1/10. Acute mastoiditis and cholesteatoma.Acute coalescent mastoiditis is an uncommon sequela of acute otitis media. It occurs principally in the well-pneumatized temporal bone. The findings of fever, pain, postauricular swelling, and otorrhea are classic. cholesteatoma, on the other hand, being associated with chronic infection, usually occurs in the sclerotic temporal bone. The signs and symptoms are isidious in nature and consist of chronic discharge and hearing loss which result from its mass, bone erosion, and secondary infection. Of 17 consecutive cases of acute mastoiditis over a six-year period, four were atypical because they were complications of chronic otitis media and cholesteatoma, yet they had the physical findings of acute mastoiditis-subperiosteal abscess and purulent otorrhea, plus radiographic evidence of mastoid coalescence.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
2/10. Foreign body neonatal otitis media in infants.HYPOTHESIS: An influx of amniotic fluid cellular content (AFCC) into the middle ears during birth may lead to the development of a chronic inflammatory process in the form of varying amounts of granulation tissue even if signs of otitis media are absent. This foreign body neonatal otitis media may predispose the child to recurrent otitis media. BACKGROUND: Foreign body neonatal otitis media caused by AFCC was described by Aschoff and elaborated by Wittmaack 100 years ago. Recent studies have shown how AFCC spreads to various middle ear compartments and causes histologic changes, the severity of which is related to the amount of AFCC. Specific elements become phagocytized after the first months of life but have caused the formation of inflammatory polyps and granulation tissue with round cell secretions in the meantime. methods: Ten temporal bones from the temporal bone Foundation, derived from infants aged 5 months to 1 year 11 months, were serially sectioned at 20 microm, saved at 0.2-mm intervals, numbered, and stained with hematoxylin and eosin. Every slide was studied for the presence, nature, and stage of pathologic tissue changes of the middle ear and the mastoid antrum. RESULTS: Pseudocystic granulation tissue was massive in the temporal bone of the 8-month-old child born through thick meconium. Severe changes were present in the temporal bones of two infants aged 5 months, one of which showed traces of AFCC. In the temporal bones of two older children, long-standing changes were minor, one of them still showed traces of AFCC. Fresh acute changes and long-standing histologic changes occurred side by side. CONCLUSIONS: Neonatal otitis media caused by AFCC can give rise to extensive granulation tissue and round cell secretion, which is likely to make the ear susceptible to infectious otitis media. Cumulative development of granulation tissue as a result of infection may lead to blockage of attic aeration and drainage pathways, causing irreversible adhesive otitis media. A data base should be formed of all neonates born through meconium-stained amniotic fluid to allow a comparison with those born through clear fluids. Surgery with the creation of auxiliary aeration pathways becomes advisable in the treatment of ears with massive development of granulation tissue.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
3/10. The use of computerized tomographic imaging in revision mastoid surgery for chronic otitis media.Recurrent otorrhea, pain, and a conductive hearing deficit are common indicators of possible recurrent disease following mastoidectomy for chronic otitis media. High-resolution computed tomography (CT) provides an excellent method for examination of the surgically altered mastoid. Areas of residual infected air cells, cholesteatoma, cholesterol granuloma, and other surgical conditions within the mastoid are localized by this technique prior to reexploration. The technique provides information regarding the extent of disease as well as possible anatomic variations and potential complications that may be avoided during surgery. The imaging modality illustrates the detailed nature and extent of the prior mastoid surgery. CT of the temporal bone is therefore a useful guide to the surgeon in managing patients after unsuccessful surgery. Nine illustrative case examples are presented in which CT results prior to reoperation are directly compared to the surgical findings. The causes of recurrent disease and the utility of CT scanning prior to reexploration of the mastoid are discussed. High-resolution CT scanning should be performed on all patients presenting with signs or symptoms of possible recurrent disease following mastoid surgery for chronic otitis media.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
4/10. Combined otoneurosurgical approach to patients with chronic ear disease and cerebrospinal otorrhea.We report a combined otoneurosurgical approach in the treatment of a patient with meningitis due to an arachnoid cyst, extending through the dura and petrous bone into the middle ear. The combination of mastoid surgery and temporal craniotomy including opening the dura was necessary to determine the nature of the problem, excise the disease and repair the defects. Two recent cases at our Institution of cerebrospinal otorhinorrhea and chronic ear disease illustrate the difficulty in carrying out definitive repair of dural defects from within the mastoid cavity. Case 2 had three bouts of meningitis and two brain abscesses separated by 25 years. Case 3 had eight bouts of meningitis in 19 years. The authors recommend at otoneurosurgical team approach in patients with cerebrospinal otorhinorrhea permitting treatment of the temporal bone, dura and brain.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
5/10. The otologic manifestations of mucopolysaccharidoses.patients with mucopolysaccharidoses are frequently hard of hearing. This disorder is often conductive in nature and considered the result of chronic serous otitis media. Such patients frequently undergo myringotomy. A coexisting progressive neurosensory hearing loss in some children is recognized far less often. Examination of temporal bones in such patients suggests arrested development including incomplete pneumatization. hair cell dysfunction is implicated in the neurosensory component. Close communication among pediatrician, otolaryngologist, and speech and hearing personnel is essential to maximize the communicative skills of these patients.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
6/10. temporomandibular joint dysfunction with facial pain in children.temporomandibular joint dysfunction with myofascial pain, a well-known clinical disorder in adults, is reported in children. In a series of 400 patients, 40 children less than 16 years of age were seen. Of these pediatric patients, 35% had a reactive depression as primary psychopathology. The multifactorial nature of the disorder is described. The need to differentiate this syndrome from recurrent otitis media and other pain syndromes is emphasized. A combined medical, oral surgical, and psychiatric management program is outlined.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
7/10. Staging in cholesteatoma surgery.The closed technique is the treatment of choice for middle ear cholesteatoma in the opinion of the author. Several interventions may be required. At the onset, the purpose of the systematic second stage procedure was to verify the absence of any residual cholesteatoma. Experience has shown that the interest of this second intervention lies equally in the opportunity to observe the evolution of the otitis disease process, and the tubal status and in the possibility of restoring transmission under optimal conditions, thanks in particular to the utilization of thick silastic sheeting. This technique necessitates, however, a long-term follow-up. On occasion, a third intervention may be required. Despite the iterative nature of this surgery, it should be considered as a form of a logical progression offering the best chances of a successful anatomic and functional outcome for the patient.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
8/10. Presentation and management of uncommon lesions of the middle ear.Infrequently encountered tumors involving the middle ear cleft can cause symptoms and signs that are identical with those of acute or chronic otitis media. Selection of patients who require a more thorough evaluation is predicated upon a high index of clinical suspicion. Integration of the results of a preoperative neuroradiologic evaluation, including high resolution computerized tomography, magnetic resonance imaging, and either conventional or magnetic resonance angiography, may suggest the histopathologic nature of the lesion and direct appropriate treatment. The authors present their experience with the management of 11 patients who had either malignant or benign middle ear lesions that were initially believed to represent infectious middle ear disease. The perioperative decision making process and patient outcomes are compared to other historical reports.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
9/10. sjogren's syndrome and serous otitis media.Extrasalivary lymphoid abnormalities in sjogren's syndrome are well described. patients have been found to have lymphoid infiltration of many organ systems. The nature of the lymphoid abnormalities constitutes a spectrum ranging from benign to malignant disease. A case of an elderly patient with long standing sjogren's syndrome is presented because of the unusual manifestation of a benign lymphoid mass in the nasopharynx producing unilateral eustachian tube obstruction and serous otitis media. Serous otitis media associated with sjogren's syndrome is recognized, but to our knowledge in previous cases an extrasalivary lymphoid abnormality has not been implicated as the underlying pathology.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
10/10. Del (X)(p21.2) in a mother and two daughters with variable ovarian function.We report a family in which a woman with the mosaic karyotype 45,X/46,X,del(X)(p21.2) transmitted the deleted x chromosome to two daughters. The nature of the deletion was confirmed by fluorescent in situ hybridization (FISH). All three family members showed somatic Ullrich-turner syndrome features, but only one daughter had ovarian failure. These observations have implications for the diagnosis of Ullrich-turner syndrome and genotype/phenotype correlations of x chromosome deletions.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
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