Agujero Timpánico bilateral. Análisis de caso desde la literatura / Bilateral tympanic hole. Case analysis from the literature

La pared del conducto auditivo externo (CAE) parte de la formación del hueso timpánico; integrándose posteriormente a la porción petrosa del hueso temporal. El agujero timpánico o foramen de Huschke corresponde a un defecto en la osificación en donde existe fusión incompleta de porciones anteriores y posteriores del anillo timpánico dejando una abertura que comunica el CAE hacia anterior. Su presencia es normal hasta los 5 años de edad, tiempo en que se debiese obliterar. Su incidencia es baja (3-24%), pero la persistencia en adulto, conlleva sintomatología inespecífica caracterizada por otalgia, dolor en articulación temporomandibular (ATM), tinnitus, hipoacusia o manifestaciones complejas como descarga salival en CAE durante la masticación. Clínicamente puede complicar procedimientos de infiltración y artroscopias de ATM. Rara vez ocasiona, en pacientes mayores de 50 años, herniación de la cabeza del cóndilo mandibular. Su diagnóstico puede ser clínico por medio de otoscopia, donde se observa protuberancia de tejido en pared anterior del CAE, que aumenta de tamaño con la boca cerrada. También puede ser imagenológico con una tomografía computarizada. El tratamiento incluye desde medidas conservadoras para manejo del dolor e inflamación, hasta quirúrgicas con la implantación de injertos, placas o prótesis para cerrar la estructura o para reemplazar el cóndilo mandibular. El presente estudio pretende aportar incidencia dentro del área de estudio. Se analiza por observación directa, cráneo seco, completo, masculino, edad entre 12 a 15 años (según morfología del cóndilo mandibular y erupción dental). Se observa agujero de Huschke, bilateral, ambos permeables de diámetro 4 mm en ambos casos, determinados con regla milimetrada. La relevancia del defecto se asocia a la práctica clínica de otorrinolaringólogos, cirujanos maxilofaciales y odontólogos, ya sea como diagnóstico diferencial asociado a los síntomas inespecíficos, como para procedimientos más invasivos en la zona tales como infiltraciones o artroscopias de ATM

The wall of the external auditory canal (EAC) starts from the formation of the tympanic bone; later it is integrated to the petrous portion of the temporal bone. The tympanic foramen or foramen of Huschke corresponds to a defect in ossification where there is incomplete fusion of the anterior and posterior portions of the tympanic ring leaving an opening that communicates the EAC to its anterior aspect. Its presence is normal until 5 years of age, when it should be absolutely obliterated. Its incidence is low (3-24%), but its persistence in adults leads to non specific symptoms characterized by otalgia, pain in the temporomandibular joint (TMJ), tinnitus, hearing loss, or complex manifestations such as salivary discharge in the CAE during mastication. Clinically, it may complicate TMJ infiltration and arthroscopy procedures. It rarely causes herniation of the mandibular condyle head in patients older than 50 years. Its diagnosis can be clinical by means of otoscopy, where tissue protrusion is observed in the anterior wall of the CAE, which increases in size when the mouth is closed. It can also be imaging with computed tomography. Treatment includes from conservative measures to treat pain and inflammation, to surgical measures with the implantation of grafts, plates or prosthesis to close the structure or to replace the mandibular condyle. The present study aims to provide incidence within the study area. It is analyzed by direct observation, dry skull, complete, male, age between 12 to 15 years (according to mandibular condyle morphology and dental eruption). Huschke's foramen was observed, bilateral, both permeable, diameter 4mm in both cases, determined with a millimeter ruler. The relevance of the defect is associated with the clinical practice of otolaryngologists, maxillofacial surgeons and dentists, either as a differential diagnosis associated with nonspecific symptoms, or for more invasive procedures in the area such as infiltrations or TMJ arthroscopies.

CT anatomic study of the persistent foramen Huschke and the weakness of the remains of the foramen Huschke / 实用放射学杂志

Objective To study the morphology of the persistent foramen of Huschke (PHF)and the weakness of the remains of foramen of Huschke (WRHF)in the external auditory canal (EAC)by high resolution computer tomography (HRCT)in vivo. Methods The thin HRCT images of 525 cases elder than 5 years were retrospectively reviewed by two radiologists,to detect the PHF or WRHF,and to depict the precise location,size and the distance to the tympanic membrane.The incidence,sex differences, and morphologic data of PHF and WRHF were statistical analyzed.Results ①PHFs were found in 146 EACs of 40 males and 77 fe-males with the prevalence of 13.91%,and were found on both sides in 29 cases.Mean maximum axial diameter was 2.35 mm± 1.1 6 mm (0.6-5.8 mm)and sagittal diameter was 2.09 mm±1.2 mm (0.5-6.2 mm).Mean distance between the inner edge of PFH and the sulcus tympanicus was 1.61 mm±2.4 mm (0-10 mm).②WRHFs were found in 233 EACs of 58 males and 122 fe-males with the prevalence of 22.1 9%,and were found on both sides in 53 cases.Mean maximum axial diameter was 2.43 mm± 0.89 mm (0.8-5.4 mm)and sagittal diameter was 2.08 mm±0.73 mm (0.6-4.3 mm).Mean distance between the inner edge of WRPFH and the sulcus tympanicus was 1.55 mm±1.2 mm (0 - 9.9 mm).③The distance to the sulcus tympanicus was within 3 mm in 137 cases (90.73%)of PFHs and 221 cases (94.43%)of WRFHs.Conclusion Both PHF and WRFH are common by the CT morphological study in vivo.The medial part of EAC is predominant and female is predominant.The incidence and the location of PHF and WRFH are no significant difference.

Foramen of Huschke in North Indians: an anatomical study.

Background: The deficiency in the antero-inferior wall of the bony part of external auditory canal (EAC) closes by 5 years of age but if it persists beyond that age it is called foramen of Huschke. Depending on the population studied, persistence of this foramen has been seen in 0-67% of adult crania. Review of literature revealed that no data was available in North Indian population; therefore the present study is being undertaken. Methods: Sixty North Indian adult human crania were examined and the presence of foramen of Huschke was noted. The side to which it belonged to, its shape and size were observed. Size of the foramen was measured using vernier caliper. Results: Out of sixty North Indian adult human crania seen, foramen of Huschke was present in 14 crania. It was observed unilaterally in 10 crania and bilaterally in 4. Although different shapes of the foramen like pin point, pin head, circular, irregular and U shape were observed but in majority of cases it was U shaped. Its size varied from pin point- 10 mm transversely and pin point to 9 mm longitudinally. Conclusion: This study revealed that about 23% of North Indian adult human crania have foramen of Huschke. Persistent foramen of Huschke in the adult life may be involved in different abnormalities of the EAC and may lead to otological complications. Therefore, ENT surgeons should be aware of persistent foramen of Huschke and keep it as one of the possible diagnoses while dealing with patients presenting with otological complications. Also the surgeons should be careful while performing endoscopy of Temporomandibular Joint (TMJ) so that accidental damage of TMJ can be prevented.

A Case of Temporomandibular Joint Disorder Accompanied with Ear Bleeding / 대한이비인후과학회지

Temporomandibular joint disorder (TMD) is a generic term used for any problem concerning the jaw joint. The clinical signs of TMD are crepitus associated with movement, restriction of jaw movements, and pain within the joint cavity. But ear bleeding and an external auditory canal (EAC) mass as presenting symptoms are rare. We report the case of 78-year-old man with TMD, whose initial symptoms were ear bleeding, and temporomandibular pain intensifying when he is chewing, accompanied by an EAC mass. Physical examination revealed a reddish mass that originated from the anterior wall of EAC and bled when touched. Computed tomography showed a mass with soft tissue density and a bony defect in the anterior EAC wall. After conducting arthrocentesis and lavage repetitively, the wound was healed completely. It is likely that the patient's ear bleeding was due to patent foramen of Huschke or erosion of the anterior wall of EAC due to temporomandibular joint inflammation.

A Case of Spontaneous Temporomandibular Joint Herniation into the External Auditory Canal with Clicking Sound

A bony defect of the external auditory canal (EAC) and herniation of the temporomandibular joint (TMJ) can be caused by tumorous conditions, inflammation, trauma, and otologic procedures. Spontaneous TMJ herniation into the EAC can be caused by a congenital bony defect known as patent Huschke's foramen, which is a very rare condition. In our case, an objective clicking sound was produced when the patient opened his mouth. A protruding mass was found in the anterior wall of the EAC during mouth closing, and herniation of the TMJ was confirmed with computed tomography. Therefore, we thought the clicking sound of our case could have resulted from spontaneous TMJ herniation through the patent foramen of Huschke.

A Case of Spontaneous Temporomandibular Joint Herniation into the External Auditory Canal / 대한이비인후과학회지

Bony defects of the external auditory canal (EAC) may arise from a tumor, infection, inflammation, trauma, complications from ear surgery, or congenital disease. Congenital bony defects of the EAC are known as a patent Huschke's foramen. Here, we describe a 76-year-old male patient who presented an otalgia in his right ear. Physical examination revealed a dome shaped swelling of the anterior EAC wall, which repeated swelling and retraction as the patient's mouth closed and opened. Computed tomography revealed a bony defect of the anterior EAC wall. We believe that the patent Huschke's foramen allowed spontaneous herniation of the temporomandibular joint into the EAC.

A Case of Patent Foramen of Huschke Confirmed during Tympanoplasty / 대한이비인후과학회지

Herniation of the temporomandibular joint (TMJ) into the external auditory canal (EAC) has been reported to occur spontaneously or as a result of trauma, neoplasia, infection, or inflammatory processes. It was postulated that spontaneous herniations were attributable to a patent foramen of Huschke, which represents a non-ossified portion of the tympanic plate. Eight cases of spontaneous herniation of the TMJ into the EAC were reported internationally. Recently, we experienced a case of a patent foramen of Huschke confirmed during a tympanoplasty. We reviewed the intimate relation of the TMJ to the temporal bone as well as the characteristic location, clinical and radiographic findings of a patent foramen of Huschke.