1/37. Acute necrotizing otitis media in an infant: a case report.Acute necrotizing otitis media (ANOM), an uncommon but severe form of bacterial otitis media, frequently causes distressing sequelae if not properly diagnosed and treated. A four-month-old female infant initially became ill with intermittent fever, followed by left facial nerve paralysis and left otorrhea four days later. Microscopic examination of the left ear revealed congestion and swelling of the external ear canal, perforation of the eardrum and erosions on the malleus. culture of pus from the otic lesion grew pseudomonas aeruginosa. The patient's condition did not improve despite systemic administration of antibiotics; thus, surgical intervention was arranged. During the operation, near-total perforation of the eardrum, a dislodged incus, cholesteatoma-like matrix around the stapes, and granulation tissue occupying the middle ear and mastoid cavities were noted. Radical mastoidectomy was conducted and pathologic examination of the surgical specimen disclosed necrotic changes in both soft and bony tissues. The patient recovered soon after surgery. Her fever subsided one day after surgery and the patient was discharged in a stable condition 12 days later. However, she still had left facial nerve paralysis six months later.- - - - - - - - - - ranking = 1keywords = cholesteatoma (Clic here for more details about this article) |
2/37. Soft-wall reconstruction for cholesteatoma surgery: reappraisal.OBJECTIVE: To reevaluate the validity of the soft-wall reconstruction method of the posterior meatal wall in surgeries for cholesteatomas. STUDY DESIGN: Retrospective case review. patients: Subjects consisted of 52 patients (54 ears) with fresh cholesteatoma (excluding residual or recurrent cholesteatomas) who were operated by the soft-wall reconstruction method in our clinic and observed for more than 2 years after surgery, and 29 patients (29 ears) who were operated by canal-wall-down and open method. MAIN OUTCOME MEASURES: postoperative period required for complete epithelization (dry ear), hearing, and incidence of the residual and recurrent cholesteatomas were compared with those operated by canal-wall-down and open method. The postoperative conditions of the soft posterior meatal wall was also investigated. RESULTS: postoperative period to be a dry ear was significantly shorter in the soft-wall reconstruction group than in the canal-wall-down and open group (Student's t-test, t = 2.99, p < 0.01). There was no significant difference in the postoperative hearing or incidence of residual and recurrent cholesteatomas between the two groups. CONCLUSIONS: These results indicate that the soft-wall reconstruction method seems more versatile than the canal-wall-down and open method for cholesteatoma surgery.- - - - - - - - - - ranking = 10keywords = cholesteatoma (Clic here for more details about this article) |
3/37. Otogenic brain abscess--a case report.brain abscess is one of the life-threatening complications of otitis media. mortality and morbidity have decreased with the advent of antibiotic therapy. More frequently encountered in cases of acute otitis media in the preantibiotic era, in recent years otogenic brain abscess was noticed almost only in patients of chronic otitis media with cholesteatoma. A case of brain abscess in a 49-year-old female was initially diagnosed as a headache. A high resolution computed tomography (HRCT) scan of the temporal bones later revealed that there were two abscesses over the right side temporal lobe. A modified radical mastoidectomy was performed. Cultures of the middle ear cholesteatoma later grew pseudomonas aeruginosa and Strenotrophomonas maltophilia. Antibiotic therapy was carried on for three months postoperatively. The patient improved but retained a conductive hearing loss.- - - - - - - - - - ranking = 2keywords = cholesteatoma (Clic here for more details about this article) |
4/37. Attic aeration in temporal bones from children with recurring otitis media: tympanostomy tubes did not cure disease in Prussak's space.HYPOTHESIS: Blockage of the aeration pathways to the attic may cause circumscribed or widespread alterations that are difficult to diagnose clinically. The narrow route via the posterior pouch to Prussak's space is especially vulnerable to obstruction in recurring otitis media. BACKGROUND: Recent studies of the epitympanic diaphragm and compartments have clarified the anatomy of the attic aeration and drainage pathways and emphasized the role of their patency in the healing process of middle ear infections. In neonatal otitis media, the amniotic fluid cellular content (AFCC) has proved to be a good indicator in outlining the areas where inflammation products concentrate, possibly causing early blockage of ventilation. methods: Twenty-eight temporal bones from 14 children were studied; 4 of these children had experienced bilateral recurring otitis media. In the latter group, 1 ear was studied by microdissection and the other by serial sectioning. RESULTS: Prussak's space was involved in all 4 pairs of bones and either contained thick mucus, contained secretion in the process of organization, or was obliterated. The tympanic isthmus was fully obstructed in 1, partially blocked in 2, and open in 5 specimens. CONCLUSIONS: If a thick mature connective tissue mass develops under the epidermal layer of Shrapnell's membrane during an obliteration process of Prussak's space, the condition may stay stable and benign. Severe retraction of Shrapnell's membrane represents a likely forerunner of a retraction pocket cholesteatoma. Systematic otomicroscopy allows early detection, and cure can be achieved by minor surgery. In some children, despite the treatment of recurring otitis media with ventilation tubes, the attic and mastoid can be extensively involved, necessitating atticomastoidectomy and the creation of new pathways for attic aeration.- - - - - - - - - - ranking = 1keywords = cholesteatoma (Clic here for more details about this article) |
5/37. Clinical experiences with acute mastoiditis--1988 through 1998.The incidence of acute mastoiditis has declined dramatically during the postantibiotic era. Even so, antibiotic-resistant or unusual pathogens can still cause this disease entity. At our hospital, we documented an increase in antibiotic-resistant and atypical pathogens such as actinomyces spp. and mycobacterium tuberculosis. In this paper, we discuss the optimal diagnosis and treatment strategy for acute mastoiditis, and we describe our retrospective review of 13 patients with mastoiditis who were treated at our hospital from 1988 through 1998. Eight of these patients recovered following treatment with intravenous antibiotics, with or without myringotomy, and five who had complications of disease were managed surgically. Among these five, one developed chronic otitis media and one developed cholesteatoma 3 years later. For patients with acute mastoiditis, we emphasize the need to be aware of any unusual pathogens that do not respond to empiric antibiotic therapy.- - - - - - - - - - ranking = 1keywords = cholesteatoma (Clic here for more details about this article) |
6/37. 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 = 5keywords = cholesteatoma (Clic here for more details about this article) |
7/37. Promontory dehiscence: a case report.Dehiscence of the bony promontory without preoperative fistula formation occurred in a patient with a history of chronic otitis media and perforation of the tympanic membrane without cholesteatoma.- - - - - - - - - - ranking = 1keywords = cholesteatoma (Clic here for more details about this article) |
8/37. July 2001: 58-year-old man with a temporal bone mass.The July 2001 Case of the Month (COM). A 58-year-old man with right ear hearing loss since childhood presented with a two year history of dizziness and vertigo. Neuroradiological studies showed a large mass arising from the petrous portion of the temporal bone. The lesion was resected and microscopic examination revealed a cholesterol granuloma with a small component of cholesteatoma. It is important to distinguish between cholesterol granuloma and cholesteatoma because of treatment differences. However, these two entities can occasionally be seen together and rare giant variants have been described.- - - - - - - - - - ranking = 2keywords = cholesteatoma (Clic here for more details about this article) |
9/37. The natural history of congenital cholesteatoma.OBJECTIVES: To describe the natural history of congenital cholesteatoma (CC) and to determine whether such a description provides clues about the origins and end points of these lesions. DESIGN: A retrospective qualitative analysis of intraoperative illustrations of 34 consecutive patients with 35 CCs (1 bilateral). SETTING: Two tertiary care children's hospitals. patients: Thirty-four children with CC, mean age, 5.6 years (range, 2-13 years). RESULTS: Congenital cholesteatoma originates generally, but not universally, in the anterior superior quadrant. The progression of growth is toward the posterior superior quadrant and attic and then into the mastoid. Contact with the ossicular chain generally results in loss of ossicular continuity and in conductive hearing loss. CONCLUSIONS: Congenital cholesteatoma appears to have a predictable trajectory of growth, starting as a small pearl in the middle ear, eventually growing to involve the ossicles and mastoid, and causing varying degrees of destruction and functional impairment. The clinical picture of a young child with otorrhea, conductive hearing loss, tympanic membrane perforation in a nontraditional location, and a mastoid filled with cholesteatoma may represent the end point in the natural history of CC, despite the fact that this type of lesion is outside the accepted definition of CC.- - - - - - - - - - ranking = 8keywords = cholesteatoma (Clic here for more details about this article) |
10/37. Gas-containing otogenic brain abscess.BACKGROUND: Gas-containing brain abscesses are very rare. Two mechanisms may be responsible for the presence of intracavitary gas: bacterial fermentation or penetration through an abnormal communication between the exterior and the intracranium. The need to search for this potential communication is considered an indication for open surgery. We report the case of a surgically treated gas-containing brain abscess originating from an undiagnosed chronic otitis media. CASE DESCRIPTION: A 54-year-old man developed acute neurologic deterioration, becoming comatose within 24 hours. A contrast-enhanced computed tomography (CT) scan disclosed a gas-containing cystic mass in the right temporal lobe. Urgent surgical decompression revealed the presence of an abscess, which was excised. During the same surgery, we performed a radical mastoidectomy, removing a previously undiagnosed attic cholesteatoma. Neither procedure revealed a discontinuity of the floor of the middle cranial fossa. Cultures grew a mixed flora. Antibiotics were administered for 6 weeks. The patient made a complete neurologic recovery. CONCLUSION: This report demonstrates that otogenic brain abscesses may contain gas due to fermentation of nonclostridial bacteria.- - - - - - - - - - ranking = 1keywords = cholesteatoma (Clic here for more details about this article) |
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