosuppressed 62-year-old woman with facial nerve paralysis caused by disease complication. The case was cured with radical tympanomastoidectomy and prolonged multiple antibiotic therapy. CONCLUSIONS Nontuberculous mycobacteriosis should be suspected in immunosuppressed patients with intractable middle ear granulations. Cultural and histologic examinations are the mainstay for diagnosis. Long-standing multiantibiotic therapy together with aggressive surgery should be considered as appropriate management.
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Affiliation(s)
- Holger Sudhoff
- Department of Otorhinolaryngology, Head and Neck Surgery, St. Elisabeth Hospital, University of Bochum, Germany
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Affiliation(s)
- John C Shelton
- Department of Otolaryngology, University of Florida, Gainesville 32610-0264, USA
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Sakamoto M, Ito K, Sugasawa M, Taniguchi M. Otogenic meningitis caused by the pneumococci that had acquired resistance to cephalosporins. Otolaryngol Head Neck Surg 2001; 124:350-1. [PMID: 11241009 DOI: 10.1067/mhn.2001.113509] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Affiliation(s)
- M Sakamoto
- Department of Otolaryngology, Faculty of Medicine, University of Tokyo, Japan
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Pérez Plasencia D, Santa Cruz Ruiz S, Blanco Pérez P, Benito González J, Pérez Liedo C, Gómez Benito M, Del Cañizo Alvarez A. [Benign necrotizing osteitis of the external ear canal. A report of a clinical case]. Acta Otorrinolaringol Esp 1999; 50:402-4. [PMID: 10491479] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/14/2023]
Abstract
Benign necrotizing osteitis of the external ear canal is a process of unknown origin. This necrotic process with sequestration of the tympanic bone occurs in healthy, non-diabetic patients. It should be differentiated from malignant otitis externa and radionecrosis of the tympanic bone. A case is reported and the literature on this rare clinical entity is discussed.
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Affiliation(s)
- D Pérez Plasencia
- Servicio de ORLy Patología Cérvico-Facial, Hospital Clínico Universitario de Salamanca, Salamanca, 37007, España
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Abstract
Abscess formation in the infratemporal and temporal fossae is rare. Their presentation to accident and emergency departments is unusual and consequently may cause problems with diagnosis. Once diagnosed, treatment should be aggressive with intravenous antibiotics and surgical drainage.
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Abstract
Actinomycosis of the temporal bone is uncommon. There have only been 24 cases previously reported in the English literature. The responsible organism is Actinomyces israelii, an anaerobic filamentous Gram positive bacterium. While the cervico-facial region is the most common site of the disease, involvement of the temporal bone is rare. The diagnosis can sometimes be made clinically by identification of sulphur granules in a glue-like substrate but in all cases involving the temporal bone, the diagnosis has been made at histopathology. Effective therapy consists of surgery followed by the long-term administration of penicillin.
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Affiliation(s)
- M Ajal
- Department of Neuro-Otology/Skull Base Surgery, St Vincent's Hospital, Sydney, Australia
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23
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Palva T, Ramsay H. Incudal folds and epitympanic aeration. Am J Otol 1996; 17:700-8. [PMID: 8892564] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Thirty-seven temporal bones were dissected, and the posterior tympanic and epitympanic folds recorded and photographed. Histologic details were documented from four serially sectioned temporal bones, two normal and two inflamed. Of these 41 specimens, 31 were normal, and 10 showed signs of inflammation. The type for the lateral fold was incudomalleal in 16 and incudal in 25 ears. Incus intercrural and incudostapedial folds appeared only exceptionally. Medial and superior incudal folds were not present in normal ears. The anterior tympanic isthmus was a constant, large aeration pathway. In chronically inflamed ears, its partial or total block was caused by polypoid or large sheet-like folds. Inactive sequelae appeared as mature, simple, one-layer or extensive multilayer networks of webs, connected with a deeply indrawn incudomalleal fold. The small posterior isthmus was open to the incudal fossa in 13 ears, and in 28, it was sealed off by a posterior incudal fold. The mastoid air cell tracks were (in ten of 37 dissected ears) open to the incudal fossa, or directly, to the posterior tympanum. Auxiliary pathways due to membrane defects were found in both the horizontal and descending portions of the incudomalleal fold. Excepting the chordal, incudomalleal, and posterior incudal folds, fold-like webs in the posterior tympanum and epitympanum are of inflammatory origin.
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Affiliation(s)
- T Palva
- Helsinki Ear, Nose and Throat Hospital, University of Helsinki, Finland
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24
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Merchant SN, Gopen Q. A human temporal bone study of acute bacterial meningogenic labyrinthitis. Am J Otol 1996; 17:375-85. [PMID: 8817013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
It is well established that sensorineural hearing loss (SNHL) is an important sequela of acute bacterial meningitis. Previous human temporal bone histopathologic studies have suggested that such hearing loss is due to labyrinthitis. This study involved a detailed and systematic evaluation of the auditory and vestibular end-organs in 41 human temporal bones from patients with acute bacterial meningitis, aimed at describing the spectrum of histopathologic changes within the labyrinth, ascertaining likely routes for spread of infection from the meninges to the inner ear, and comparing the data from humans with those described in a rabbit model of meningogenic labyrinthitis. Our study revealed the following: (a) Suppurative labyrinthitis occurred in 20 (49%) bones. Of these 20 bones, the cochlea was affected in all, whereas the vestibular organs were involved in 10. Eosinophilic staining of inner ear fluids without the presence of inflammatory cells (so-called "serous" labyrinthitis) occurred in 14 of the remaining 21 bones. This staining occurred primarily within the vestibular system. Its significance and pathogenesis remains unknown; (b) Sensory and neural structures of the inner ear appeared intact in the majority of specimens, including bones with suppurative labyrinthitis and those with eosinophilic staining of inner ear fluids. This finding raises the possibility of preventing or reversing SNHL by therapeutic intervention. Spiral ganglion cells were severely degenerated in 12% of bones, indicating a retrocochlear site of hearing loss in addition to the cochlea. This subset of patients may perform poorly after cochlear implantation; (c) It has been traditionally assumed that irreversible and permanent SNHL is caused by suppurative labyrinthitis, whereas reversible SNHL is caused by serous labyrinthitis. Our findings question the validity of these assumptions; (d) The data were consistent with the hypothesis that both the cochlear modiolus and cochlear aqueduct can serve as potential pathways for spread of infection from the meninges to the inner ear; (e) There were many similarities in the histopathology of the inner ear in humans when compared with the rabbit model of meningogenic labyrinthitis. A notable difference was that the cochlear aqueduct appeared to be the sole pathway for spread of infection in the rabbit, whereas in the human, both the modiolus and aqueduct were possible pathways.
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Affiliation(s)
- S N Merchant
- Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Boston 02114, USA
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Abstract
A destructive granulomatous lesion of the temporal bone caused by Coccidioides immitis disseminated from a pulmonary lesion was found in a 4-year-old immunocompetent child. To our knowledge, it is the first case of coccidioidomycosis of the temporal bone reported in the world literature. The child presented with pain in her right ear and a 6-month history of intermittent fever, which partially responded to multiple courses of antibiotics. A tender erythematous postauricular swelling consistent with a subperiosteal abscess subsequently developed over 1 month. A mastoidectomy showed granulation tissue with pockets of purulence, and histologic evaluation of the specimen revealed spherules of C immitis, later verified by culture. The patient responded to intravenous amphotericin B therapy, without evidence of disease recurrence. Coccidioides immitis is endemic in regions of the Southwestern United States, with extremely infectious characteristics and relative resistance to medical therapy. Coccidioidomycosis should be considered in the differential diagnosis of a granulomatous lesion of the temporal bone.
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Affiliation(s)
- W S Low
- Division of Otolaryngology-Head and Neck Surgery, University of California, San Diego, School of Medicine, USA
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Kerr J. Fungal osteomyelitis of the temporal bone: a review of reported cases. Ear Nose Throat J 1994; 73:339. [PMID: 8080580] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
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Abstract
By use of the very sensitive polymerase chain reaction technique, evidence is given that otosclerosis is a measles-virus-associated disease of the otic capsule. These results support recent observations which demonstrated the expression of measles antigen within active otosclerotic foci by immunohistochemical methods. Thus it is hypothesized that the viral infection acts as at least one pathogenetic factor during the development of this obscure, locally restricted inflammatory bone disease.
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Affiliation(s)
- H Niedermeyer
- Department of Otorhinolaryngology, Head and Neck Surgery, Klinikum rechts der Isar, Technical University, Munich, FRG
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Lyos AT, Malpica A, Estrada R, Katz CD, Jenkins HA. Invasive aspergillosis of the temporal bone: an unusual manifestation of acquired immunodeficiency syndrome. Am J Otolaryngol 1993; 14:444-8. [PMID: 8285317 DOI: 10.1016/0196-0709(93)90121-m] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Affiliation(s)
- A T Lyos
- Department of Otorhinolaryngology and Communicative Sciences, Baylor College of Medicine, Houston, TX 77030
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Hanna E, Hughes G, Eliachar I, Wanamaker J, Tomford W. Fungal osteomyelitis of the temporal bone: a review of reported cases. Ear Nose Throat J 1993; 72:532, 537-41. [PMID: 8404555] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Affiliation(s)
- E Hanna
- Department of Otolaryngology and Communicative Disorders, Cleveland Clinic Foundation, Ohio 44195
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Affiliation(s)
- C Y Chang
- Department of Otolaryngology, Head and Neck Surgery, University of California, San Francisco
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Abstract
We have presented the clinical history and temporal bone findings in a patient who manifested sudden hearing loss, and who subsequently was found to have cryptococcal meningitis associated with AIDS. The histopathologic findings are similar to earlier reports in patients without AIDS. Because cryptococcal infection is so much more common in AIDS patients than in the general population, it must be considered a causative factor when presented with an AIDS patient with progressive or sudden hearing loss. This offers the patient a chance for timely and effective treatment.
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Affiliation(s)
- J A Kwartler
- Division of Otolaryngology, University of Medicine and Dentistry of New Jersey, Newark
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Abstract
Despite intensive investigation, the cause of otosclerosis remains uncertain. Recent studies of Paget's disease of bone have revealed a possible viral origin. Because of similarities between otosclerosis and Paget's disease, we have pursued investigation of a possible viral cause of otosclerosis. Four temporal bone specimens from patients with otosclerosis, processed for immunohistochemistry, demonstrated positive specific reactivity with monoclonal antibodies to measles virus antigens using the indirect immunofluorescent and immunoperoxidase techniques. Reactivity was most intense in active foci. Reactivity in the peroxidase assay was also observed in areas of acting otosclerosis with application of primary antisera from patients with subacute sclerosing panencephalitis, a disorder of the central nervous system in which a defective measles virus has been isolated. Other related paramyxoviruses, including mumps and respiratory syncytial virus, were negative, as were negative controls.
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Affiliation(s)
- M J McKenna
- Department of Otology and Laryngology, Harvard Medical School, Boston, MA
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Abstract
Materials collected from the tympanic cavity before operation and from the mastoid antrum during operation of 58 discharging ears of patients with chronic otitis media were cultured, and the bacteria in these two cavities were compared. Staphylococcus aureus was the commonest organism in the tympanic cavity, and S epidermidis in the mastoid antrum. Anaerobic bacteria were found only in the mastoid antrum of patient with cholesteatoma. In 32 (55 per cent) of the 58 ears examined, bacteria were detected in both the tympanic and mastoid cavities. In 17 ears (53 per cent), the bacterial strains in the two cavities differed. The results indicate the necessity of bacteriologic examination of the mastoid cavity during operation to select antibiotics for postoperative treatment.
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Abstract
Cryptococcus neoformans is a yeast-like organism which, after inhalation, may cause pulmonary disease or a systemic fungemia associated with numerous extrapulmonary sites of infection, but most notably affecting the central nervous system. Despite this frequent involvement of the leptomeninges, only three cases of infection of the temporal bones have been previously described. We describe an additional case with comments on the possible significance of infection of this site.
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