April 30, 2008 Lesley C. French, MD, Mary S. Dietrich, PhD, and Robert F. Labadie, MD, PhD
article
Abstract
We conducted a study to estimate the number of mastoidectomy procedures performed annually in the United States. Our results are based on state-specific healthcare utilization data and Medicare-funded procedural data from 2002. The utilization data were obtained from the State Ambulatory Surgery Database, which is made available through the Healthcare Cost and Utilization Project. Statistical Package for the Social Sciences (SPSS) statistical software was used to quantify the number of mastoidectomy procedures performed during 2002 in Maryland, New Jersey, New York, and Florida. Information was also obtained from the Federated Ambulatory Surgery Association on the number of Medicare-funded mastoidectomy procedures performed in 2002. State and U.S. population statistics were obtained from the U.S. Census Bureau. These data were extrapolated to obtain a nationwide estimate of the number of mastoidectomies performed annually in the U.S. With 99% confidence, we determined that 0.73 to 0.94 mastoidectomy procedures were performed per 10,000 population in Maryland and 2.55 to 2.74/10,000 in New York. Estimates for both New Jersey and Florida fell in between. Medicare patients underwent between 1.68 and 1.79 procedures per 10,000 population. Based on these data, we estimate that between 30,000 and 60,000 mastoidectomies are performed each year in the U.S., although we suspect that our range may be an underestimation of the actual number because of some limitations inherent in the data collection process. Although mastoidectomy is a common outpatient procedure, to the best of our knowledge, no report on the annual frequency of mastoidectomy procedures in the U.S. has ever been published in the English-language literature. We hope that our report will serve to motivate further research into technological and surgical advancements surrounding this procedure.
February 1, 2008 Rodrigo Martinez, MD and Jay B. Farrior, MD
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Abstract
Fibrous dysplasia is a benign condition that can affect the skull and facial bones and cause a broad spectrum of otolaryngologic conditions. We present the case of a boy with polyostotic fibrous dysplasia with involvement of the temporal bone that was first diagnosed when he was 9 years old. His condition eventually became complicated by cholesteatoma and thrombophlebitis of the left transverse and sigmoid sinuses, and he died of his disease at the age of 19 years. We discuss these and other complications of fibrous dysplasia of the temporal bone and their management.
September 30, 2007 Joo Hyung Lee, MD; Min Kyo Jung, MD; Chang Eun Song, MD; Sang Won Yeo, MD; Hye Kyung Lee, MD; Po Song Yang, MD; Soo Whan Kim, MD
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Abstract
Inflammatory pseudotumors are histologically benign but locally destructive lesions that are usually found in the lung, although some cases of temporal bone involvement have been reported. To the best of our knowledge, no case of simultaneous involvement of the temporal bone and the lung has been previously reported in the literature. We describe such a case in a 39-year-old man. The temporal bone lesion was removed in its entirety, and the lung lesion was treated with steroid therapy. At the 2-month follow-up, the size of the lung mass on chest x-ray was significantly reduced, and at 1 year, the patient was asymptomatic.
July 31, 2007 Hamid R. Djalilian, MD; Kunal H. Thakkar, MD; Sanaz Hamidi, MD; Aaron G. Benson, MD; Mahmood F. Mafee, MD
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Abstract
We conducted a study to establish standardized measurements of the common anatomic landmarks used during surgery via the middle cranial fossa approach. Results were based on high-resolution computed tomography (CT) images of 98 temporal bones in 54 consecutively presenting patients. Measurements were obtained with the assistance of the standard PACS (picture archiving and communication system) software. We found that the superior semicircular canal (SSC) dome was not the highest point on the temporal bone (i.e., the arcuate eminence) in 78 of the temporal bone images (79.6%). Pneumatization above the SSC and above the internal auditory canal (IAC) was found in 27 (27.6%) and 39 (39.8%) temporal bone images, respectively. The anterior wall of the external auditory canal was always anterior to the anterior wall of the IAC. The mean angles between the SSC and the posterior and anterior walls of the IAC were 42.3° and 60.8°, respectively. We also measured other distances, and we compared our findings with those published by others. We hope that the results of our study will help surgeons safely and rapidly locate anatomic landmarks when performing surgery via the middle cranial fossa approach.
June 30, 2007 Edwin K. Chan, MD; Lawrence Z. Meiteles, MD
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Abstract
Tension pneumocephalus occurs when a continuous flow of air accumulates in the intracranial cavity and produces a mass effect on the brain. We describe a case in which tension pneumocephalus was caused by the performance of continuous lumbar CSF drainage in a middle-aged man who had experienced a temporal bone fracture. Continuous lumbar CSF drainage is commonly performed in patients with temporal bone or basilar skull fractures to treat concomitant post-traumatic CSF rhinorrhea, CSF otorrhea, and/or hydrocephalus. However, to the best of our knowledge, there has been no previously reported case of tension pneumocephalus occurring as a complication of this procedure in a patient with a temporal bone fracture.
May 31, 2007 Chester P. Barton III, MD; Drew Horlbeck, MD
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Abstract
Eosinophilic granuloma is an uncommon condition that is characterized by unifocal or multifocal osteolytic lesions that often affect the skull. Unilateral lesions of the temporal bone are not uncommon, but bilateral temporal bone lesions are rare. In fact, to the best of our knowledge, fewer than 20 such cases have been reported during the past 40 years. We report a new case of bilateral temporal bone eosinophilic granuloma, and we review the disease process and its treatment.
March 31, 2007 Borlingegowda Viswanatha, MS, DLO
February 1, 2007 Henriëtte E. Westerlaan, MD; Joost Gravendeel, MD
August 31, 2006 Sheldon P. Hersh, MD; Winston G. Harrison, MD; David J. Hersh, MD
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Abstract
Temporal bone lymphomas are rare and typically metastatic neoplasms. We describe a case of primary B cell lymphoma that originated in the external auditory canal of an elderly woman. The diagnosis was based on histopathologic examination supplemented by immunophenotypic analysis. The patient was treated with external-beam radiation and remained disease-free throughout 9 years of follow-up. We also point out that the presence of non-Hodgkin's lymphoma in an unusual site may be an indication that the patient has an acquired immunodeficiency syndrome.
June 30, 2006 Esen Beder, MD; Ozan Bagis Ozgursoy, MD; Selmin Karatayli Ozgursoy, MD; Yucel Anadolu, MD
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Abstract
Eagle's syndrome represents a group of symptoms that includes recurrent throat pain, globus pharyngeus, dysphagia, referred otalgia, and neck pain possibly caused by elongation of the styloid process or ossification of the stylohyoid or stylomandibular ligaments. The medical history and physical and radiologic examinations are the main guides to the precise diagnosis. The radiologic diagnostic modality of choice is three-dimensional computed tomography (3-D CT). We describe a case of bilaterally symptomatic Eagle's syndrome that was diagnosed by 3-D CT of the styloid processes and successfully treated with surgery via a transoral approach.
April 1, 2006 David Foyt, MD; William H. Slattery III, MD; Matthew J. Carfrae, MD
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Abstract
We investigated the feasibility of using laser tissue welding techniques to perform transcanal underlay tympanoplasty. We used 10 temporal bones obtained from human cadavers. After creating a subtotal tympanic membrane perforation, we introduced harvested periosteum through the perforation and used laser tissue welding to secure the periosteum graft in place in an underlay fashion. The procedure was performed via a transcanal approach and did not require middle ear packing. Immediately after the graft had been placed, we qualitatively tested its integrity with a blunt probe. The graft was as strong as the native cadaver tympanic membrane in all 10 cases. We conclude that laser transcanal underlay tympanoplasty is a feasible and effective method of repairing a tympanic membrane. The ultimate goal is to develop a technique that will allow physicians to routinely perform underlay tympanoplasty on moderately sized perforations in an office setting.
November 1, 2005 John P. Leonetti, MD; Sam Marzo, MD; Douglas Anderson, MD; Thomas Origitano, MD, PhD; Daniel D. Vukas, MD
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Abstract
We conducted a retrospective study of 51 cases of spontaneous transtemporal cerebrospinal fluid (CSF) leakage in 48 adults who had presented to our tertiary care academic referral center between July 1, 1988, and June 30, 2002. All patients had undergone high-resolution temporal bone computed tomography, and 26 patients had undergone magnetic resonance imaging. All patients were treated with a middle fossa craniotomy to repair the CSF fistulae. During a mean follow-up of 4.9 years, 46 of the 48 patients (95.8%) had experienced a complete cessation of CSF leakage (49 of 51 cases [96.1%]). The 2 patients whose leakage recurred were successfully managed with a subtotal petrosectomy with occlusion of the eustachian tube and obliteration of the middle ear and mastoid. No patient developed meningitis.
