Delayed-onset unilateral facial paralysis after mastoidectomy: A case report

Objective@#To discuss the case of a 36-year-old man who presented with left unilateral facial paralysis 11 days after mastoidectomy.@*Methods@#Design: Case Report Setting: Tertiary Government Training Hospital Patient: One@*Results@#A 36-year-old man with recurrent left ear discharge of 30 years duration underwent left canal wall-down mastoidectomy and was discharged well after 3 days. On follow up after 8 more days, he was noted to have House Brackmann IV left facial paralysis. Following 5 days methylprednisolone, neurologic evaluation and physical therapy rehabilitation, facial paralysis improved in the ensuing weeks until House-Brackmann I was achieved at week 12.@*Conclusion@#Delayed-onset Facial Palsy (DFP) following tympanomastoid surgery may be approached conservatively, including steroids, acyclovir, and, if with a history of herpes or varicella infection, immunization can be given. Prognosis for DFP is good especially when the facial nerve is identified intraoperatively during otologic surgeries

Absceso mastoideo como presentación de colesteatoma congénito en preescolar ¿cuál es el origen? / Mastoid abscess as congenital cholesteatoma presentation in a child what is the origin?

Resumen El colesteatoma congénito es una entidad que puede manifestarse con una amplia variedad de síntomas o ser silente durante largo tiempo y constituir un hallazgo incidental. Una vez diagnosticada es importante valorar su extensión y el compromiso de estructuras adyacentes, para lograr una adecuada planificación quirúrgica, eliminando la enfermedad y manteniendo la mejor funcionalidad posible. Se presenta un caso de colesteatoma congénito infantil.

Abstract Congenital cholesteatoma is an entity that can manifest with a wide variety of symptoms or be silent for a long time and constitute an incidental finding. Once diagnosed, it is important to assess the extension to apply the most efficient treatment, eliminating the disease and providing functionality if possible. A case of congenital cholesteatoma in a child is presented.

Luc’s abscess: The zygomatic route of infection from cholesteatoma

@#Luc’s abscess is an uncommon complication of otitis media wherein a subperiosteal abscess develops into the temporalis muscle and follows the route of a pneumatized zygoma.1 In uncomplicated cases, surgical drainage and antibiotics are adequate management with mastoidectomy reserved for severe or complicated cases. We report a case of complicated Luc’s abscess presenting with many complications that required multiple surgical interventions.

Fatal otitic hydrocephalus due to sinus thrombosis: A case report

Objective@#To report a case of chronic suppurative otitis media with complications of lateral sinus thrombosis and otitic hydrocephalus and to discuss its clinical manifestations, clinical course, ancillary procedures and management.@*Methods@#Study Design: Case Report. Setting: Tertiary Government Training Hospital. Patient: One. @*Results@#A 35-year-old man was admitted due to intermittent right otorrhea for 20 years and headache for a month. The Glasgow Coma Scale (GCS) score was 12, and mastoidectomy performed on the second hospital day showed cholesteatoma with erosion of the bony covering of the sigmoid sinus with scanty purulent discharge. The GCS improved to 15 few hours post- operatively, however, 24 hours post-operatively, GCS decreased from 15 to 10 and a CT scan showed dilatation of cerebral ventricles and lateral sinus thrombosis which persisted on subsequent imaging studies. His condition deteriorated irreversibly despite a ventriculostomy, and he eventually expired after 3 weeks in the ward. @*Conclusion@#Otitic hydrocephalus due to lateral sinus thrombosis is a serious complication of chronic suppurative otitis media seldom encountered nowadays. In this case, otitic hydrocephalus developed and progressed despite broad spectrum antibiotics, mastoidectomy and a ventricular shunt. This case report underscores the importance of early recognition of warning signs of intracranial complications to institute prompt management.

Clinical manifestation and treatment of temporal bone tympanic plate fracture / 中华耳鼻咽喉头颈外科杂志

Objective: To elucidate the clinical manifestations of temporal bone tympanic plate fracture and the correlation between treatment time after injury and its prognosis, and to discuss the importance of early treatment of tympanic fracture. Methods: Retrospective analysis was carried out on the clinical data of 15 patients(17 ears)with temporal bone tympanic plate fracture from March 2006 to July 2019. The course of disease was less than 1 month (initial stage) in 7 cases (7 ears), 1 month to 6 months (middle stage) in 2 cases (3 ears), and 6 months or more (late stage) in 6 cases (7 ears). The symptoms, signs, CT findings, pure tone audiometry results, surgical methods and clinical efficacy of each group were summarized. Results: Most patients with temporal bone tympanic plate fracture were referred to otology department by maxillofacial surgery. Fracture occured indirectly with the chin or zygomatic region as the direct stress point. Thirteen of the 15 patients had mental region wounds or scars, and 14 patients had external acoustic canal bleeding immediately after injury. In the initial-stage group, hearing was mostly unchanged, while in the middle and late-stage groups, hearing loss was mainly caused by conduction factors. In the initial stage group, 6 cases/7 cases were cured by external acoustic canal packing; External acoustic canal stenosis or atresia occurred in 2 cases in the middle-stage group and were cured by external acoustic canal plasty. All the 6 patients in the late-stage group had external acoustic canal stenosis or atresia, among whom 5 patients with external acoustic canal cholesteatoma were cured by external acoustic canal plasty, and the other one patient with middle ear cholesteatoma was cured by modified radical mastoidectomy and tympanoplasty after external acoustic canal plasty for three times. Conclusions: Temporal bone tympanic plate fracture is a special type of temporal bone fracture. In the early stage of temporal bone tympanic fracture, bleeding of the external acoustic canal is the main symptom, and hearing is normal mostly. Advanced conductive deafness may result from external acoustic canal stenosis and/or cholesteatoma formation later. Bleeding of the external acoustic canal and irregular bulge of the anterior wall of the external acoustic canal with mental region wound are important signs for early diagnosis of temporal bone fracture. Temporal bone tympanic fracture should be paid attention to, early detection and timely treatment can avoid external acoustic canal stenosis and atresia.

Recurrence of Cholesteatoma: A Retrospective Study Including 1006 Patients for More than 33 Years

Abstract Introduction Cholesteatomas are benign tumors consisting of skin, and growing inside a retraction pocket in the tympanic membrane. Cholesteatomas can occupy the entirety of the middle ear, and are known for their osteolytic capabilities. Surgery is the only curative treatment for cholesteatomas. Objective To describe the risk of recurrence after first-time surgically-treated middle- ear cholesteatoma (STMEC1) on the island of Funen from 1983 to 2015. Methods Cases of STMEC1 were identified in the Danish National Hospital Register. The medical records were reviewed. Time-to-event analyses were applied. The ears were followed from STMEC1 to a secondary cholesteatoma, emigration, death, or end of follow-up. Results Records from 1,006 patients with STMEC1 were reviewed. A total of 54 patients were submitted to surgery on both ears. The total sample consisted of 1,060 ears with STMEC1; 300 were children's (< 16 years) ears, and 760 were adult's ears. The total observation time was of 12,049 years. The overall estimated proportion with recurrence 5 years after surgery was of 37% in children and of 15% in adults. The older the child was at the first surgery, the risk decreased by 7% per year. In children, canal wall up (CWU) mastoidectomy without obliteration was associated with a hazard ratio for recurrence of 1.9 (95% confidence interval [95%CI]: 1.2-3.0) compared with CWU with obliteration. Conclusion Compared with adults, children were had 2.6 times more risk of recurrence. Procedures performed without mastoidectomy had the lowest risk of recurrence. In children, obliteration was associated with a significantly lower risk of recurrence. However, patients were not randomized regarding the surgical approach; thus, the association between approach and risk of recurrence was likely influenced by confounding factors.

Study of Sigmoid Sinus Variations in the Temporal Bone by Micro Dissection and its Classification - A Cadaveric Study

Abstract Introduction Sigmoid sinus (SS) variations have been classified variously in the literature. These classifications suffer from some form of shortcoming from a clinical point of view for their application. Objective We propose a clinically relevant classification of the SS in relation to the posterior semicircular canal (PSCC) and to the exposure of the presigmoid dural plate. The positioning of the SS was analyzed with reference to the volume of themastoid and to the level of mastoid pneumatization. Methods A total of 94 formalin-preserved human cadaveric temporal bones were microdissected to carry out a complete mastoidectomy. The SS, the presigmoid dural plate, and the PSCCwere exposed, and the position of the former was analyzed in relation to the latter two in order to classify the position of the SS into three grades. Results GradeI hadthebest exposureof the presigmoid dura andof the PSCC,while grade III had the poorest exposure of the presigmoid dura and of the PSCC. Grade I SS was associated with good pneumatization and highermastoid volumescompared with grades II and III. Conclusions The SS exhibits considerable anatomic variability. A favorable positioning of the SS is associated with a large mastoid volume and pneumatization. A careful preoperative study of the imaging may help in understanding the positioning of the SS and the safety of various transmastoid approaches.

Effects of cavity reconstruction on morbidity and quality of life after canal wall down tympanomastoidectomy / Efeitos da reconstrução da cavidade da timpanomastoidectomia com técnica aberta na morbidade e qualidade de vida

Abstract Introduction: Canal wall down tympanomastoidectomy is commonly used to treat advanced chronic otitis media or cholesteatoma. The advantages of canal wall down mastoidectomy are excellent exposure for disease eradication and postoperative control of residual disease; its disadvantages include the accumulation of debris requiring life-long otological maintenance and cleaning, continuous ear drainage, fungal cavity infections, and the occurrence of dizziness and vertigo by changing temperature or pressure. Objective: To evaluate whether cavity-induced problems can be eliminated and patient comfort can be increased with mastoid cavity reconstruction. Methods: In total, 11 patients who underwent mastoid cavity reconstruction between March 2013 and June 2013 comprised the study group, and 11 patients who had dry, epithelialized CWD cavities were recruited as the control group. The study examined three parameters: epithelial migration, air caloric testing, and the Glasgow Benefit Inventory. Epithelial migration, air caloric testing, and the Glasgow Benefit Inventory were evaluated in the study and control groups. Results: The epithelial migration rate was significantly faster in study group (1.63 ± 0.5 mm/week) than control group (0.94 ± 0.37 mm/week) (p = 0.003, p < 0.05). The mean slow component velocity of nystagmus of the study group (13.33 ± 5.36°/s) was significantly lower when compared to control group (32.11 ± 9.12°/s) (p = 0.018). The overall the Glasgow Benefit Inventory score was −7.21, and the general subscale, physical and social health scores were −9.71, −21.09, and +20.35, respectively in the control group. These were +33.93, +35.59, +33.31, and +29.61, respectively in the study group. All but the social health score improved significantly (0.007, 0.008, 0.018, and 0.181, respectively). Conclusions: Cavity reconstruction improves epithelial migration, normalizes caloric responses and increases the quality of life. Thus, cavity rehabilitation eliminates open-cavity-induced problems by restoring the functional anatomy of the ear.

Resumo Introdução: A timpanomastoidectomia com a técnica Canal Wall Down, ou técnica aberta, é comumente utilizada para tratar otite média crônica avançada ou colesteatoma. As vantagens da mastoidectomia pela técnica aberta são uma excelente exposição para a erradicação da doença e controle pós-operatório da doença residual; suas desvantagens incluem o acúmulo de detritos que requerem manutenção e limpeza otológica ao longo da vida, drenagem contínua da orelha, infecções fúngicas na cavidade e a ocorrência de tonturas e vertigem com alterações de temperatura ou pressão. Objetivo: Avaliar se os problemas induzidos pela cavidade podem ser eliminados e o conforto do paciente aumentado com a reconstrução da cavidade mastoide. Método: No total, 11 pacientes submetidos à reconstrução da cavidade mastoide entre março de 2013 e junho de 2013 constituíram o grupo de estudo, e 11 pacientes com cavidades secas e epitelizadas, operadas pela técnica aberta, foram recrutados como grupo controle. O estudo analisou três parâmetros: migração epitelial, prova calórica com estimulação a ar e o questionário Glasgow Benefit Inventory. A migração epitelial, a prova calórica e o Glasgow Benefit Inventory foram avaliados nos grupos de estudo e controle. Resultados: A taxa de migração epitelial foi significativamente mais rápida no grupo de estudo (1,63 ± 0,5 mm/semana) do que no grupo controle (0,94 ± 0,37 mm/semana) (p = 0,003, p < 0,05). A velocidade média do componente lento do nistagmo no grupo de estudo (13,33 ± 5,36°/s) foi significativamente menor se comparada ao grupo controle (32,11 ± 9,12°/s) (p = 0,018). O escore global do Glasgow Benefit Inventory foi de -7,21 e os escores da subescala geral, saúde física e social foram -9,71, -21,09 e +20,35, respectivamente, no grupo controle. Esses escores foram +33,93, +35,59, +33,31 e +29,61, respectivamente, no grupo de estudo. Todos, exceto o escore de saúde social, melhoraram significativamente (0,007, 0,008, 0,018 e 0,181, respectivamente). Conclusões: A reconstrução da cavidade melhora a migração epitelial, normaliza as respostas da prova calórica e aumenta a qualidade de vida. Assim, a reabilitação da cavidade elimina os problemas induzidos por cavidades abertas ao restaurar a anatomia funcional da orelha.

Carcinoma de osso temporal sem foco metastático primário: relato de caso e revisão de literatura / Carcinoma temporal bone unfocused metastatic primary: case report and literature review

Os tumores do osso temporal são raros e geralmente apresentam sintomas como otorreia, otalgia e hipoacusia, por isso podem ser facilmente confundidos com um processo infeccioso, retardando o diagnóstico e piorando o prognóstico do paciente. KS, 7 anos, masculino. Estado geral: regular. Ao exame: consciente; linfonodos cervicais palpáveis, móveis; massa palpável, imóvel e indolor em topografia retroauricular esquerda; surdez à esquerda e paralisia facial esquerda. Tomografia computadorizada de crânio evidenciou lesão expansiva do osso temporal captante de contraste com extensão para fossa média e posterior do crânio. Realizada complementação radiológica com ressonância de encéfalo, a qual apresentou imagem hipercaptante em T1 contrastado. Nas incidências T2, observa-se edema lobotemporal adjacente à lesão. Exame angiográfico cerebral apresentou obstrução tumoral do seio sigmoide esquerdo. Paciente submetido à mastoidectomia radical esquerda com ligadura e ressecçãodo seio sigmoide esquerdo resultando em ressecção completa lesional. Anatomopatológico e exame imunoistoquímico compatíveis com adenocarcinoma. Encaminhado para terapia oncológica com quimioterapia e radioterapia. Óbito após quatro meses do tratamento neurocirúrgico. O diagnóstico precoce associado com a extensão do tumor acarreta melhor ou pior prognóstico para os pacientes acometidos por essa moléstia.

Tumors of the temporal bone are rare and usually have symptoms such as otorrhea, otalgia and hearing loss and, therefore, can be easily confused with an infectious process delaying diagnosis and worse prognosis. KS, age 7, male. General condition: regular. On examination: conscious, palpable cervical lymph nodes, mobile; palpable mass, painless and property surveying retroauricular left, left deafness and facial paralysis left. Cranial computed tomography showed a lesion of the temporal bone with extensionto the middle fossa and posterior skull that enhance with contrast. Performed complementation with radiological MRI brain image which showed uptake, in contrast T1. Incidences in T2, there is edema temporal lobe adjacent to the lesion. Cerebral angiography showed a tumor obstructing the left sigmoidsinus. Patient underwent left radical mastoidectomy with ligation and resection of the left sigmoid sinus resulting in complete lesional resection. Histopathological and immunohistochemical examination compatible with adenocarcinoma. Referred for cancer therapy with chemotherapy and radiation. Death within four months after neurosurgical treatment. Early diagnosis associated with tumor extension carries a better or worse prognosis for patients affected by this disease.

Cirugía del colesteatoma y audición / Cholesteatoma surgery and audition

Introducción: El colesteatoma es una entidad clínica que se presenta principalmente en edades medias de la vida. El tratamiento definitivo es quirúrgico, el cual apunta a erradicar la enfermedad, mientras que mantener o mejorar la audición es un objetivo secundario. Existen diversas técnicas quirúrgicas siendo la aticoantromastoidectomía con o sin preservación de la pared posterosuperior del conducto auditivo externo la más utilizada. Objetivos: Caracterizar a la población sometida a tratamiento quirúrgico del colesteatoma en el Hospital Clínico de la Universidad de Chile y determinar los cambios auditivos posoperatorios. Material y método: Se realiza un estudio descriptivo retrospectivo en donde se analizan los procedimientos quirúrgicos entre los años 2007y 2012. Se registran y analizan datos individuales, valores audiométricos pre y posoperatorios y tipo de cirugía realizada. Resultados: Se incluyen 143 pacientes con promedio de edad de 41 años, siendo el 56% de sexo masculino. El 54,5% fueron aticoantromastoidectomía; 21,6% aticoantrostomía; 16,7% aticoantromastoidectomía más timpanoplastía IIIA y 6,7% aticoantromastoidectomía más timpanoplastía IIIB. Los umbrales auditivos se mantuvieron en la aticoantrostomía, en la aticoantromastoidectomía y en la aticoantromastoidectomía con timpanoplastía tipo IIIB, mientras que la audición mejoró significativamente en las aticoantromastoidectomía con timpanoplastía tipo IIIA. Conclusión: La técnica mayormente utilizada en el Hospital Clínico de la Universidad de Chile para el manejo del colesteatoma es la aticoantromastoidectomía con o sin preservación de la pared posterosuperior del conducto auditivo. Aquellos pacientes a los que se les asocia una timpanoplastía tipo IIIA presentan una mejoría auditiva significativa.

Introduction: The cholesteatoma is a clinical entity that presents mostly in middle ages. The definitive treatment is surgery; which aims to eradicate the disease, while maintaining or improving hearing thresholds is a secondary goal. Several surgical techniques have been described, being the tympanomastoidectomy with or without preservation of the postero-superior wall of the external auditory canal the most commonly used. Aim: To characterize the population that underwent surgical treatment forcholesteatoma in the Clinical Hospital of the University of Chile and to determine the post-surgical hearing thresholds changes. Methods: Retrospective and descriptive study of the surgical procedures carried out between the years 2007 and 2012. Individual data, pre and post-surgical treatment audiometric values and types of surgery are registered and analyzed. Results: 143 patients were included with a 41 year age average, 56% were males. 54,4% of surgeries were tympanomastoidectomy; 21,6% atticotomy; 16,7% tympanomastoidectomy with type IIIA tympanoplasty and 6,7% tympanomastoidectomy with type IIIB tympanoplasty. Hearing thresholds were maintained in atticotomy, tympanomastoidectomy and tympanomastoidectomy with type IIIB tympanoplasty, while hearing thresholds improved in the tympanomastoidectomy with type IIIA tympanoplasty reconstruction. Conclusion: The most used technique for cholesteatoma treatment in the Clinical Hospital of the University of Chile was tympanomastoidectomy with or without preservation of the posterosuperior wall of the external ear canal. Patients who had a type IIIA tympanoplastyimproved their hearing thresholds.