Middle Ear

Osteoma of the middle ear

October 17, 2014     Tsung-Shun Chang, MD; Wen-Sen Lai, MD; Chao-Yin Kuo, MD; Chih-Hung Wang, MD, PhD
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Management of middle ear osteoma can be complicated when the round window is obliterated. Therefore, the patient should be informed about what to expect prior to surgery.

Salivary gland choristoma of the middle ear

October 17, 2014     Paolo Fois, MD; Anna Lisa Giannuzzi, MD; Carlo Terenzio Paties, MD; Maurizio Falcioni, MD
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Abstract

Choristoma of the middle ear is a rare condition characterized by the presence of normal salivary gland tissue in the middle ear space. Salivary gland choristomas are benign lesions that are frequently associated with ossicular chain and facial nerve anomalies. Total surgical excision is indicated when there is no risk of damaging the facial nerve. We describe a new case of salivary gland choristoma of the middle ear, and we discuss the etiology, histologic features, and management of such lesions. Our patient was a 22-year-old woman in whom we surgically removed a whitish retrotympanic mass. Intraoperatively, we also detected an ossicular chain malformation. Histologic examination of the choristoma revealed the presence of salivary gland tissue. Furthermore, the lesion contained an extensive and previously undescribed component: a well-defined pseudostratified respiratory-type epithelium, similar to that of a normal eustachian tube. Ten months after removal of the choristoma, we surgically repaired the ossicular chain anomalies. No recurrence was noted on follow-up.

Ear mold impression material as an aural foreign body

September 17, 2014     Yu-Hsuan Lin, MD; Ming-Yee Lin, MD, PhD
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Physicians should not rush indiscriminately into action without a careful otoscopic examination and a detailed history, to discern whether a patient has abnormal anatomy and is at risk for complications.

Bilateral nontuberculous mycobacterial middle ear infection: A rare case

September 17, 2014     Ing Ping Tang, MS; Shashinder Singh, MS; Raman Rajagopalan, MS
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Abstract

Nontuberculous Mycobacterium (NTM) middle ear infection is a rare cause of chronic bilateral intermittent otorrhea. We report a rare case of bilateral NTM middle ear infection in which a 55-year-old woman presented with intermittent otorrhea of 40 years' duration. The patient was treated medically with success. We conclude that NTM is a rare but probably under-recognized cause of chronic otitis media. A high index of suspicion is needed for the diagnosis to avoid prolonged morbidity. Treatment includes surgical clearance of infected tissue with appropriate antimycobacterial drugs, which are selected based on culture and sensitivity.

Otologic manifestation of Samter triad

July 13, 2014     Danielle M. Blake, BA; Alejandro Vazquez, MD; Senja Tomovic, MD; Robert W. Jyung, MD
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It is important for otolaryngologists to be aware of the mucoid quality of these middle ear effusions, as they tend to be persistent and they do not respond well to myringotomy and tube placement, which usually results in tube obstruction.

Ototoxicity in Nigeria: Why it persists

July 13, 2014     Daniel D. Kokong, MBBS, FWACS; Aminu Bakari, MBBS, FWACS, FICS; Babagana M. Ahmad, MBBS, FWACS, FICS
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Abstract

No therapy is currently available to reverse the serious damage that can be caused by ototoxic drugs, such as permanent hearing loss and balance disorders. Otolaryngologists in various regions of the world have developed strategies aimed at curtailing drug-induced ototoxicity, but similar efforts in most developing nations have yet to be well established. We conducted a study to document our experience in Nigeria. Our study population was made up of 156 patients-66 males and 90 females, aged 5 to 85 years (mean: 32.1 ± 30.7)-who were diagnosed with drug-induced ototoxicity over a 3-year period. Tinnitus was the first and the predominant symptom in 140 patients (89.7%). The most common cause of drug-induced ototoxicity among the 156 patients was injection of an unknown agent (n = 55 [35.3%]); among the known agents, the most common were chloramphenicol (n = 25 [16.0%]), chloroquine (n = 22 [14.1%]), and gentamicin (n = 20 [12.8%]). One pregnant woman experienced a miscarriage at 4 months after receiving intramuscular chloroquine, and another woman fell into a coma after receiving intramuscular streptomycin. Two agents that have not been linked to ototoxicity-oxytocin and thiopentone sodium-were found to be ototoxic in our study (1 case each). Of the 312 ears, 31 (9.9%) showed normal audiometric patterns; on the other end of the spectrum, 155 ears (49.7%) had profound sensorineural hearing loss (SNHL). Mixed hearing loss was seen in 90 ears (28.8%). Hearing loss was bilaterally symmetrical in 127 patients (81.4%), bilaterally asymmetrical in 15 patients (9.6%), and unilateral in 14 patients (9.0%). Treatment was primarily medical; hearing aids were fitted for 7 patients (4.5%). Only 41 patients (26.3%) kept as many as 3 scheduled follow-up appointments. Ototoxicity remains prevalent in the developing countries of Africa. Numerous drugs and other agents are responsible, and management outcomes are difficult to ascertain. Thus, our emphasis must be placed on prevention if we are to minimize the potentially devastating effects of ototoxicity.

Tympanic paraganglioma

May 7, 2014     Danielle M. Blake, BA; Senja Tomovic, MD; Robert W. Jyung, MD
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Patients classically present with pulsatile tinnitus and a red mass medial to the tympanic membrane. Some patients may have findings of a red mass that blanches with pneumatic otoscopy, called Brown's sign.

Ceruminous adenocarcinoma of the ear

May 7, 2014     Jagdeep Singh Virk, MA (Cantab), MRCS, DOHNS; Gaurav Kumar, FRCS(ORL-HNS); Sherif Khalil, MS, FRCS(ORL-HNS), MD
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Ceruminous carcinomas are extremely rare and tend to present as a mass or with otalgia. They are difficult to diagnose histopathologically (in part due to varied and nonstandardized nomenclature).

Modified radical mastoidectomy and its complications-12 years' experience

May 7, 2014     Sardar U. Khan, DLO, FCPS, FRCS(Ire); Rajesh K. Tewary, MS, FRCS(Ed); Timothy J. O'Sullivan, FRCS(Canada)
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Abstract

To find the incidence of complications of modified radical mastoidectomy and to evaluate different parameters that play a role in their causation, we conducted a retrospective study spanning a period of 12 years. Included were 210 patients who underwent primary modified radical mastoidectomies performed by one senior surgeon; of these patients, 163 fulfilled the inclusion criteria. The charts were evaluated for patients' age and sex, laterality, intraoperative pathology, and complications. The complications were grouped into nine categories for analysis of their etiology. The results in this study were compared with those from other published reports. Complications were documented in 46 of 163 (28.2%) operated ears; 21 (45.7%) of them were noted in children <15 years of age, and 25 (54.3%) were found in adults. Sex and laterality were of no significance. The most common complication recorded was residual/recurrent cholesteatoma (20 [12.3%]), followed by meatal stenosis (11 [6.7%]). A moist cavity with discharging ear was noted in only 4 (2.5%) patients. No facial nerve palsies or dead ears were observed. Eleven (6.7%) patients had more than one complication. The parameters evaluated were size of the meatus, tympanic membrane appearance, status of the mastoid cavity, height of the facial ridge, and extent of the disease process. Complications can be caused by a number of factors, such as congenital anomalies, disease process, and the surgeon's skill. Each complication must be thoroughly evaluated for immediate management and to learn how to avoid it in the future.

Eosinophilic otitis media

February 12, 2014     Alejandro Vazquez, MD; Danielle M. Blake, BA; and Robert W. Jyung, MD
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Eosinophilic otitis media is refractory to conventional therapy for otitis media and may lead to severe hearing impairment if not recognized promptly.

Glial choristoma of the middle ear

December 20, 2013     Karen A. Shemanski, DO; Spencer E. Voth, DO; Lana B. Patitucci, DO; Yuxiang Ma, MD, PhD; Nikolay Popnikolov, MD, PhD; Christos D. Katsetos, MD, PhD; Robert T. Sataloff, MD, DMA, FACS
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Abstract

Glial choristomas are isolated masses of mature brain tissue that are found outside the spinal cord or cranial cavity. These masses are rare, especially in the middle ear. We describe the case of an 81-year-old man who presented with left-sided chronic otitis media, mastoiditis, hearing loss, tinnitus, and aural fullness. He was found to have a glial choristoma of the middle ear on the left. Otologic surgeons should be aware of the possibility of finding such a mass in the middle ear and be familiar with the differences in treatment between glial choristomas and the more common encephaloceles.

Medial migration of a tympanostomy tube

December 20, 2013     Alejandro Vazquez, MD; Robert W. Jyung, MD
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