Correlation of Mastoid Pneumatization with Middle Ear Pathology in Unilateral Squamous Type of Chronic Otitis Media (original) (raw)
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Pneumatization Pattern and Status of the Mastoid Antrum in Chronic Otitis Media: A Review
Cureus
Chronic otitis media is generally more prevalent in individuals with a weakly pneumatized temporal bone, whereas acute otitis media has a propensity for pneumatized temporal bone. Antimicrobial drugs are thought to have influenced the incidence and progression of middle ear infections. The mastoid air cell system, a part of the middle ear cleft, has recently been recognized as a crucial factor in the genesis, behaviour, course, and outcome of middle ear inflammatory conditions. Epithelium infiltrates the growing bone and produces epithelium-lined air cell chambers, a process known as pneumatization. Conventional temporal bone radiography, i.e. X-ray mastoid, has not kept up with recent otology breakthroughs. Detailed visualization of the aural structures has advanced significantly with the introduction of high-resolution computed tomography (HRCT). HRCT has a clear edge in the assessment of the temporal bone, especially when thin-section, high-resolution methods are used, resulting in a more precise description of the pneumatization pattern and the anatomical extent of middle ear pathology. Our results of the review indicated that persistent inflammation of the middle ear in children inhibits pneumatization of the temporal bone. Due to its potential to exert a greater negative middle ear pressure, the middle ear volume is insufficient to generate a retraction pocket; thus, the size and state of the antrum is also a significant factor in the establishment of a COM-like retraction pocket in inactive squamosal disease. Numerous factors, including the number of patients, regional, genetic, ethnic and hereditary characteristics, as well as the cellularity of the mastoid, which is impacted by a multitude of factors, may account for the variable reports and inter-study variation in this regard.
International Journal of Otorhinolaryngology and Head and Neck Surgery, 2020
Background: Chronic otitis media (COM) affects 0.5-30% of individuals in any community and over 20 million people are estimated to suffer from this condition worldwide. COM often evolves in a continuum. Squamosal disease is more commonly found in poorly pneumatized bones, but whether the sclerosis is relevant to the etiology of the disease or is caused by it, has not been fully resolved. Our study aimed at comparing the mastoid pneumatization patterns obtained using X-ray mastoid and high-resolution computed tomography (HRCT) temporal bone. It was an interventional study.Methods: Sixty patients of unilateral squamosal COM, aged more than 8 years, underwent X-ray mastoid Schuller’s view and HRCT temporal bone, using Philips extended brilliance 48 slice CT. Results: Upon analysis, in diseased and healthy ears, the coincidence of X-ray and HRCT findings was 63.33% and 80% respectively.Conclusions: HRCT temporal bone should be done in all cases of squamosal COM to know the extent of th...
International journal of pediatric otorhinolaryngology, 2006
To assess the relation between mastoid size and attic blockage in COME patients treated with ventilation tube insertion and prognosis regarding tympanometric compliance and computed tomography findings of temporal bones. Twenty-four ears of 15 patients with chronic otitis media with effusion were selected prospectively. The ages of patients were between 5 and 13 years old and eight of them were females. All patient received medical treatment for 10 days. Ventilation tubes were inserted with or without adenoidectomy or adenotonsillectomy to the unimproved patients. Postoperative compliances were measured on first day, first week, and first month and the tympanometric results were compared each one with others and with mastoid pneumatization degree using computerized tomographic findings. The hearing thresholds were between 23 and 43 dB in left ears and between 22 and 45 dB in right ears. Mastoid pneumatization and aditus were normal and open in three (12.6%); sclerotic and open in ei...
Indian Journal of Otolaryngology and Head & Neck Surgery, 2018
Squamous chronic otitis media (COM) implies formation of a retraction pocket (inactive form) or frank cholesteatoma (active form) in pars tensa or pars flaccida of tympanic membrane. A retraction pocket or frank cholesteatoma are believed to occur due to tubal dysfunction. The present study was undertaken to investigate the pattern of mastoid pneumatisation and Eustachian dysfunction by dynamic slow motion videoendoscopy (DSVE) in cases of both, active and inactive type of squamous chronic otitis media (COM). 52 patients (65 ears) comprising of twentysix ears with pars flaccida squamous disease and 39 ears with Pars Tensa squamous disease were enrolled for the study. DSVE findings, in terms of grade and type of Eustachian dysfunction were noted. Mastoid pneumatization pattern on CT-scans, and peroperative status of mastoid pneumatisation, especially contracted mastoid with anteriorly placed sigmoid sinus or low lying dura were also recorded for every case while performing tympano-mastoidectomy. Primary sclerotic/diploic type of mastoid pneumatisation pattern and Eustachian dysfunction were found to have inverse relationship in the cases of squamous otitis media. Eustachian dysfunction, diagnosed on DSVE, had significant association with both pars flaccida (P = 0.0001) and pars tensa disease (P = 0.0007). Primary sclerotic or diploic mastoid were found to be more common in ears with pars flaccida squamous disease than pars tensa COM (46.15% vs. 38.46%, P \ 0.05).
Importance of mastoid pneumatization on secretory otitis media
International Journal of Pediatric Otorhinolaryngology, 1997
Secretory otitis media is the most common middle ear disease of childhood. It heals spontaneously, by medical therapy or by minor surgical procedures in most of the cases. Sequelae such as retraction pockets and adhesive otitis that lead to cholesteatoma rarely occur, but initially it is hard to diagnose which patient will acquire a sequela. It is well known that mastoid pneumatization is poor in the patients who had complications like retraction pocket, adhesive otitis and cholesterol granuloma. The aim of this study was to determine if any relationship exists between mastoid pneumatization and secretory otitis media. Lateral mastoid X-rays of 47 children with secretory otitis media were evaluated. After 2 months of follow-up with medical therapy, 30 of the 47 patients needed ventilation tube insertion. The remaining 17 patients showed total recovery with medicines only. Control X-rays of the operated patients were taken 6 months after the operation. Mastoid pneumatizations of patients healed with medicine were compared with the operated patients. There were statistically significant differences between the mastoid pneumatizations of surgically and medically treated groups. In addition we observed a statistically significant difference between the mastoid areas of the preoperative and the postoperative X-rays. We concluded that mastoid pneumatization might be considered as a prognostic indicator in secretory otitis media. The estimated prognosis is poor when the mastoid pneumatization is poor.
The Journal of International Advanced Otology, 2020
The Journal of International Advanced Otology (J Int Adv Otol) is an international, peer reviewed, open access publication that is fully sponsored and owned by the European Academy of Otology and Neurotology and the Politzer Society. The journal is published triannually in April, August, and December and its publication language is English. The scope of the Journal is limited with otology, neurotology, audiology (excluding linguistics) and skull base medicine. The Journal of International Advanced Otology aims to publish manuscripts at the highest clinical and scientific level. J Int Adv Otol publishes original articles in the form of clinical and basic research, review articles, short reports and a limited number of case reports. Controversial patient discussions, communications on emerging technology, and historical issues will also be considered for publication. Target audience of J Int Adv Otol includes physicians and academics who work in the fields of otology, neurotology, audiology and skull base medicine.
Volume and Surface of the Mastoid Cell System in Otitis Media With Effusion in Children
Otology & Neurotology, 2011
Objective: To characterize the pneumatization of the temporal bone in age-matched healthy children and in children with otitis media with effusion (OME). Study Design: Prospective case-control study. Setting: Tertiary hospital center. Patients: This study included 40 healthy children and 56 children with OME, with age ranging from 2 to 18 years. Intervention: Mastoid volume and surface determination by 3-dimensional reconstruction of axial temporal bone computed tomographic images. Main Outcome Measure: Mastoid volume and surface area comparison of healthy children and children with OME. Results: The mastoid cell system (MCS) grows continuously up to the age of 18 years, with different intensities. The mean T SD MCS volume and surface of children with OME are significantly lower (2.82 T 1.51 ml and 40.45 T 18.14 cm 2 , respectively) than those of healthy children (10.05 T 5.3 ml and 84.47 T 37.95 cm 2 , respectively). The mastoid volume and surface area of the left and right ears correlate well in healthy children. In children with bilateral OME, the ipsilateral and contralateral ears can be largely different. The ratio of surface and volume is constant in age groups. Conclusion: In children with OME, the functional volume of MCS acting as a pressure buffer and the surface area serving for gas exchange are small. In case of OME, 1 ear could be more seriously affected by the disease. Otitis media with effusion presumably has a negative effect on the mastoid pneumatization process. The surface-to-volume ratio is constant through chronological age and is a good indicator of a normal middle ear function. Key Words: Computed tomographic reconstruction of temporal boneVGrowth rate of mastoid cell systemVMastoid surface-to-volume ratioVPediatric otitis with effusion.
Journal of Babol University of Medical Sciences, 2018
BACKGROUND AND OBJECTIVE: Nasal septum deviation (NSD) is one of the leading causes of chronic otitis media and pneumatization of mastoid air cells. In this study, the effect of NSD on pneumatization of mastoid cells and the relationship between NSD and chronic otitis media were investigated using CT scan. METHODS: In this cross-sectional study, 75 paranasal sinus CT scans with NSD and mastoid view were investigated. Patients were divided into three groups based on the severity of NSD: mild (deviation less than 9 degrees, 25 patients), moderate (deviation from 9 to 15 degrees, 25 patients) and severe (deviation equal to or greater than 15 degrees, 25 patients). Chronic otitis media is defined as the presence of bone destruction or sclerosis accompanied by mass fluid or structural changes in temporal bone air cells. The pneumatization of mastoid cells was determined visually and as formation of mastoid air cells. FINDINGS: There was no significant difference in the frequency of pneumatization of mastoid cells between mild (25 patients, 100%), moderate (25 patients, 100%) and severe (23 patients, 92%) nasal septum deviation (p = 0.128). However, the prevalence of chronic otitis media was significantly higher in severe NSD (13 patients, 52%) compared to mild (4 patients, 16%) and moderate (9 patients, 36%) NSD (p = 0.028) CONCLUSION: The results of the study showed that the severity of NSD does not have an effect on pneumatization of mastoid cells, but severe NSD increases the frequency of otitis media.
The Egyptian Journal of Otolaryngology
Background Active squamous chronic otitis media (COM) is an entity with a deep retraction pocket of the pars tensa or flaccida that has retained debris of squamous epithelial where the fundus cannot be visualized involving the pars flaccida or pars tensa, associated with cholesteatoma. Eustachian tube dysfunction (ETD) is a known etiological factor for squamous COM, based on Wittmack’s theory; however, there are very few recent studies in this regard. Contracted mastoid pneumatisation (diploic or primary sclerosis) and presence of Korner’s septum have also been implicated to be associated with middle ear pathology, with conflicting results. Hence, the present study was undertaken to find out the association of three important factors, namely eustachian tube dysfunction, type of mastoid pneumatisation, and Korner’s septum related to mastoid buffer and middle ear ventilation in etiopathogenesis of active squamous chronic otitis media. The study also attempted to identify various condi...
The Journal of Laryngology & Otology, 1992
The relationship between temporal bone pneumatization and the location of the lateral sinus and length of the mastoid process was investigated in 60 fresh frozen adult temporal bones, by plain X-rays, computed tomography and surgical dissection including otomicroscopic findings. Temporal bone pneumatization was classified as small, moderate and large. After drilling, the shortest distances between the middle fossa dura and mastoid tip representing the mastoid length and between the sigmoid sinus and posterior border of external auditory canal were measured and compared to the degree of pneumatization. The distances in the specimens with pathological eardrum and adhesions in the middle ear were compared to the ones without gross pathology. The length of mastoid process was significantly shorter in specimens with small pneumatization than those with large (Mann Whitney P<0.001).The specimens with a pathological eardrum and middle ear adhesions had a significantly shorter mastoid le...