High jugular bulb and conductive hearing loss

A high jugular bulb is often discovered as an incidental finding that is asymptomatic. Conductive hearing loss in association with this anomaly may occur, but has been reported infrequently in the literature. We report five cases of high jugular bulb and associated conductive hearing loss. Mechanisms to explain the conductive hearing loss include contact of the jugular bulb with the tympanic membrane, interference with the ossicular chain, and obstruction of the round window niche. The operative findings, radiographic and audiometric data that support these mechanisms of conductive hearing loss are presented.

Fenestration of the internal carotid artery: a rare mass of the hypotympanum associated with persistence of the stapedial artery

A 61-year-old woman was examined because of unilateral nonpulsatile tinnitus involving the right ear. CT scanning showed a soft-tissue mass in the hypotypanum. Angiographically, the mass was identified as a fenestrated or duplicated internal carotid artery associated with persistence of the stapedial artery. Embryologic considerations are discussed.

Cholesterol cysts of the temporal bone: diagnosis and treatment

Cholesterol cyst (or granuloma) of the temporal bone, a recognized clinical entity distinct from cholesteatoma, is more common than previously thought. Apparently it is caused by obstruction of previously pneumatized temporal bone air cells. Surgical cure is achieved by drainage and reestablishment of normal pneumatization. This paper reviews 14 cholesterol cysts of the temporal bone, emphasizing the importance of preoperative imaging and surgical approach. Use of magnetic resonance imaging differentiates cholesterol cysts from cholesteatoma or other neoplasms. Computed tomography delineates the location of the lesion and defines temporal bone anatomy essential to surgical approach. The two studies together allow the surgeon to properly plan drainage, as in the case of a cholesterol cyst, versus excision or exteriorization, as in the case of cholesteatoma. The infralabyrinthine approach to a petrous apex cholesterol cyst is the procedure of choice when hearing preservation is desired.

An unusual laryngeal lesion in children: granular cell tumor

Granular cell tumor, a relative rare neoplasm, is of particular interest of the otolaryngologist as some 50% of cases appear in the head and neck region. The youngest reported case of a laryngeal granular cell tumor is presented. Involvement of the larynx is uncommon, but when it occurs it may create diagnostic and therapeutic dilemmas.

Pyogenic liver abscess in Crohn's disease

We describe six cases of pyogenic liver abscess occurring among 1227 Crohn's disease patients admitted to The Mount Sinai Hospital from 1960 through 1982, and review the features of the seven similar cases that have been previously reported. Mechanisms of formation of liver abscess in these 13 patients included direct extension of intraabdominal abscess (three cases), propagation via the portal vein (eight cases), biliary complications (one case), or metastatic cancer (one case). Five of the 13 patients died. All five deaths occurred among the eight patients with multiple abscesses; all five patients with solitary abscess survived. The mean age of the patients who died was 56 years, versus 37 years for the survivors. Three of the four patients treated with antibiotics only died; only two of the nine patients who underwent some form of drainage succumbed. Mortality was usually attributable to failure in making the diagnosis, especially as liver function test abnormalities were often subtle. Furthermore, the generally nonspecific clinical signs and symptoms were often obscured by underlying bowel disease. If a high index of suspicion is maintained, CT scanning and ultrasonography should reveal the lesion at an early stage, so that the necessary drainage procedure can be carried out, with or without concomitant resection of affected bowel and drainage of intraabdominal abscess.

Acute septic pancreatitis presenting as colonic necrosis

A 43-year-old alcoholic male homosexual, developed acute ischemic necrosis of the descending colon secondary to acute necrotizing pancreatitis. CT scan was diagnostic of pancreatitis. Necrosis of the left colon required colectomy with colostomy. Postoperatively recovery was slow but ultimately complete. The patient is in excellent health 18 months postoperatively.