Fibrous dysplasia: rare manifestation in the temporal bone / Displasia fibrosa: manifestação rara no osso temporal

Abstract Introduction: Fibrous dysplasia is a benign disorder, in which normal bone is replaced by fibrosis and immature bone trabeculae, showing a similar distribution between the genders, and being more prevalent in the earlier decades of life. Fibrous dysplasia of the temporal bone is a rare condition, and there is no consensus as to whether it is more common in monostotic or polyostotic forms. External auditory meatus stenosis and conductive dysacusis are the most common manifestations, with cholesteatoma being a common complication, whereas the involvement of the otic capsule is an unusual one. Surgical treatment is indicated to control pain or dysacusis, otorrhea, cholesteatoma, and deformity. Objectives: To describe the clinical experience of a tertiary referral hospital with cases of fibrous dysplasia of the temporal bone. Methods: Sampling of patients diagnosed with fibrous dysplasia of the temporal bone, confirmed by tomography, treated at the pediatric otology and otorhinolaryngology outpatient clinics, between 2015 and 2018. The assessed variables were age, gender, laterality, external auditory meatus stenosis, deformity, hearing loss, presence of secondary cholesteatoma of the external auditory meatus, lesion extension and management. Results: Five patients were included, four females and one male, with age ranging from 13 to 34 years. Three had the polyostotic form and two the monostotic form of fibrous dysplasia of the temporal bone. Four patients had local deformity and external auditory meatus stenosis, two of which progressed to cholesteatoma. All patients showed some degree of hearing impairment. All had preserved otic capsule at the tomography. Two patients are currently undergoing clinical observation; two were submitted to tympanomastoidectomy due to secondary cholesteatoma; one was submitted to lesion resection, aiming to control the dysacusis progression. Conclusion: Five cases of fibrous dysplasia of the temporal bone were described, a rare disorder of which the otologist should be aware.

Resumo Introdução: Displasia fibrosa é uma desordem benigna, na qual o osso é substituído por fibrose e trabeculado ósseo imaturo, com distribuição semelhante entre sexos, mais comum nas primeiras décadas de vida. O acometimento do osso temporal pela displasia fibrosa é raro, não há consenso se é mais comum nas formas monostóticas ou poliostóticas. Estenose do meato acústico externo e disacusia condutiva são as manifestações mais comuns. Colesteatoma é também uma complicação comum e o acometimento da cápsula ótica incomum. O tratamento cirúrgico está indicado para controle de dor ou disacusia, otorreia, colesteatoma, deformidade. Objetivos: Descrever a experiência clínica de hospital terciário de referência com casos de displasia fibrosa do osso temporal. Método: Amostragem dos pacientes com diagnóstico de displasia fibrosa do osso temporal, confirmado pela tomografia, atendidos nos ambulatórios de otologia e otorrinolaringologia pediátrica, entre 2015 e 2018. As variáveis avaliadas foram idade, gênero, lateralidade, estenose do meato acústico externo, deformidade, perda auditiva, presença de colesteatoma secundário de meato acústico externo, extensão da lesão e conduta adotada. Resultados: Foram incluídos cinco pacientes, quatro do sexo feminino e um masculino, de 13-34 anos. Três apresentaram a forma poliostótica da displasia fibrosa do osso temporal e dois a forma monostótica. Quatro apresentaram deformidade local e estenose do meato acústico externo, dois desses evoluíram com colesteatoma. Todos manifestaram algum grau de comprometimento auditivo. Todos apresentaram cápsula ótica preservada na tomografia. Duas pacientes estão em observação clínica; duas foram submetidas a timpanomastoidectomia devido a colesteatoma secundário; um foi submetido a ressecção da lesão para controle de progressão da disacusia. Conclusão: Foram descritos cinco casos de displasia fibrosa do osso temporal, desordem rara para a qual o otologista deve estar atento.

Dehiscence of facial nerve at surgery of cholesteatoma

Facial nerve dehiscence [FND] is a common problem at surgery of cholesteatoma: The aim of this study was survey of the common site of FND and the common complication of cholesteatoma that coexists with FND. This-cross sectional study was performed from 2001 to 2006. 185 patients with cholesteatoma were studied. Middle ear Findings at surgery of cholesteatoma were surveyed. Data was analyzed using the k[2] and Fisher exact test. of 185 cases, 95 [51.4%] were male and 90 [48.6%] were female and the mean age was 30.5 years. The rate of FND was 29. 73% [55 cases]. The common site of FND was tympanic segment [85.4%]. The positive statistically association between FND incidence and the presence of lateral semicircular fistula was demonstrated. The most common area of facial nerve injury at surgery of cholesteatoma is tympanic segment. Surgeons should always consider that fallopian canal will be eroded and the facial nerve is in direct contact with cholesteatoma whenever a lateral semicircular canal fistula is suspected or vice versa

Otogenic cerebellar abscess drained through mastoidectomy in a 14 year-old girl

A 14 year old girl, with a past history of chronic otitis media was presented with otogenic cerebellar abscess. CAT scan finding, and initial management of the patient are described. Radical Mastoidectomy was performed for the drainage of the abscess which was complemented with antibiotics and metronidazol therapy. A second operation for covering cerebellar hernia was performed. The outcome of the whole procedure was good the patient was-discharged after a hospital stay of 48 days

El mareo como síntoma de los tumores encefálicos. Estudio de 60 casos / Dizziness as a symptom of encephalic tumors. A review of 60 cases

Se procedió a estudiar la incidencia de manifestaciones de mareos en una muestra de 60 casos de pacientes de ambos sexos, con edades entre 6 y 76 años, con tumores encefálicos de diversa localización e histopatología. La ubicación de los tumores se estableció por métodos radiológicos y se confirmaron tras la intervención quirúrgica. Se estudió especialmente la relación del síntoma mareo con la ubicación de los tumores encefálicos. Comprobamos que el mareo aparece asociado especialmente a los tumores de fosa posterior. En los casos de tumores localizados en hemisferios cerebrales el mareo se manifiesta con menor incidencia. Estos casos se ubican en áreas próximas a los centros vestibulares corticales

Cholesteatoma; its complications

OBJECTIVE: To find out the incidence of various extracranial and intracranial complications in the patients having chronic suppurative otitis media with cholesteatoma. DESIGN: Study of 40 patients having various extracranial and intracranial complications due to chronic suppurative otitis media with cholesteatoma. SETTING: Department of ENT, Mayo Hospital, Lahore PERIOD: 1st January, 1995 to 30th December, 1997. PATIENTS AND METHODS: This study was carried out on 40 patients having chronic suppurative otitis media with cholesteatoma. The incidence of various extracranial and intracranial complications found in these patients was recorded. Thirty patients [75%] presented with extracranial complications. The most common extracranial complication was postaural fistula [35%] followed by mastoid abscess [20%] and facial paralysis [15%]. Ten patients [25%] presented with intracranial complications. The most common intracranial complication was brain abscess [10%] followed by extradural abscess [7.5%] and meningitis [5%]. Twelve patients [30%] presented with more than one complications. Chronic suppurative otitis media with cholesteatoma is a dangerous condition. It can lead to various extracranial and intracranial complications. More patients present with extracranial complications than the patients presenting with intracranial complications. Some patients present with more than one complications

Absceso cerebeloso por colesteatoma: a propósito de un caso / Braian abcess for cholesteatoma: a propos the a case a purpose

Las infecciones de origen otógeno tales como otitis media, otomastoiditis y colesteatoma pueden complicarse con infecciones a nivel del sistema nervioso central. Se presenta el caso de un escolar de 12 años de edad, con otomastoiditis y colesteatoma del oído derecho, quien desarrolló un absceso cerebeloso, el cual fue diagnosticado por resonancia magnética nuclear. Mediante este estudio se le hizo seguimiento para evaluar respuesta al tratamiento médico y tomar la decisión de tratamiento quirúrgico. Los sígnos y síntomas iniciales fueron inespecíficos, desarrollando posteriormente hipertensión endocraneana y síndrome de lesión de ocupación de espacio de fosa posterior. Se realizó resonancia magnética nuclear (RMN) confirmándose el diagnóstico de hidrocefalia obstructiva y cerebelitis bilateral a predominio derecho. Se procedió a colocar válvula de derivación ventricular peritoneal y antibioticoterapia. A las 4 semanas se realizó RMN de control evidenciándose absceso cerebeloso derecho por lo que se decide practicar exéresis del mismo, de cuyo material extraído se logró aislar Bacteroides fragilis. Evoluciona satisfactoriamente. Posteriormente se realiza resección del colesteatoma. El paciente egresa con parálisis facial periférica posterior a cirugía del colesteatoma. La audiometría revela ausencia total de audición por el oído derecho. El propósito de presentar este caso es resaltar la alta incidencia de complicaciones intracraneales que tienen las infecciones otógenas y la importancia del diagnóstico precoz y tratamiento adecuado de estas afecciones

Pathological profile in chronic suppurative otitis media-the regional experience

Peroperative findings in 145 consecutive cases of chronic suppurative otitis media, operated at Civil Hospital, Karachi were recorded. The mean age was 24 years. More than half of the patients [51%] had subtotal perforations and majority had damage of more than one ossicle. Involvement of all the three ossicles was seen in 30 [40%] cases. The frequency of damaged malleus alongwith incus was higher than other series. Granulations and subtotal perforations were commoner and could account for it. Extensive cholesteatoma was present in 30 cases