Hearing aids worn with tympanic membrane perforation: complications and solutions.

Hearing aids are sometimes recommended in ears with tympanic membrane perforation. Presented are six illustrative cases that represent various degrees of perforation, ear-mold styles, and wearing habits. The degrees of perforation represented include total, 50%, 20%, myringotomy tube, and modified mastoid cavity (canal up). Patients wearing earmolds with total perforation experience nearly constant irritation, infection, itching, or drainage. Rare periods of success are achieved in such cases by strict adherence to hygiene and ventilation guidelines. Lesser degrees of perforation usually experience significantly fewer problems if such guidelines are followed. Ear ventilation is found to be the primary success factor, whether achieved by periods of non-use or earmold venting. Since the potential for serious complications always exists, such fittings require patient education and regular otologic follow-up.

The masticator space: the influence of CT scanning on therapy.

The masticator space is an important suprahyoid tissue compartment bounded by the superficial layer of the deep cervical fascia, enclosing the ramus of the mandible plus the masseteric and pterygoid muscles. Pathology of this space has been clinically difficult to diagnose and treat. Twenty-five patients with either tumor or infection involving the masticator space who underwent CT scanning were evaluated retrospectively. Ten patients had infection and 15 had tumor. CT was influential in directing appropriate biopsies or therapy in 24 of 25 patients. It misguided therapy once. The gross anatomic and CT appearance of the normal and the diseased masticator space is described along with pictures of representative cases. A discussion is given of the advantages, disadvantages, and pitfalls of computerized tomography of the masticator space.

Infection and tumor of the masticator space: CT evaluation.

The masticator space is a distinct deep facial space, bounded by the superficial layer of deep cervical fascia and containing the four muscles of mastication and the ramus and posterior body of the mandible. Trismus often complicates evaluation of masticator space disease. However, computed tomography (CT) clearly delineates the normal and pathologic anatomy of this region. The CT appearance of the masticator space was demonstrated in a retrospective review of 32 patients with either infection or tumor involving this space. Masticator space infections were found to have characteristic CT appearances and patterns of spread. CT was especially useful in differentiating inflammation from frank abscess, detecting mandibular osteomyelitis, and directing surgical drainage to the precise deep-tissue space involved. In cases of tumor, the primary utility of CT was in defining tumor extent accurately and in helping to assess resectability and determine radiation therapy ports.