New morphometric findings in adhesive otitis media: petroclival angle and eustachian tube-tympanic cavity ventilation angle.

OBJECTIVE: Observations during adhesive otitis media (OM) surgery led us to consider that morphometric variations might cause formation of the middle ear cavity with smaller bony boundaries during developmental process. Among the various factors mentioned in the literature, we thought that angle of the petrous bone relative to the midsagittal line and the eustachian tube-tympanic cavity ventilation angle might be factors in the course of adhesive otitis media. METHODS: Axial computerized tomography scans from 14 patients with adhesive OM and 19 cases (control group) with normal middle ear-tympanic membrane were retrospectively examined in terms of petroclival angle and eustachian tube-tympanic cavity ventilation angle. Measurements of these two angles were compared between the two groups. A correlation was also investigated between these two angles. RESULTS: The petroclival angle (54.5 degrees vs 62.3 degrees) and the eustachian tube-tympanic cavity ventilation angle (156 degrees vs 162.6 degrees) in the adhesive OM group were narrower than those of controls (p<0.01). The correlation analysis showed that there was a strong association between two angles (r, 0.803; p<0.01). CONCLUSIONS: More medially positioning of the petrous bone and acutely angled-eustachian tube-tympanic cavity ventilation axis were observed in this study. It would be reasonable to conclude that these findings might take part in development of adhesive OM. We should also admit that these results do not decline the previous theories that account for development of the adhesive otitis media.

Abnormal petrous apex aeration. Review of 12 cases.

OBJECTIVE: Abnormal aeration of the petrous bone, which may be responsible for some clinical symptoms, is an incidental radiological finding. It has been reported that people with abnormal aeration at the petrous bone are more prone to develop complications. In an attempt to make clear the clinical importance of a giant air cell at the petrous apex or abnormal aeration of this region, a prospective analysis has been planned. METHOD: 430 temporal bone CTs taken for diagnostic imaging only between 1992-2000 have been reviewed and 12 cases with petrous air cell were selected. Aeration was measured on computer basis. Patients were invited for interview and subjected to complete audilogical and ENG testing Symptoms of the patients were reviewed and the possible link with the radiological findings has been discussed. RESULTS: The internal distance of the air cell was ranging between 1.6 to 2.5 cm at transverse axis and between 2.0 to 4.2 cm at longitudinal axis. It was noted that all patients with large air cell at the apex also had extensive mastoid and temporal bone aeration. The degree of temporal bone aeration and the size of air cell was the same in both sexes. Four patients had balance problems. One patient had sudden hearing loss. Two patients had Bell's palsy. Two patients were asymptomatic. Six patients had normal hearing level. Five patients demonstrated ENG abnormality. CONCLUSIONS: It was found that these patients had some ear symptoms which were usually vague and nonlocalizing. It was unlikely to attribute these symptoms to a giant apical air cell or abnormal aeration of the petrous bone.

Complications of chronic otitis media.

In summary, recent literature indicates that the complications of chronic otitis media have been decreasing. However, even with the advent of modern and more powerful antimicrobials and aggressive surgical eradication of disease, the morbidity and mortality are still high. Some complications may initially be quite obvious and some complications may be quite subtle. Therefore, the most important tools in making early diagnosis are careful history and physical examination, and a high index of suspicion for impending complications.

[Petronasal fistula caused by the epidermal cyst of the cerebellopontine angle region]. / Przetoka skalisto-nosowa spowodowana torbiela naskórkowa okolicy kata mostowo-mózdzkowego.

The authors report a rare case of the occurrence of the paradoxical CFN rhinerrhea in a three months after epidermal cyst of the cerebellopontine region removal. The good result of the surgical fistula obliteration was reached by using muscle graft and tissue glue.

[Treatment of petrous bone cholesteatoma]. / Tratamiento del colesteatoma intrapetroso (CIP).

Cholesteatoma involving the petrous compartment of the temporal bone is rare and is a difficult surgical challenge for the neuro-otological surgeon. A series of 60 cases of petrous bone cholesteatoma is presented. The diagnosis, surgical treatment, results, and complications are discussed. Our present surgical attitude is based on closed obliterative procedures that allow a wide field exposure with radical removal excision, control and protection of vital structures, and management of problems related to the facial nerve. The treatment of dura mater involved by matrix is still unsolved. Regular follow-up with CT and MRI is mandatory.