Congenital absence of the oval window: radiologic diagnosis and associated anomalies.

BACKGROUND AND PURPOSE: In most children with conductive hearing loss, acquired otitis media and/or middle ear effusion are ultimately diagnosed. Congenital conductive hearing loss is a rare condition; absence of the oval window is an unusual pathogenesis for this type of hearing impairment and can be associated with an anomalous horizontal facial nerve canal. Our goal was to describe the imaging features of congenital absence of the oval window, to determine the frequency with which anomalous development of the horizontal facial nerve canal occurs, and to review the developmental error responsible for this malformation. METHODS: Nine temporal bones in seven patients (5 to 36 years old) were found to have an inadequately formed oval window on high-resolution CT scans; seven ears showed complete lack of oval window formation, and two showed partial absence of the oval window. Records were reviewed for clinical information, and images were examined for associated anomalies. RESULTS: Six of nine ears with abnormal oval window formation showed malposition of the horizontal facial nerve canal. In each of these, the canal was abnormally low, overlying the expected location of the oval window; three of the canals lacked a visible bony covering. Seven of the nine ears were found to have a dysplastic or absent stapes. CONCLUSION: Congenital absence of the oval window can be diagnosed on CT studies. In the present series, this anomaly was associated with a grossly aberrant horizontal facial nerve canal in six of nine involved ears. Familiarity with the developmental sequence of oval window formation fosters an understanding of these anomalies. Preoperative recognition is important clinically, as a low facial nerve will block surgical access to the oval window and its presence will alter patient management.

Pediatric sinonasal imaging: normal anatomy and inflammatory disease.

Pediatric sinonasal anatomy changes and develops from birth to adolescence. This article elucidates the normal anatomy and patterns of development in the pediatric population. Issues in pediaric sinusitis include indications for imaging, the nonspecificity of sinus opacification, and the importance of clinical information. Sinonasal physiology is briefly discussed to offer insight into the interpretation of radiographic findings. Cystic fibrosis, polyps, and choanal atresia, representing the spectrum of common pediatric sinonasal inflammatory disorders are illustrated, and the spectrum of orbital and intracranial complications of sinusitis is reviewed.

Manifestations of AIDS in the head and neck.

BACKGROUND: A significant number of patients with the acquired immunodeficiency syndrome (AIDS) are initially seen with symptoms related to the head and neck. It is becoming increasingly challenging for clinicians to accurately diagnose new lesions, considering the vast array of manifestations of AIDS in this region and their many atypical presentations. A comprehensive review is a valuable clinical tool. METHODS: A MEDLINE search of the English language literature from 1984 to the present was done for this study. RESULTS: Dermatologic, otologic, nose/paranasal sinuses/nasopharynx, oral cavity/oropharynx, laryngeal, and neck manifestations are reviewed. The gross and microscopic appearances of lesions are described, with particular emphasis on various presentations of the same lesion and lesions that may mimic the appearance of others. Practical treatment strategies are also discussed. CONCLUSIONS: Accurate and early recognition of the many common and uncommon manifestations of AIDS in the head and neck is of critical importance to the timely and effective management of these patients.

Update on sinonasal imaging: anatomy and inflammatory disease.

Functional endoscopic sinus surgery, now the standard of care for surgical treatment of chronic and recurrent sinusitis, has changed current concepts of sinus health and disease. Interpretation of the CT scan must reflect this focus on anatomy and function. This article seeks to provide a clear understanding of sinonasal drainage. The normal frontal recess, ostiomeatal unit, and sphenoethmoid recess are considered along with the anatomic variations that distort their appearance and predispose the patient to developing sinus disease. The spectrum of uncomplicated and complicated sinonasal inflammatory disease is discussed.

Allergic fungal sinusitis: CT findings.

PURPOSE: To determine the computed tomographic (CT) findings in patients with allergic fungal sinusitis. MATERIALS AND METHODS: The authors retrospectively reviewed CT scans and surgical and histopathologic reports in 45 patients (27 male, 18 female; age range, 8-68 years) with allergic fungal sinusitis from multiple institutions. The median age (25 years) and demographics of the patients were determined. Two head and neck radiologists together evaluated the CT scans for the presence of intrasinus high-attenuation areas, extent of sinus involvement, bone expansion and thinning, bone erosion, and extension of disease into the adjacent soft tissues. RESULTS: Allergic fungal sinusitis was more common in male patients and in patients aged 20-30 years. All patients had increased intrasinus attenuation at non-contrast material-enhanced CT. Multiple sinus involvement occurred in 43 patients. Bilateral involvement was more common than unilateral disease. Forty-four patients had complete opacification of at least one of the involved sinuses; 43 of these patients had expansion of an involved sinus, 42 had remodeling and thinning of the bony sinus walls, and 41 had erosion of the sinus wall. CONCLUSION: Allergic fungal sinusitis is a distinct clinical entity with nonspecific symptoms that may be initially suggested by the CT findings. These findings should alert the clinician to the possibility of allergic fungal sinusitis and prompt other diagnostic studies to establish the diagnosis and treatment plan.

Case report: extensive brain calcification in hypoparathyroidism.

It is well known that most patients with hypoparathyroidism have radiologically detectable basal ganglia calcification. Not as well known is that the brain calcinosis may be more extensive. We describe a 55-year-old woman with a 44-year history of symptomatic idiopathic hypoparathyroidism who has extensive calcification of her cerebrum and cerebellum as well as her basal ganglia, evident on computed tomography of the head. When first evaluated here 32 years ago, plain radiography of the skull demonstrated calcification of both caudate and lentiform nuclei (basal ganglia). Despite fair control of her serum calcium level, she has developed focal seizures, possibly related to the calcinosis of her brain.

CT appearance of primary CNS lymphoma in patients with acquired immunodeficiency syndrome.

Cranial CT studies of 32 patients with biopsy-proven AIDS-related primary CNS lymphoma were reviewed retrospectively. A wide variety of different CT appearances were identified. Mass lesions varied in location, size, and number. Most lesions were either iso- or hyperdense and all enhanced with contrast medium. Several different patterns of enhancement were observed. Mass effect and edema were seen in almost all patients. After radiotherapy, most tumors decreased in diameter, became hypodense, and no longer enhanced with contrast medium. Edema and mass effect decreased or resolved in all but one patient. Postradiotherapy CT scans also revealed interval enlargement of the ventricles and cortical sulci. This study demonstrates the wide diversity of CT appearances of AIDS-related primary CNS lymphoma. The CT findings cannot be used in lieu of biopsy for diagnosis of this disorder. The appearance of postradiotherapy CT scans was consistent with regressing lymphoma.

Computed tomography of the clinically negative neck.

Members of the New York Head and Neck Society conducted a multi-institutional review correlating preoperative computed tomography (CT) of the neck with postoperative pathology in 59 patients with squamous cell carcinoma of the oral cavity, pharynx, and larynx, without palpable lymphadenopathy. All underwent CT followed by surgery that included partial or complete cervical lymphadenectomy. Sixteen (28%) patients had occult cervical metastases including 6 (17%) of 36 patients with "early stage" (T1 and T2) primary tumors and 10 (44%) of 23 patients with "advanced" (T3 or T4) lesions. There was agreement of CT scan findings with presence or absence of metastatic disease in 41 (69%) of 59 studies, with sensitivity 38%, and with specificity 81%. Findings of central lucency and nodal confluence were highly reliable indicators of malignancy, whereas nodal size bore a less direct relationship. Intravenous contrast medium was useful for anatomical delineation, but not for identification of malignancy. Review of films by a single radiologist did not produce greater diagnostic accuracy than the original interpretations. The authors conclude that while it is not possible to identify all instances of cervical node involvement, employment of CT in addition to physical examination and prognostication based on primary tumor stage will facilitate appropriate selection of patients for elective treatment of the neck.