scholarly journals Supratubal recess and sinus tympani: CT analysis of middle ear hidden areas

2019 ◽  
Vol 50 (1) ◽  
Author(s):  
Mohammad Waheed El-Anwar ◽  
Diaa Bakry Eldib ◽  
Ashraf Elmalt ◽  
Alaa Omar Khazbak
Keyword(s):  
Middle Ear ◽  
Preoperative Imaging ◽  
High Resolution Computed Tomography ◽  
Sinus Tympani ◽  
Ct Analysis ◽  
Length Width ◽  
Middle Ear Anatomy ◽  
Grade 3 ◽  
Temporal Bones ◽  
Ct Classification

Abstract Background High-resolution computed tomography (HRCT) magnifies the role of preoperative imaging for detailed middle ear anatomy particularly its hidden area. The purpose of the current study was to assess the sinus tympani (ST) and supratubal recess (STR) by HRCT, to create CT classification of the STR depth, and to study the relationship between ST types and the new STR grades. Results In HRCT of non-pathological temporal bones of 100 subjects (200 ears), measurements of the STR and ST were calculated, registered, and analyzed. The depth of the STR was classified into grade 1 with depth less than 3 mm, grade 2 with depth ranged between 3 and 5 mm, and grade 3 with depth more than 5 mm. The mean STR length, width, and height were 4.17 ± 0.86, 3.55 ± 0.65, and 3.64 ± 0.7 mm, respectively, while the ST mean length and width of were 2.52 ± 0.5 and 1.82 ± 0.78 mm, respectively, without significant differences between either sexes or sided. The ST types were found to be type A in 56 ears (28%), type B in 142 ears (71%), and type C in 2 ears (1%). The STR grading was grade 1 in 12 ears (6%), grade 2 in 160 ears (80%), and grade 3 in 28 ears (14%) without significant relationship between ST types and STR grading (P = 0.3). Conclusion The current study provided reliable and applicable methods of CT assessment of STR and ST that can help to predict the degree of surgical visibility of the ST and STR during ear surgery.

Marrow-Mesenchyme Connections in the Fetal and Newborn Tympanum

1997 ◽  
Vol 106 (6) ◽  
pp. 466-470 ◽  
Author(s):  
Fred H. Linthicum ◽  
Qing Tian ◽  
William Slattery
Keyword(s):  
Middle Ear ◽  
Immunohistochemical Staining ◽  
Fibrous Tissue ◽  
Postnatal Period ◽  
Bacterial Invasion ◽  
Sinus Tympani ◽  
Stapedius Muscle ◽  
Microscopic Evaluation ◽  
Temporal Bones ◽  
Hematopoietic Bone Marrow

Examinations of 41 human fetal, 8 infant, and 8 juvenile temporal bones prepared for light microscopic evaluation revealed direct connections between the hematopoietic bone marrow and the unresolved mesenchyme in the middle ear. The connections first appeared at 15 weeks of gestation and became bridged by fibrous tissue, in most cases, by the postpartum age of 10 months. Between 16 and 18 months after birth, the marrow-mesenchyme connections gradually disappeared. The areas in which the connections were most numerous were the anterior epitympanum, the sinus tympani medial to the stapedius muscle, and transitory bone that occupies the area that will become the aditus of the antrum. Immunohistochemical staining demonstrated the existence of mature leukocytes in these connections. These connections may help protect the middle ear against bacterial invasion during the postnatal period.

scholarly journals High Resolution Computed Tomography (HRCT) Imaging Findings of Oval Window Atresia with Surgical Correlation

2020 ◽  
Vol 49 (6) ◽  
pp. 346-353
Author(s):  
Hau Wei Khoo ◽  
Chih Ching Choong ◽  
Seng Beng Yeo ◽  
Julian PN Goh ◽  
Tiong Yong Tan
Keyword(s):  
Computed Tomography ◽  
High Resolution ◽  
Facial Nerve ◽  
Middle Ear ◽  
Ossicular Chain ◽  
Oval Window ◽  
Imaging Findings ◽  
High Resolution Computed Tomography ◽  
Facial Nerve Canal ◽  
Temporal Bones

Introduction: Isolated oval window atresia (OWA) is a rare cause of congenital conductive middle ear deafness and may be overlooked owing to the normal appearance of the external ear. This anomaly has been previously described, although the published numbers with both imaging and surgical findings are few. Our aim is to correlate the imaging features of OWA with intraoperative findings. Materials and Methods: This is a single-centre retrospective evaluation of patients who were diagnosed with OWA and who received surgery from January 1999 to July 2006. No new case was diagnosed after 2006 to the time of preparation of this manuscript. High resolution computed tomography (HRCT) imaging of the temporal bones of the patients were retrospectively evaluated by 2 head and neck radiologists. Images were evaluated for the absence of the oval window, ossicular chain abnormalities, position of the facial nerve canal, and other malformations. Imaging findings were then correlated with surgical findings. Results: A total of 9 ears in 7 patients (two of whom with bilateral lesions) had surgery for OWA. All patients had concomitant findings of absent stapes footplate with normal, deformed or absent stapes superstructure and an inferiorly displaced facial nerve canal. HRCT was sensitive in identifying OWA and associated ossicular chain and facial nerve abnormalities, which were documented surgically. Conclusion: OWA is a rare entity that can be diagnosed with certainty on HRCT, best visualised on coronal plane. Imaging findings of associated middle ear abnormalities, position of the facial nerve canal, which is invariably mal-positioned, and associated deformity of the incus are important for presurgical planning and consent. Ann Acad Med Singapore 2020;49:285–93 Ann Acad Med Singapore 2020;49:346–53 Key words: Absent oval window, Conductive hearing loss, Temporal bone

Mesenchyme Remaining in Human Temporal Bones

1986 ◽  
Vol 95 (3_part_1) ◽  
pp. 349-357 ◽  
Author(s):  
Tetsuo Takahara ◽  
Isamu Sando ◽  
Yoshie Hashida ◽  
Yoshihiro Shibahara
Keyword(s):  
Middle Ear ◽  
Round Window ◽  
Oval Window ◽  
The Body ◽  
First Year ◽  
Sinus Tympani ◽  
Hematoxylin And Eosin ◽  
Round Window Niche ◽  
Temporal Bones ◽  
Middle Ear Cleft

This study was conducted in order to gain basic information about mesenchyme remaining in the middle ear cleft in normal infants. Because no previous report has objectively described the quantity or quality of such postnatal remnants in normal infants, it has not been possible to accurately evaluate the significance of mesenchyme remaining in the middle ears of infants with pathologic conditions, such as otitis media and congenital anomalies. Thus, 53 temporal bones obtained from 41 individuals reported upon here—from 26 weeks' gestation to 8 years of age—will be controls for future studies of pathologic conditions. The children from whom these temporal bones were obtained had no anomalies of the ear (or any other known part of the body); nor did they have any pathologic conditions in the ear. The temporal bones were prepared for histologic study with hematoxylin and eosin staining and were examined under the light microscope. After areas of the mesenchyme in the histologic sections were projected and illustrated for each of 19 portions in the middle ear cleft under the microprojector, those areas were measured by compensating polar planimetry. The findings obtained in this study were as follows: (1) The amount of mesenchyme remaining in the days after birth seemed to gradually decrease in volume with increased maturity and had nearly disappeared within the first year in normal infants. Where mesenchyme was noted in the temporal bones of infants over 1 year of age, it was usually present only in small niches. (2) Most mesenchyme found in temporal bones of normal infants was seen in the mastoid antrum; it was also found in the aditus ad antrum, the epitympanum, the hypotympanum, the sinus tympani, the round window niche, the oval window niche, and the mesotympanum.

Dimensions of the Sinus Tympani and its Surgical Access VIA a Retrofacial Approach

1996 ◽  
Vol 105 (10) ◽  
pp. 776-783 ◽  
Author(s):  
Orhan Ozturan ◽  
Charles C. Miller ◽  
Carol A. Bauer ◽  
Herman A. Jenkins
Keyword(s):  
Facial Nerve ◽  
Temporal Bone ◽  
Middle Ear ◽  
Surgical Approaches ◽  
Sinus Tympani ◽  
Surgical Access ◽  
Extensive Evaluation ◽  
Temporal Bones ◽  
A Site ◽  
Anatomic Region

The sinus tympani (ST) is a critical anatomic region of the temporal bone. It lies medial to the facial nerve, between the ponticulus and the subiculum, and therefore is not easily visualized by routine surgical approaches to the middle ear and mastoid. This limited access makes the ST a site that is notorious for residual cholesteatoma. An extensive evaluation of the anatomic dimensions of the ST was made from human temporal bones. Three hundred twenty-seven bones were examined at four standardized levels to describe the dimensions and anatomic relationships of the ST with other structures of the temporal bone. The region of the stapedial tendon was found to be the most limited anatomic substructure in the vicinity of the ST. This study demonstrates the feasibility of a retrofacial approach to the ST as an aid in eradication of otherwise hidden disease.

Postnatal Growth of the Human Temporal Bone

1986 ◽  
Vol 95 (4) ◽  
pp. 356-364 ◽  
Author(s):  
Thomas L. Eby ◽  
Joseph B. Nadol
Keyword(s):  
Temporal Bone ◽  
Middle Ear ◽  
Cochlear Implantation ◽  
Postnatal Growth ◽  
Three Dimensions ◽  
Radiographic Measurements ◽  
Stapes Footplate ◽  
Length Width ◽  
Skull Radiographs ◽  
Temporal Bones

Recent interest in cochlear implantation for children has made it important to understand how postnatal growth of the ear will affect such devices. In this study, the postnatal growth of the labyrinth, middle ear, and mastoid was measured in three dimensions using radiographic and temporal bone data. Measurements were made from histologic sections of 48 temporal bones from children and compared to adult temporal bones. Radiographic measurements were made from 253 sets of skull radiographs of children and compared to adult skull series. In the three dimensions measured, there was no postnatal growth of the labyrinth and little variation in size between individuals. Measurements of the middle ear showed greater variation between individuals than measurements of the inner ear, but growth only in the distance from stapes footplate to the tympanic membrane. The mastoid showed growth in all three dimensions: length, width, and depth. The pattern of growth for mastoid length and width appears to follow a double logistic model, with differences between males and females. The growth in mastoid depth is smaller and appears to follow a single exponential curve. The implications for cochlear implantation in children are discussed.

Otopathologic Abnormalities in CHARGE Syndrome

2021 ◽  
pp. 019459982110089
Author(s):  
Rafael da Costa Monsanto ◽  
Renata Malimpensa Knoll ◽  
Norma de Oliveira Penido ◽  
Grace Song ◽  
Felipe Santos ◽  
...  
Keyword(s):  
Facial Nerve ◽  
Middle Ear ◽  
Spiral Ganglion ◽  
Internal Auditory Canal ◽  
Semicircular Canals ◽  
Charge Syndrome ◽  
University Of Minnesota ◽  
Bony Canal ◽  
Ganglion Neurons ◽  
Temporal Bones

Objective To perform an otopathologic analysis of temporal bones (TBs) with CHARGE syndrome. Study Design Otopathologic study of human TB specimens. Setting Otopathology laboratories. Methods From the otopathology laboratories at the University of Minnesota and Massachusetts Eye and Ear Infirmary, we selected TBs from donors with CHARGE syndrome. These TBs were serially sectioned at a thickness of 20 µm, and every 10th section was stained with hematoxylin and eosin. We performed otopathologic analyses of the external ear, middle ear (middle ear cleft, mucosal lining, ossicles, mastoid, and facial nerve), and inner ear (cochlea, vestibule, internal auditory canal, and cochlear and vestibular nerves). The gathered data were statistically analyzed. Results Our study included 12 TBs from 6 donors. We found a high prevalence of abnormalities affecting the ears. The most frequent findings were stapes malformation (100%), aberrant course of the facial nerve (100%) with narrow facial recess (50%), sclerotic and hypodeveloped mastoids (50%), cochlear (100%) and vestibular (83.3%) hypoplasia with aplasia of the semicircular canals, hypoplasia and aplasia of the cochlear (66.6%) and vestibular (91.6%) nerves, and narrowing of the bony canal of the cochlear nerve (66.6%). The number of spiral ganglion and Scarpa’s ganglion neurons were decreased in all specimens (versus normative data). Conclusions In our study, CHARGE syndrome was associated with multiple TB abnormalities that may severely affect audiovestibular function and rehabilitation.

Assessment of Middle Ear Anatomy Teaching Methodologies Using Microscopy versus Endoscopy: A Randomized Comparative Study

2018 ◽  
Vol 12 (5) ◽  
pp. 507-517 ◽  
Author(s):  
Lukas Anschuetz ◽  
Sören Huwendiek ◽  
Daniel Stricker ◽  
Abraam Yacoub ◽  
Wilhelm Wimmer ◽  
...  
Keyword(s):  
Comparative Study ◽  
Middle Ear ◽  
Teaching Methodologies ◽  
Middle Ear Anatomy ◽  
Anatomy Teaching

Tympanometry Revealing Middle Ear Pathology

1976 ◽  
Vol 85 (2_suppl) ◽  
pp. 209-215 ◽  
Author(s):  
Ulf Renvall ◽  
Jörgen Holmquist
Keyword(s):  
Middle Ear ◽  
Pure Tone ◽  
Screening Method ◽  
Initial Study ◽  
Predisposing Factor ◽  
Pilot Studies ◽  
Impedance Audiometry ◽  
Middle Ear Pressure ◽  
Stapedius Reflex ◽  
Temporal Bones

In order to evaluate the usefulness of impedance audiometry as a screening method for school children, two different pilot studies were performed. The results indicated that impedance audiometry (tympanometry and stapedius reflex test) was more efficient than otoscopy and pure tone screening in the detection of ears with secretory otitis media (SOM). In order to gain some more experience, an extended study of 800 7-year-olds was performed. The results from this investigation showed 6.5% pathological values with pure tone screening, 13.5% pathological values with tympanometry and 32% elevated or nonelicitable stapedius reflexes. Analysis of our observations indicates that the stapedius reflex may be too sensitive a test to be used as a screening method. Tympanometry, however, is recommended as a complement to pure tone screening in screening of children. A 6–12 months follow-up was also performed on 357 ears in which an initial study had shown a middle ear pressure of ≤ −100 mm H2O. At the repeated test 20% had pathological pure tone screening, 40% had a middle ear pressure of ≤ −100 mm H2O, 57% had elevated or nonelicitable stapedius reflexes, and 14% had middle ear effusion. The high frequency of persisting abnormal middle ear pressure and effusion in these 357 ears suggests that a middle ear pressure of ≤ −100 mm H2O can be a predisposing factor for SOM. In an experimental study on human temporal bones it was demonstrated that the tympanogram preserves its original appearance when the water level is low in the middle ear, while a higher level gives rise to a pathological tympanogram. It is also demonstrated that there is a discrepancy between the tympanometrically, indirectly recorded middle ear pressure and the middle ear pressure as measured manometrically, directly from the middle ear.

Bilateral Choanal Atresia Associated with Malformation of the Anterior Skull Base: Embryogenesis and Clinical Implications

1992 ◽  
Vol 101 (11) ◽  
pp. 916-919 ◽  
Author(s):  
Michael E. Dunham ◽  
Robert P. Miller
Keyword(s):  
Skull Base ◽  
Choanal Atresia ◽  
Three Dimensional ◽  
Anterior Skull Base ◽  
Preoperative Imaging ◽  
Clinical Implications ◽  
High Resolution Computed Tomography ◽  
Ethmoid Bone ◽  
Intracranial Complications ◽  
Skull Base Defect

A number of craniofacial and systemic malformations have been described in association with choanal atresia. We report a case of bilateral choanal atresia associated with congenital absence of the cribriform plate, crista galli, and perpendicular plate of the ethmoid bone. The anterior skull base defect was detected by using high-resolution computed tomography with three-dimensional reconstructions. The findings support the mesodermal flow theory of choanal atresia, in which there is excess migration of neural crest cells into the developing nasal septum and posterior choanae. This occurs at the expense of cells that would otherwise form the rest of the ethmoid complex. Clinical implications include the need for adequate preoperative imaging of the anterior skull base and consideration of potential intracranial complications during surgical repair.

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