[Otogenic meningitis and bilateral spontaneous dehiscences of the lateral skull base. Two case reports]. / Otogene Meningitis bei bilateralen knöchernen Dehiszenzen der Laterobasis. Zwei Fallberichte.

Meningitis in the case of spontaneous dehiscences of the lateral skull base is rare. We report on two patients with otogenic meningitis. High-resolution CT (HR-CT) showed bilateral dehiscences at the lateral skull base in both cases. Infection along the skull base was assumed. In the first case sufficient repair was achieved using a multilayered technique, while in the second case conservative treatment on an intensive care unit was successful. Conservative therapy can prove successful in exceptional cases.

[Application of glass-crystalline granules of biosit-elcor for reducing the size of trepanation cavity in middle ear surgery].

The authors describe experience in application of bioglass preparations (biosit-elcor) for partial obliteration of mastoid cavities in open operations on the middle ear in 17 patients. Long-term results were studied with otomicroscopy and computed tomography of the temporal bones. A good morphological result of the operation (complete epithelization of the wound surface, no discharge from the ear) was achieved in all the patients. Computed tomography showed step-by-step osteointegration of the implant.

[Clinical assessment of patients with chronic otitis media with cholesteatoma]. / Kolesteatomlu kronik otitis media: Olgularin klinik degerlendirilmesi.

OBJECTIVES: We evaluated clinical features and treatment results of patients with chronic otitis media (COM) with cholesteatoma. PATIENTS AND METHODS: The study included 83 patients (53 males, 30 females; mean age 27.5 years; range 7 to 60 years) who were treated for COM with cholesteatoma. All patients underwent otoscopic examination, audiometric investigation, temporal bone computed tomography, and when necessary, cranial tomography. Open or closed mastoidectomy was performed depending on the extent of cholesteatoma and perioperative appearance of the ear. RESULTS: Open- and closed-technique mastoidectomies were performed in 64 and 19 patients, respectively. Ossicular chain defects were observed in 90.3% of patients, and 9.7% had no detectable ossicular chain. Cranial complications were present in 28%. Of patients who had undergone open mastoidectomy, 75% had dry ears, 11% had recurrent ear discharge, and 14% required revision mastoidectomy because of recurrence. Of those who had been treated by closed-technique, 79% had dry ears, whereas 21% required revision mastoidectomy. Recurrent cholesteatoma was detected in 85% of patients during revision mastoidectomy. CONCLUSION: We prefer open-technique mastoidectomy in chronic otitis media patients with extensive cholesteatoma, bone destruction, and hearing impairment. This choice mainly relies on the socioeconomic status of patients and difficulty in having patient compliance with follow-up controls.

[Otologic signs and symptoms as first manifestations of Wegener's granulomatosis with very severe clinical course--review of the literature and case report]. / Objawy uszne pierwszymi manifestacjami ziarniniaka Wegenera o bardzo ciezkim przebiegu klinicznym--przeglad pismiennictwa i opis przypadku.

A case of Wegener's granulomatosis in female aged 47 is described. Otological symptoms and signs connected with middle ear inflammation and masked mastoiditis about two months outstriped other signs particular from lower respiratory tract. The patient was surgically treated--antromastoidectomy was performed. After few days rapid worsening of patient's general state followed with hectic fever and inflammatory pulmonary changes. The patient was next treated in the Clinic of Pulmonary Diseases and Tuberculosis where the diagnosis of Wegener's granulomatosis was established on the basis of immunological findings (antibodies c-ANCA and PR3). The patient is treated from 9 months with cyclophosphamide and prednisone with improvement. The inability of ENT-surgeon in proper diagnosis and treatment in initial stage of the disease is stressed.

Transcanal endoscopic approach to the sinus tympani: a clinical report.

OBJECTIVES: To investigate the anatomic limitations of the endoscopic transcanal approach to sinus tympani (ST), in particular, how this approach might allow a complete visualization of the ST recesses and to propose a morphologic classification of the ST using computed tomography and to examine if this could be useful for the surgeon in preoperative planning to decide the type of approach to the ST. STUDY DESIGN: Case series. PATIENTS AND METHODS: Forty patients affected by middle ear disease with ST involvement were included in our study. All patients underwent a preoperative computed tomographic scan of the temporal bone. All patients underwent tympanomastoid surgery with intraoperative use of the endoscope. We assessed the variation in depth of the ST area, analyzing the posterior and medial extension of the medial boundary of the ST, and performing a radiomorphologic classification of the ST. RESULTS: Of the 40 patients, it has been possible to describe the detailed morphology of the shape of the ST in 38. We classified the depth of the ST into 3 types based on radiologic findings: Type A (a limited ST), Type B (a deep ST), and Type C (a deep ST with a posterior extension). Of 35 ST of Types A and B, there was good exposure of the medial boundary of the sinus using a transcanal endoscopic approach in 33 (94.2%), whereas in 3 (60%) of 5 patients of Type C, it was not possible to explore the complete depth of the sinus, especially the ST portion under and posterior to the facial nerve. CONCLUSION: The transcanal endoscopic approach to the ST is indicated in ST of Types A and B. In ST of Type C, it is not always possible to have good control of the ST; in these cases, a posterior retrofacial approach is suggested.