Anatomical and Clinical Evaluation of Tympanic Tegmen and Mastoid Bone with Multidetector Computed Tomography / Evaluación Anatómica y Clínica del Tegmen Timpánico y Hueso Mastoideo con Tomografía Computarizada Multidetector

SUMMARY: Tegmen level and mastoid bone thickness are important parameters of surgical risk in middle ear and mastoid region surgeries. This retrospective cohort study was conducted to provide a risk classification for the mastoid and middle ear regions. The study population comprised of 300 patients who underwent multidetector computed tomography (MDCT) for various indications. Patients with no pathology that disrupted the structure of the temporal region were included in the study. A risk classification was generated by analyzing the data obtained from mastoid and tympanic tegmen depths and the mastoid bone thickness by MDCT. The mastoid and tympanic tegmen were lower on the right side than on the left. In women, the right-sided mastoid bone thickness and mastoid tegmen were lower, and low-level tympanic and mastoid tegmen on the left and thin right mastoid bones were more common. According to the risk classifications for mastoid and middle ear region surgeries, women demonstrated a higher risk than men. In addition, as the thickness of the mastoid bone increased, the levels of the mastoid and tympanic tegmen increased. The present study provides a proper risk classification that may be helpful for preoperative risk assessment prior to middle ear and mastoid region surgery.

El nivel del tegmen y el grosor del hueso mastoideo son parámetros importantes del riesgo quirúrgico en las cirugías del oído medio y la región mastoidea. Este estudio de cohorte retrospectivo se llevó a cabo para proporcionar una clasificación del riesgo en las regiones mastoidea y del oído medio. La población de estudio estuvo compuesta por 300 pacientes que se sometieron a una tomografía computarizada multidetector (MDCT) por diversas indicaciones. Se incluyeron en el estudio pacientes sin patología que alterase la estructura de la región temporal. Se generó una clasificación de riesgo analizando los datos obtenidos de las profundidades del tegmen mastoideo y timpánico y el grosor del hueso mastoideo por TCMD. El tegmen mastoideo y timpánico estaban más bajos en el lado derecho que en el izquierdo. En las mujeres, el grosor del hueso mastoideo del lado derecho y el tegmen mastoideo eran más bajos, y eran más frecuente la presencia de tegmen timpánico y mastoideo de bajo nivel en los huesos mastoideos izquierdo y delgados en el lado derecho. Según las clasificaciones de riesgo de las cirugías de la región mastoidea y del oído medio, las mujeres presentaban un mayor riesgo que los hombres. Además, a medida que aumentaba el grosor del hueso mastoides, aumentaban los niveles del tegmen mastoideo y timpánico. El presente estudio proporciona una clasificación de adecuada de riesgo que puede ser útil para la evaluación preoperatoria del riesgo antes de la cirugía del oído medio y la región mastoidea.

Comparison of preoperative computerized tomography scan imaging of temporal bone with the intra-operative findings in patients undergoing mastoidectomy

To compare the consistency rates of pre- and intra-operative radiological findings in patients with chronic suppurative otitis media CSOM. In a cross-sectional study, 80 patients with CSOM underwent pre-operative CT scanning and we compared the results with intra-operative clinical findings during mastoidectomy from 2000-2004 in the Otology Department, Amiralmomenin Hospital of Guilan Medical University, Rasht, Iran. Sensitivity, specificity, positive and negative predictive value of CT scan in tympanic and mastoid cholesteatoma, ossicular chain erosion, tegmen tympani erosion, dehiscence of facial canal, lateral semicircular canal LSCC fistula were assessed. Then, correlation between radiological findings and intra-operative findings were calculated. The mean age of the patients was 27.9 +/- 16.3 years. Mostly were males n = 57 [71.3%]. Correlation of preoperative radiological images with intra-operative clinical findings were moderate to good on tympanic cholesteatoma, mastoid cholesteatoma and ossicular chain erosion, but weak and insignificant in cases of tegmen tympani erosion, facial canal dehiscence and LSCC fistulae. Preoperative CT scan may be helpful in decision-making for surgery in cases of cholesteatoma and ossicular erosion. Despite of limitations radiological scanning is a useful adjunct to management of CSOM

Evaluation of the effect of diagnostic X-ray in the improvement of the outcome of active safe chronic suppurative otitis media

To evaluate the impact of diagnostic mastoid X-ray in the improvement of the outcome of active safe chronic suppurative otitis media [CSOM]. Retrospective study, for two groups of patients. A total of 270 patients with safe active CSOM were managed by routine aural toilet, antibiotics and decongestant, divided in to two groups, those who were not exposed to diagnostic x-ray [Group I] and those who were exposed to diagnostic mastoid x-ray [group II]. Oto-Rhino-Laryngological Department in Mosul General Hospital and Al-Rahma hospital during the period from January 2002 to December 2004. The final result after 10-15 weeks of follow-up indicated that 50% of patients had complete dryness of the ear from discharge in those exposed to diagnostic X-ray and Only 25% of those not exposed to diagnostic X-rays showed complete dryness of the ear, [p-value = 0.000] which is statistically a significant result. Some patients with active safe CSOM may get benefit from exposure to diagnostic mastoid X-rays

Ear teratoma; a case report

Teratomas are tumors originated from mature or immature tissues. Teratomas are made up of one embryonic layer or all three embryonic layers [endoderm, mesoderm, or ectoderm]. Herein we report a 41-year-old man who presented with vertigo, vomiting, and tinnitus. After physical examination, laboratory evaluation and performing computed tomography, cholesteatoma was diagnosed, however, during radical mastoidectomy a cystic tumor was found. The result of pathology proved middle ear and mastoid teratoma

comparison of tragal perichondrium with or without cartilage with temporalis fascia for tympanoplasty

A comparative study of 160 patients who had tympanoplasty performed at Pakistan Institute of Medical Sciences, Islamabad, between the periods of Oct. 1987 and Oct. 1990 is presented. Two types of grafting materials were used in the repair of the tympanic membrance, viz; temporalis fascia and tragal perichondrium with or without cartilage. Results of 99 patients with tragal perichondrium-cartilage vs. 61 patients with temporalis fascia are presented. All these cases were followed up for at least one year. Tragal perichodrium with or without cartilage was found to be superior to temporalis fascia