Juvenile xanthogranuloma of the tympanic membrane: A case report

September 7, 2012     Michael W. Chu, MD; Alice Werner, MD; Stephanie A. Moody-Antonio, MD


Juvenile xanthogranuloma (JXG) is a benign, non-Langerhans cell histiocytic lesion that generally affects infants and children. These lesions characteristically appear as a solitary, yellow, cutaneous nodule of the head, neck, or trunk. Subcutaneous and extracutaneous forms can involve the gastrointestinal tract, kidney, lung, gonads, pericardium, central nervous system, temporal bone, larynx, and eye. We describe the clinical presentation, imaging, histochemical findings, and management of a solitary JXG of the tympanic membrane in a 17-month-old girl. The patient underwent surgical resection and was without disease several months following surgery and reconstruction of the defect. To the best of our knowledge, this is the first reported case of a JXG of the tympanic membrane.

Bilateral hemotympanum secondary to septoplasty

September 7, 2012     Jae Hoon Lee, MD

Hemotympanum can be caused by temporal bone fractures, barotrauma, administration of anticoagulants, hematologic disorders, and chronic otitis media secondary to the formation of granulation tissue or a cholesterol granuloma. It can also occur secondary to nasal packing or spontaneous epistaxis, as well as eustachian tube dysfunction.

Mycoplasma an unlikely cause of bullous myringitis

June 4, 2012     Lisa Cramer, BA; Dina M. Emara, MBBCh; Arun K. Gadre, MD, FACS

Despite common belief, Mycoplasma pneumoniae is an extremely rare causative agent for bullous myringitis. Instead, it is caused by the same organisms responsible for acute otitis media.

Primary acquired cholesteatoma

April 30, 2012     Joseph A. Ursick, MD; Jose N. Fayad, MD

Cholesteatomas are believed to form as the result of poor eustachian tube function with resultant tympanic membrane retraction and a lack of normal epithelial migration.

Middle ear encephalocele: Not just another chronic ear

February 18, 2012     John C. Goddard, MD and Jose N. Fayad, MD

Intratympanic steroid use for hearing salvage in Vogt-Koyanagi-Harada syndrome

December 15, 2011     Stanley Pelosi, MD and Sujana S. Chandrasekhar, MD, FACS


We discuss the rare case of a 68-year-old woman with Vogt-Koyanagi-Harada (VKH) syndrome and sensorineural hearing loss (SNHL) who was successfully treated with intratympanic corticosteroid injections. The patient had presented with bilaterally asymmetric (i.e., moderate and moderate to severe) SNHL, tinnitus, vertigo, and vitiligo. She received two intratympanic injections in her worse-hearing ear over the course of 1 month. Subsequent audiometry showed an immediate 5- to 10-dB improvement in her hearing across multiple frequencies, as well as a long-term improvement to near-normal thresholds. The hearing thresholds in her untreated ear remained stable. To the best of our knowledge, this is the first report of a patient with VKH syndrome who was successfully treated with intratympanic steroid application.

Congenital cholesteatoma of the tympanic membrane

December 15, 2011     Byung Don Lee, MD and Moo Kyun Park, MD

A case of a coexisting aberrant internal carotid artery and persistent stapedial artery: The role of MR angiography in the diagnosis

April 30, 2011     Hatice Gul Hatipoglu, MD, Mehmet Ali Cetin, MD, Enis Yuksel, MD, and Huseyin Dere, MD


We describe the case of a 37-year-old woman who presented with a complaint of recurrent headaches since childhood. Clinical examination revealed the presence of a reddish-bluish mass in the inferior half of the tympanic membrane in her right ear. Source and three-dimensional time-of-flight magnetic resonance angiography (MRA) detected a protruded right internal carotid artery (ICA) in the hypotympanum. The vertical segment of the ICA was absent, and the artery was narrowed and lateralized and had a “reverse 7” shape. Meanwhile, a persistent stapedial artery (PSA) was seen originating in the petrous portion of the ICA to form a middle meningeal artery. The A1 segment of the right anterior cerebral artery was hypoplastic. Based on these findings and on follow-up findings on computed tomography, the patient was diagnosed with a concomitant aberrant ICA and PSA. No intervention was undertaken. We review the management of this rare finding, and we discuss the role of MRA in its diagnosis.

"Epithelial pearl" after tympanoplasty with the underlay technique

April 30, 2011     Min-Tsan Shu, MD and Yu-Chun Chen, MD

Incidence of tympanic membrane perforation after intratympanic steroid treatment through myringotomy tubes

March 31, 2011     Amy L. Rutt, DO, Mary J. Hawkshaw, BSN, RN, CORLN, and Robert T. Sataloff, MD, DMA, FACS


Intratympanic (IT) steroids are often used to treat inner ear disorders such as sudden idiopathic sensorineural hearing loss, autoimmune inner ear disease, and Ménière disease. Administration of corticosteroids via IT injection, via application with a pledget to the round window, or via catheter has been used for this purpose. The frequency of adverse events related to the IT injection of steroids is low, with pain, short-lasting vertigo, otitis media, and tympanic perforations being the most common complications. However, the safety of IT steroid therapy has not yet been established in a randomized clinical trial. In this article, we discuss a group of 11 patients with sensorineural hearing loss who underwent myringotomy and tube placement for home-based dexamethasone instillation and subsequently developed the complication of tympanic membrane perforation. It appears that there is a significantly increased incidence of tympanic membrane perforations in this population.

Glomus jugulare

January 1, 2011     Jeffrey D. Suh, MD, Ashley E. Balaker, MD, Brian D. Suh, MD, and Keith E. Blackwell, MD

Measurements of the facial recess anatomy: Implications for sparing the facial nerve and chorda tympani during posterior tympanotomy

September 30, 2010     Caglar Calli, MD, Ercan Pinar, MD, Semih Oncel, MD, Bekir Tatar, MD, and Mehmet Ali Tuncbilek, MD


Posterior tympanotomy is commonly performed through the facial recess to facilitate cochlear implantation. A rare but serious complication of this procedure is paralysis of the facial nerve and/or the chorda tympani. These complications generally occur because of a limited understanding of the anatomy of the facial recess. To help further define this area, we used computer-aided design software to measure (1) the angle between the facial nerve and the chorda tympani nerve and (2) the distance between the takeoff point of the chorda tympani and the posteriormost prominent point of the short process of the incus in 30 cadaveric adult temporal bones. The mean angle was 23.58° (±6.84), and the mean distance was 7.78 mm (±2.68). Our most important finding was that there was a correlation between the two measurements in that the distance tended to be greater when the angle was less than the mean and vice versa. This trend approached but did not quite reach statistical significance (r = -0.248, p = 0.059).

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