Otology

Editors Picks

Painful rash of the auricle: Herpes zoster oticus

December 19, 2014     Chao-Yin Kuo, MD; Yuan-Yung Lin, MD; Chih-Hung Wang, MD, PhD
article

A PCR assay in addition to conventional serologic testing provides quick confirmation of the diagnosis of herpes zoster oticus infection.

Can vinegar be used in treating Pseudomonas ear infections in a patient with a perforated eardrum?

August 26, 2015     Muhamed Aslam Khan, MS, MRCSEd; Nazneen Khan, MBBS, DGO, DRCOG
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Abstract

Chronic Pseudomonas ear infections are difficult to treat, particularly in immunodeficient patients. Vinegar therapy is a time-tested measure for the treatment of these infections. It is inexpensive, simple, easy to administer, and very effective. However, some physicians are reluctant to use it in immunocompromised patients or in the setting of a perforated tympanic membrane. We describe our successful use of vinegar therapy in a 32-year-old man with both of these conditions. His Pseudomonas ear infection had persisted for more than 5 years despite conventional drug treatment. Eventually, we treated him with instillations of topical vinegar, and his infection cleared in 3 weeks.

Otic capsule dehiscence syndrome: Superior semicircular canal dehiscence syndrome with no radiographically visible dehiscence

August 26, 2015     P. Ashley Wackym, MD, FACS; Scott J. Wood, PhD; David A. Siker, MD; Dale M. Carter, MD
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Abstract

We conducted a prospective longitudinal study of two cohorts of patients who had superior semicircular canal dehiscence syndrome (SSCDS); one group had radiographically confirmed superior canal dehiscence (SCD), and the other exhibited no identified otic capsule dehiscence on imaging (no-iOCD). We compiled data obtained from prospective structured symptomatology interviews; diagnostic studies; three-dimensional, high-resolution, temporal bone computed tomography; and a retrospective case review from our tertiary care referral center. Eleven adults and 1 child with SSCDS were identified, surgically managed, and followed. Six of these patients-1 man and 5 women, aged 29 to 54 years at first surgery (mean: 41.8)-had radiologically confirmed SCD. The other 6 patients-1 man, 4 women, and 1 girl, aged 1 to 51 years (mean: 32.2)-had no-iOCD. The 6 adults with SCD underwent surgery via a middle cranial fossa approach with plugging procedures. The 5 adults and 1 child with no-iOCD underwent round window reinforcement (RWR) surgery. One SCD patient developed no-iOCD 1.5 years after SCD surgery, and she subsequently underwent RWR surgery. Our main outcome measures were patient symptomatology (with video documentation) and the results of diagnostic studies. Other than the character of migraine headaches, there was no difference in preoperative symptomatology between the two groups. Postoperatively, resolution of SSCDS symptoms ultimately occurred in all patients. Both the SCD and the no-iOCD groups experienced a highly significant improvement in postural control following treatment (Wilcoxon signed rank test, p < 0.001). We conclude that the term otic capsule dehiscence syndrome more accurately reflects the clinical syndrome of SSCDS since it includes both superior semicircular canal dehiscence and no-iOCD, as well as posterior and lateral semicircular canal dehiscence, all of which can manifest as SSCDS. We have also included links to videos in which 4 of the SSCDS patients with no-iOCD in this study discussed their symptoms and the results of their surgery; these links are found in the “References” section in citations 12-15. Links to three other videos of interest are contained in citations 10, 11, and 24.

Temporomandibular joint herniation into external auditory canal

August 26, 2015     Jui-Hsien Hsu, MD; Cheng-Chien Yang, MD; Min-Tsan Shu, MD
article

Herniation of the TMJ into the EAC is a rare condition that mostly occurs in patients with bony wall defects in the anterior EAC.

Intratympanic membrane congenital cholesteatoma

July 20, 2015     Hiroshi Sakaida, MD, PhD; Kazuhiko Takeuchi, MD, PhD
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Cholesteatoma should be differentiated from other conditions with similar otoscopic findings, such as myringosclerosis.

Primary melanoma of the petrous temporal bone

July 20, 2015     Jonathan L. McJunkin, MD; Richard J. Wiet, MD, FACS
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Abstract

Melanoma is a malignant tumor of melanocytes that is predominantly found in the skin. In rare cases, it arises from mucosal melanocytes. We describe a case of a solitary melanoma of the petrous apex of the temporal bone in a 67-year-old woman who presented with sudden hearing loss, aural fullness, and headaches, all on the right side. Magnetic resonance imaging identified a mass located at the right petrous apex; the lesion was hyperintense on T1-weighted imaging and isointense on T2 weighting, and it enhanced brightly with gadolinium contrast. The patient underwent removal of the lesion via a transcochlear approach with facial nerve translocation. Intra- and postoperative pathology identified a poorly differentiated malignancy consistent with a melanoma. Further investigations found no evidence of metastasis. Given a concern for residual disease, the patient was treated with radiation to the primary site. To the best of our knowledge, only 1 other case of primary melanoma of the petrous apex has been described in the literature.

Bezold abscess

June 4, 2015     Yu-Hsuan Lin, MD; Ming-Yee Lin, MD
article

In some circumstances, the only sign or symptom of Bezold abscess is an unnoticed neck lump.

Internal auditory canal osteoma: Case report and review of the literature

June 4, 2015     Sharon Ovnat Tamir, MD; Francoise Cyna-Gorse, MD; Olivier Sterkers, MD
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Abstract

We report a case of internal auditory canal osteoma and discuss this entity's etiology, natural history, and treatment options. The internal auditory canal osteoma is a rare entity with only a few reports published in the medical literature. Its diagnosis is based on two complementary imaging modalities: thin-slice computed tomography and magnetic resonance imaging. No consensus exists regarding the treatment of this entity, and treatment should be tailored to each patient depending on that patient's initial complaints, as well as his or her medical findings.

Dehiscent high jugular bulb attached to the tympanic membrane

June 4, 2015     Hiroshi Sakaida, MD, PhD; Kazuhiko Takeuchi, MD, PhD
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The differential diagnosis of high jugular bulb includes cholesterol granuloma, aberrant carotid artery, and tumors such as paraganglioma or schwannoma.

Malignant otitis externa

April 27, 2015     Christina H. Fang, BS; James Sun, BS; Robert W. Jyung, MD
article

The advent of anti-pseudomonal antibiotics has significantly reduced the mortality of malignant otitis externa.

Is there a relationship between myeloperoxidase activity and conductive hearing loss in chronic otitis media complicated by cholesteatoma?

April 27, 2015     Ozlem Celebi Erdivanli, MD; Arif Sanli, MD
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Abstract

We conducted a prospective, controlled study of patients with chronic otitis media and cholesteatoma (1) to examine the expression of myeloperoxidase (MPO) using immunohistochemical staining techniques and (2) to investigate the relationship between MPO activity and the degree of conductive hearing loss in these patients. Our study population included 51 adults-26 men and 25 women, aged 18 to 58 years (mean: 37.5)-who had been diagnosed with chronic otitis media and cholesteatoma by physical examination and computed tomography (study group). Another 30 patients-13 men and 17 women, aged 18 to 52 years (mean: 32.7)-who had chronic otitis media without cholesteatoma served as the control group. Following audiometric evaluations, all patients underwent appropriate surgery. Postoperatively, cholesteatoma samples were analyzed by immunostaining for MPO positivity as a marker for acute inflammation. We found that MPO activity was present in all 51 study patients (100%) but in only 10 controls (33.3%); the difference was statistically significant (p< 0.01). In the study group, the degree of MPO activity was slight in 6 patients (11.8%), moderate in 24 patients (47.1%), and intense in 21 patients (41.2%), while in the control group, all 10 MPO-positive cases showed only a slight degree of activity. We also found a statistically significant association in the study group between the degree of MPO activity and the degree of conductive hearing loss (χ2 = 13.518; p < 0.001). We encourage further study of all steps in the process of cholesteatoma formation.

Use of the chorda tympani nerve in reconstruction of the ossicular chain

April 27, 2015     Yi Qiao, MD; Wen-Wen Chen, MD; Ya-Xin Deng, MD; Jun Tong, MD
article

Abstract

We conducted a study to assess the use of the chorda tympani nerve in reconstruction of the ossicular chain. We retrospectively examined the medical records of 141 patients (154 ears) who had undergone middle ear surgery with 12 months of follow-up. The study population was made up of 58 males and 83 females, aged 9 to 83 years (mean: 45). These patients were divided into three groups based on the specific type of surgery they had undergone: in 35 patients, the chorda tympani nerve was used to spring and press the auricular bone prosthesis (CTN group); in 67 patients, the tympanic membrane was used to spring and press the auricular bone prosthesis (TM group); and in 39 patients, a gelatin sponge was used to support the auricular bone prosthesis (GS group). We compared pre- and postoperative air-bone gaps (ABGs) in each group, as well as the differences between these gaps among the three groups. We found significant differences between the pre- and postoperative ABGs in all three groups (all p < 0.01). These differences were also compared between the CTN and TM groups (t = 0.41; p > 0.05), between the CTN and GS groups (t = 2.07; p < 0.05), and between the TM and GS groups (t = 2.51; p < 0.05). In the CTN group, 1 patient experienced temporary postoperative hypogeusia, and another developed a mild case of delayed facial paralysis; both patients recovered within 2 weeks. We conclude that the chorda tympani nerve can be used to repair the ossicular chain to improve hearing without causing taste and facial nerve dysfunction and without the need for a second operation.