Otopathologic and Computed Tomography Correlation of Internal Auditory Canal Diverticula in Otosclerosis.

INTRODUCTION: Internal auditory canal (IAC) diverticula, also known as IAC cavitary lesions or anterior cupping of the IAC, observed in otopathologic specimens and high-resolution computed tomography (CT) scans of the temporal bone are thought to be related to otosclerosis. Herein, we examined the usefulness of CT scans in identifying diverticula and determined whether IAC diverticula are associated with otosclerosis on otopathology. METHODS: One hundred five consecutive specimens were identified from the National Temporal Bone Hearing and Balance Pathology Resource Registry. Inclusion criteria included the availability of histologic slides and postmortem specimen CT scans. Exclusion criteria included cases with severe postmortem changes or lesions causing bony destruction of the IAC. RESULTS: Ninety-seven specimens met criteria for study. Of these, 42% of the specimens were from male patients, and the average age of death was 77 years (SD = 18 yr). IAC diverticula were found in 48 specimens, of which 46% were identified in the CT scans. The mean area of the IAC diverticula was 0.34 mm 2 . The sensitivity and specificity of detecting IAC diverticula based on CT were 77% and 63%, respectively. Overall, 27% of specimens had otosclerosis. Histologic IAC diverticula were more common in specimens with otosclerosis than those without (37.5% versus 16%; p = 0.019). Cases with otosclerosis had a greater mean histologic diverticula area compared with nonotosclerosis cases (0.69 mm 2 versus 0.14 mm 2 ; p = 0.001). CONCLUSION: IAC diverticula are commonly found in otopathologic specimens with varied etiologies, but larger diverticula are more likely to be associated with otosclerosis. The sensitivity and specificity of CT scans to detect IAC diverticula are limited.

Two probable cases of mastoiditis in a cemetery from the Warring States to Han Dynasty (475 BCE-220 CE) in Qufu, Shandong Province, China.

In modern clinical medical practice, middle-ear infection is a frequently reported condition. If untreated, persistent inflammation caused by infection may lead to perforation of the mastoid process or other portions of the temporal bone. When the middle-ear abscess penetrates the surrounding bone and invades the mastoid process, it causes mastoiditis. Abnormal osseous fistulae were observed on the temporal bones of individuals M137 and M199, which were unearthed in Qufu Olympic Sports Center Cemetery in Qufu City, Shandong Province, and date to the Warring States to the Han Dynasty (475 BCE-220 CE). Microscopic observation and CBCT were used to examine the lesions. A differential diagnosis suggests that the lesions were related to mastoiditis, and based on reference studies, burial information, and paleopathological observation, pollution in the living environment and poor living conditions may be potential factors that caused individuals M137 and M199 to suffer from mastoiditis. The two examples from Qufu are the earliest reported cases of mastoiditis from China; however, infections in the middle ear often go unnoticed in archaeological samples.

External auditory exostoses and early Neolithic aquatic resource procurement in Cyprus: Results from Cypro-PPNB Kissonerga-Mylouthkia in regional context.

OBJECTIVE: This research is designed to evaluate the occurrence of external auditory exostoses (EAEs) in skeletal remains from the oldest known water wells in the world (Kissonerga-Mylouthkia, Cyprus, 8,200-7,200 BCE). MATERIALS: Six individuals (MNI = 6), five fragmentary temporalia, two preserved auditory canals. METHODS: Macroscopic and microscopic (up to x30) observation, with illumination; presence, type, side, severity, occlusion, number, and position of bony growths recorded. RESULTS: Bony growths within two auditory canals were discovered. Differential diagnosis includes osteomata and external auditory exostoses, with the latter consistent with the bony growths (Grade 1 EAEs, two adult males, one with single, another with two EAEs). CONCLUSIONS: The emergence of the Neolithic in Southwest Asia is thought to involve increases in dietary breadth among foraging societies (Broad-Spectrum Revolution). EAEs likely indicate maritime activity in this context, given the lack of freshwater bodies, and zooarchaeological evidence points to dietary and other uses of maritime organisms. SIGNIFICANCE: This EAE evidence is the oldest known in maritime contexts in Eastern Mediterranean and the Middle East, and first in Cyprus. It contributes towards understanding the initial colonization events by Neolithic farming communities in the 9th millennium BC, and the emergence of broad-spectrum economies at the dawn of the Neolithic in Southwest Asia, crucial for re-considerations of paradigms on the transition to the Neolithic way of life in the Near East. LIMITATIONS: Only a few skeletal remains from these prehistoric contexts were available for observation. SUGGESTIONS FOR FURTHER RESEARCH: Further intensive review of Cypriot skeletal collections for EAEs is advised.

A patient with conventional and follicular variant papillary thyroid microcarcinoma and Eagle's syndrome, Langlais type III, with hyoid bone variation.

AIM: Presenting an extraordinary case of Eagle's syndrome (ES) with the classical and follicular variant of papillary thyroid microcarcinoma (PTmC) and an uncommon stylohyoid ligament calsification, aside from O'Carroll's System. CASE REPORT: A 52-year-old Turkish man with an histopathology of the follicular variant of PTmC (FVPTmC) of his right lobe and conventional PTmC of his left lobe of the thyroid with an adjuvant 100 mCi radioactive iodine (RAI) ablation was admitted. On the routine follow-up of the present case, a lineer structure at the 3rd compartment of neck in his ultrasonography, a styloid ligament calsification in his noncontrast computed tomography (CT), and a left styloid process of the temporal bone of 29 mm in size in his three-dimensional (3D) CT scanning had been revealed. Conclusively, an ES, Langlais Type III with The Calcification Pattern IV, was recognized. DISCUSSION: A noninvasive peroral medical management was administered as a first-line treatment for the neuropathic sequelae of ES and it has provided relief of signs and symptoms without any recurrence to date, for three years and three months. CONCLUSION: To our knowledge, it is an highly extreme and first case of ES in the English literature, recognized in the course of his programmed follow-up of his conventional PTmC and FVPTmC, simultaneously possessing an exceptional stylohyoid ligament calsification, apart from O'Carroll's System, even with an anatomic variation of the hyoid bone. KEY WORDS: Eagle's Syndrome Follicular variant of papillary thyroid microcarcinoma, Hyoid bone variation, Langlais classification, O'Carroll's System, Radioactive iodine, Papillary thyroid microcarcinoma.

Osteonecrosis of the External Auditory Canal Associated With Oral Sorafenib Therapy: Sorafenib and Temporal Bone Osteonecrosis.

OBJECTIVE: To present the first case of osteonecrosis of the external auditory canal associated with sorafenib treatment. PATIENT: 58-year-old patient with right-sided otorrhea and otalgia was treated for otitis externa for 1 month without improvement. Otoscopic examination revealed a large defect in the inferior wall of the tympanic bone filled with skin debris and bony fragments. Previous medical history included treatment with sorafenib for metastatic renal cell cancer; he had never been exposed to radiotherapy. Computed tomography of the temporal bone showed a large right external auditory canal bony erosion with involvement of the tympanic bone and bony sequestra extending to the mastoid cells and temporomandibular joint. Histologic examination revealed necrotic bone and inflammatory changes with no signs of malignancy. A diagnosis of osteonecrosis of external auditory canal was made. INTERVENTION: Right subtotal petrosectomy with obliteration of surgical cavity with abdominal fat was performed. RESULTS: Final histological report revealed avascular necrosis of the bone with perivascular lymphocitic infiltration of the soft tissues. Diagnosis of medication-related external auditory canal osteonecrosis was confirmed. CONCLUSION: Medication-related osteonecrosis of the temporal bone is not a well-known entity among otolaryngologists and could therefore be misclassified as another diagnosis. In patients with othorrea and earache following sorafenib treatment, temporal bone osteonecrosis should be suspected.

Unresectable Recurrent Squamous Cell Carcinoma of the Temporal Bone Treated by Induction Chemotherapy Followed by Concurrent Chemo-Reirradiation: A Case Report and Review of the Literature.

OBJECTIVE: To report a rare case of recurrent temporal bone carcinoma encasing the carotid artery. PATIENT: A 54-year-old man underwent mastoidectomy combined with adjuvant chemoradiotherapy of squamous cell carcinoma of the temporal bone. He developed metastatic disease and received parotidectomy and lymph node dissection. Three months later, the magnetic resonance imaging scan showed that the tumor had relapsed and invaded the carotid artery. INTERVENTION: The patient completed TPF-C induction chemotherapy (docetaxel, cisplatin, 5-fluorouracil, cetuximab), followed by concurrent chemotherapy with reirradiation. RESULTS: Magnetic resonance imaging revealed a complete response of tumor 1 month after treatment. The patient had no detectable recurrence after 53 months of follow-up. CONCLUSION: Concurrent chemotherapy with reirradiation is a potential curative treatment option for patients who have unresectable recurrent squamous cell carcinoma of the temporal bone.

Isolated Horner Syndrome From an Elongated Styloid Process (Eagle Syndrome).

Eagle syndrome occurs when an elongated styloid process causes otolaryngological or neurological symptoms or signs. We report a patient who had an isolated asymptomatic Horner syndrome that resulted from a pinned internal carotid artery being dynamically injured by an elongated styloid process during chiropractic neck manipulation. There was no evidence of arterial dissection.

Osteoradionecrosis of the temporal bone: a case series.

OBJECTIVE: To study osteoradionecrosis (ORN) of the temporal bone. STUDY DESIGN: Retrospective case review. SETTING: Academic medical center. PATIENTS: Patients were included who had previously undergone radiation to the head and neck and then developed exposed necrotic bone within the ear canal that persisted at least 3 months. INTERVENTIONS: Patients were treated with a variety of modalities, including conservative therapy with antibiotic ear drops and in-office debridements, hyperbaric oxygen therapy, and surgery. MAIN OUTCOME MEASURES: To describe the presentation and management of patients with temporal bone osteoradionecrosis. RESULTS: Thirty-three patients with temporal bone osteoradionecrosis were included. The most common site of primary tumor was the parotid gland (n = 11), followed by the nasopharynx (n = 7). The time to development of ORN varied between 1 and 22 years, with mean of 7.9 years. The mean radiation dose was 62.6 Gy to the primary tumor, 53.1 Gy to the affected temporal bone, and 65.2 Gy to the affected tympanic bone. The most common symptoms of ORN were otorrhea (n = 15), hearing loss (n = 13), and otalgia (n = 12). Fifteen patients had bacterial superinfection, most commonly Staphylococcus aureus (n = 9). Conservative therapy was successful at managing symptoms but not in eradicating exposed bone in most patients. Surgery was used for recalcitrant pain, infection, cholesteatoma, cranial neuropathies, and intracranial complications. CONCLUSION: Osteoradionecrosis is a rare complication of radiation to the temporal bone. Management should be aimed at relief of symptoms, eradication of superinfection, and treatment of other commonly present radiation effects like cholesteatoma and hearing loss.

Ototoxicity of gentian violet on the guinea pig cochlea.

PURPOSE: Gentian violet (GV) is an antimicrobial and antifungal agent that has been used widely to treat intractable discharge in the ear. The purpose of this report is to warn clinicians about the ototoxic effect of GV in the middle ear. MATERIALS AND METHODS: GV ototoxicity was evaluated by measuring compound action potentials (CAPs) in the VIIIth nerve in adult Hartley guinea pigs. The middle ear cavities of the animals were filled with GV solution (0.5% or 0.13%), and CAPs were measured after intervals of 5 and 30 minutes and 1, 2, 6, and 24 hours. After all measurements were completed, the temporal bones were harvested for histopathologic evaluation. Celloidin-embedded specimens were cut into 20-µm slices and examined using light microscopy. The bacteriostatic activity of GV was evaluated using a disk-diffusion assay. RESULTS: A 0.5% GV solution produced a mild elevation in the CAP threshold at 30 minutes, a greater reduction at 1 hour, and complete abolishment of CAP at 24 hours. A 0.13% GV solution caused mild elevation in the CAP threshold at 2 hours and severe elevation at 6 hours. Massive new bone formation was found in the middle ear cavity at 6 weeks. GV concentrations of 0.13% and 0.06% were effective against all bacteria tested, with the exception of Pseudomonas aeruginosa. CONCLUSIONS: Although GV has marked antibacterial and antifungal activities, its use should be limited to the external ear canal. GV exerts an ototoxic effect in a concentration- and time-dependent manner, and so the use of this drug in the middle ear cavity is not recommended.

Osteogenesis imperfecta and pneumatization of bone-- a hidden reality.

Osteogenesis imperfecta is a bone disorder in which three factors that influence bone strength (quality, mass, and geometry of osseous tissue) are affected. Pneumatization refers to the development of air-filled cavities inside the bone. Knowledge about these air-filled cavities provides valuable information for understanding the diagnosis and spread of various pathologic entities like hemangiomas, giant cell tumors, eosinophilic granulomas, and even metastatic tumor deposits. This paper presents a case in which radiologic, clinical, biochemical, and karyotypic evaluations lead to a diagnosis of osteogenesis imperfecta.

Clinical use of vestibular evoked myogenic potentials in the evaluation of patients with air-bone gaps.

OBJECTIVE: To determine the value of vestibular evoked myogenic potential (VEMP) test in clinical evaluation of air-bone gaps. STUDY DESIGN: Retrospective case review. SETTING: Tertiary referral center. PATIENTS: A total of 120 patients underwent VEMP testing during clinical investigation of significant air-bone gaps in their audiograms. INTERVENTION(S): Otologic examination and surgeries, high-resolution computerized tomography (CT), air and bone audiometry, tympanometry, acoustic reflex, and VEMP test. MAIN OUTCOME MEASURE(S): Imaging studies demonstrating structural anomalies in the temporal bone. Audiologic outcomes of air-bone gaps and VEMP thresholds. Surgical findings confirming imaging results. RESULTS: Middle ear pathologies, such as otosclerosis and chronic otitis media, were identified in 50 patients, and all of them had absent VEMP responses elicited by air-conduction stimuli. Moreover, 13 of them had successful middle ear surgeries with closures of the air-bone gaps. Abnormally low VEMP thresholds were found in 71 of 73 ears with inner ear anomalies, such as semicircular canal dehiscence and enlarged vestibular aqueduct. Seven patients with superior semicircular canal dehiscence underwent plugging procedure via middle fossa approach, and VEMP thresholds became normalized after the surgery in 3 of them. VEMP test failed to provide accurate diagnosis in only 3 cases. CONCLUSION: Air-bone gaps may be a result of various otologic pathologies, and the VEMP test is useful during clinical evaluation, better than tympanometry and acoustic reflexes. To avoid unnecessary middle ear surgery for air-bone gaps with unknown or unsure cause, VEMP test should be used in the differential diagnosis before an expensive imaging study.

How does closure of tympanic membrane perforations affect hearing and middle ear mechanics? An evaluation in a patient cohort and temporal bone models.

OBJECTIVE: This study aimed to determine how tympanic membrane (TM) perforations and their closure, using a paper-patch technique, affect middle-ear mechanics and, thus, conductive hearing for different sizes of the TM perforation. STUDY DESIGN: Temporal bone (TB) study and prospective clinical trial. SETTING: Tertiary referral center. PATIENTS: Nine patients with chronic otitis media for more than 3 months. INTERVENTION: The TM perforations were closed with a paper patch in all 9 patients. In 5 of 9 patients, myringoplasty was performed. Matching TM perforations were created in a TB model (n = 8) and closed using the paper patch. MAIN OUTCOME MEASURES: Air-bone gap was measured in all 9 patients of the patient cohort with TM perforations before and after closure and in 5 patients after myringoplasty. Stapes velocity and sound pressure difference between the ear canal and middle-ear cavity were measured in TBs with intact TM, with TM perforations, and with the perforations closed by the paper patch. All measurements in the patient cohort and TBs were performed for different sizes of TM perforations to determine if the effects varied as a function of size. RESULTS: Degree of the air-bone gap differed as a function of size of the TM perforations and its recovery after closure, and myringoplasty was independent of the size of the TM perforation in the frequency range of 0.25 to 4 kHz. In the TB measurements, although pressure difference across the TM was almost fully recovered by closing the perforation with a paper patch, recovery of the stapes motion was limited at frequencies above 4.5 kHz for larger sizes of TM perforations. CONCLUSION: Hearing loss caused by TM perforations depends on the size of the perforation. Hearing returns almost completely across the frequency range after closure except above 4 kHz for larger perforations. This is because the structural damage caused by large TM perforations cannot be completely restored by application of a paper patch.

Effect of ciprofloxacin/dexamethasone versus ciprofloxacin/hydrocortisone on lipopolysaccharide-induced experimental otitis media.

OBJECTIVES: The purpose of this study is to compare the effect of topical ciprofloxacin/dexamethasone versus topical ciprofloxacin/hydrocortisone on the outcome of lipopolysaccharide (LPS)­induced otitis media with effusion in chinchillas. STUDY DESIGN: A randomized experimental animal study. SETTING: Jerry L. Pettis Veteran's Medical Center. SUBJECTS AND METHODS: Otitis media with effusion was induced in 5 groups of chinchillas, 6 per group, by injecting 0.3 mL (1 mg/mL) of Salmonella enteric LPS into the superior bullae of each chinchilla with a venting needle in place. Each group was treated with 0.2 mL of test substance at ­2, 24, 48, and 72 hours relative to the 0-hour LPS induction. Group 1 was treated with vehicle control. Groups 2 to 5 received 0.3% ciprofloxacin with either 0.1% dexamethasone (group 2), 1% dexamethasone (group 3), 0.1% hydrocortisone (group 4), or 1% hydrocortisone (group 5). The outcome of each treatment was measured by the amount of middle ear effusion present and mucosal thickness at 120 hours posttreatment. RESULTS: Ciprofloxacin/dexamethasone 1% significantly (P = .0150) reduced middle ear effusion compared with control. Ciprofloxacin/dexamethasone 1% significantly reduced the mucosal thickness when compared with vehicle control (P = .0005), ciprofloxacin/dexamethasone 0.1% (P = .0240), and ciprofloxacin/hydrocortisone 0.1% (P = 1.00). Results also showed a dose-response effect between the ciprofloxacin/dexamethasone concentrations. CONCLUSIONS: This study demonstrated that treatment with a combination of topical ciprofloxacin and corticosteroid decreased the middle ear effusion when compared with the control group and that ciprofloxacin/dexamethasone suspension reduced the severity of LPS-induced experimental otitis media more than ciprofloxacin/hydrocortisone did.

Sensitivity and specificity of auditory steady-state response testing.

INTRODUCTION: The ASSR test is an electrophysiological test that evaluates, among other aspects, neural synchrony, based on the frequency or amplitude modulation of tones. OBJECTIVE: The aim of this study was to determine the sensitivity and specificity of auditory steady-state response testing in detecting lesions and dysfunctions of the central auditory nervous system. METHODS: Seventy volunteers were divided into three groups: those with normal hearing; those with mesial temporal sclerosis; and those with central auditory processing disorder. All subjects underwent auditory steady-state response testing of both ears at 500 Hz and 2000 Hz (frequency modulation, 46 Hz). The difference between auditory steady-state response-estimated thresholds and behavioral thresholds (audiometric evaluation) was calculated. RESULTS: Estimated thresholds were significantly higher in the mesial temporal sclerosis group than in the normal and central auditory processing disorder groups. In addition, the difference between auditory steady-state response-estimated and behavioral thresholds was greatest in the mesial temporal sclerosis group when compared to the normal group than in the central auditory processing disorder group compared to the normal group. DISCUSSION: Research focusing on central auditory nervous system (CANS) lesions has shown that individuals with CANS lesions present a greater difference between ASSR-estimated thresholds and actual behavioral thresholds; ASSR-estimated thresholds being significantly worse than behavioral thresholds in subjects with CANS insults. This is most likely because the disorder prevents the transmission of the sound stimulus from being in phase with the received stimulus, resulting in asynchronous transmitter release. Another possible cause of the greater difference between the ASSR-estimated thresholds and the behavioral thresholds is impaired temporal resolution. CONCLUSIONS: The overall sensitivity of auditory steady-state response testing was lower than its overall specificity. Although the overall specificity was high, it was lower in the central auditory processing disorder group than in the mesial temporal sclerosis group. Overall sensitivity was also lower in the central auditory processing disorder group than in the mesial temporal sclerosis group.

Sensitivity and specificity of auditory steady-state response testing

INTRODUCTION: The ASSR test is an electrophysiological test that evaluates, among other aspects, neural synchrony, based on the frequency or amplitude modulation of tones. OBJECTIVE: The aim of this study was to determine the sensitivity and specificity of auditory steady-state response testing in detecting lesions and dysfunctions of the central auditory nervous system. METHODS: Seventy volunteers were divided into three groups: those with normal hearing; those with mesial temporal sclerosis; and those with central auditory processing disorder. All subjects underwent auditory steady-state response testing of both ears at 500 Hz and 2000 Hz (frequency modulation, 46 Hz). The difference between auditory steady-state response-estimated thresholds and behavioral thresholds (audiometric evaluation) was calculated. RESULTS: Estimated thresholds were significantly higher in the mesial temporal sclerosis group than in the normal and central auditory processing disorder groups. In addition, the difference between auditory steady-state response-estimated and behavioral thresholds was greatest in the mesial temporal sclerosis group when compared to the normal group than in the central auditory processing disorder group compared to the normal group. DISCUSSION: Research focusing on central auditory nervous system (CANS) lesions has shown that individuals with CANS lesions present a greater difference between ASSR-estimated thresholds and actual behavioral thresholds; ASSR-estimated thresholds being significantly worse than behavioral thresholds in subjects with CANS insults. This is most likely because the disorder prevents the transmission of the sound stimulus from being in phase with the received stimulus, resulting in asynchronous transmitter release. Another possible cause of the greater difference between the ASSR-estimated thresholds and the behavioral thresholds is impaired temporal resolution. CONCLUSIONS: The overall sensitivity of auditory steady-state response testing was lower than its overall specificity. Although the overall specificity was high, it was lower in the central auditory processing disorder group than in the mesial temporal sclerosis group. Overall sensitivity was also lower in the central auditory processing disorder group than in the mesial temporal sclerosis group.

[Dentofacial Orthopedics to treat facial asymmetries before six years of age. How to balance craniofacial growth and enhance temporomandibular function]. / Traiter orthopédiquement les asymétries avant six ans ou comment symétriser la croissance cranio-faciale et optimiser le fonctionnement temporo-mandibulaire.

Minor facial asymmetries that can be detected in newborn infants indicate that facial growth for this child will also be asymmetric. When practitioners observe a displacement of the mandible in temporary dentition it probably indicates the presence of asymmetric masticatory function and they should look for an inter-temporal axial asymmetry by tracing cutaneous landmarks in the vicinity of the external ears. If they find the possible presence of asymmetric remodeling of glenoid fossas, they have to anticipate future temporo-mandibular disorders. By using a measurement grid (Orthogrille type) placed on the teeth of the upper plaster cast, they can assess sagittal and transverse status of the temporary teeth. If indicated, they can use acrylic plates fitted with sectional distalizing or expansion screws designed for full or partial arch correction. They can also modify the upper occlusal plane inclination by using acrylic bite blocks that keep all of the teeth from occluding and thus allow the displaced mandible to return to symmetrical movements during mastication and at the same time allow the temporal bones to remodel symmetrically. Finally, they can re-center the two dental arches and their midlines with a Frankel re-centering device that will also restore harmony to respiratory and vocalization functions. Thanks to this type of orthopedic treatment carried out for patients before they reach the age of six the asymmetric direction of their facial growth will become normal and the functioning of their temporo-mandibular joints will become optimal.

Non-organic hearing loss in childhood.

OBJECTIVE: The present study aimed to investigate the etiology, symptoms, diagnosis and prognosis of pediatric patients with non-organic hearing loss (NOHL), and to heighten awareness of this disorder among physicians. METHODS: Between January 2000 and July 2009, we retrospectively reviewed the medical records of 47 pediatric patients (aged 6-18 years of age) diagnosed with NOHL. The diagnosis was made when there were audiometric discrepancies between the subjective and objective hearing thresholds of the patient in the absence of any organic disease. RESULTS: Eighteen patients presented with unilateral hearing loss, and 29 showed bilateral hearing loss. Five patients received steroid treatment before the correct diagnosis was made, and six had secretory otitis media and underwent a tympanostomy tube placement. CONCLUSION: If physicians are unaware of the possibility of NOHL; they may misdiagnose children with idiopathic sudden sensorineural hearing loss and administer high-dose steroid treatments or exploratory tympanotomies. Otoacoustic emissions are abolished when NOHL patients have secretory otitis media. In these cases, after tympanostomy tube placement, they should undergo objective electrophysiologic examinations to reevaluate NOHL.

A successful combined endovascular and surgical treatment of a cranial base mucormycosis with an associated internal carotid artery pseudoaneurysm.

OBJECTIVE: We report a rare case of internal carotid artery pseudoaneurysm owing to rhinocerebral mucormycosis and review 40 reported cases from 1980 to present. CLINICAL PRESENTATION: A 38-year-old Caucasian man presented with a 3-day history of headache, diplopia, and numbness in the distribution of the left ophthalmic and maxillary branches of the trigeminal nerve. A complete left cavernous syndrome was discovered upon neurological examination. Magnetic resonance imaging scans revealed an inflammatory process involving the paranasal sinuses with extension into the left cavernous sinus, temporal fossa, and petrous bone. INTERVENTION: The patient was immediately treated with amphotericin B, atorvastatin, and daily hyperbaric oxygen sessions before surgical intervention. The patient underwent endovascular treatment of the associated mycotic pseudoaneurysm after carotid test occlusion in addition to a radical bilateral debridement of the paranasal sinuses and infratemporal and temporal fossa. CONCLUSION: Aggressive multimodal therapy is imperative for late-stage rhinocerebral mucormycosis. Extensive resection of infected tissue combined with amphotericin B, atorvastatin, and hyperbaric oxygen seems to be the best course of management. If the internal carotid artery is involved, endovascular intervention is clearly an option to attain this goal. Further research and longer follow-up periods are required to better understand the long-term implications of endovascular coiling and hyperbaric oxygen therapy for rhinocerebral mucormycosis.

Osteoradionecrosis of tympanic bone: reconstruction of outer ear canal with pedicled skin flap, combined with hyperbaric oxygen therapy, in five patients.

OBJECTIVE: To evaluate the results of one-stage surgical repair of the meatal skin defect in patients with long-lasting osteoradionecrosis of the outer ear canal, using a postauricular, inferiorly pedicled skin flap. All patients were also treated with hyperbaric oxygen both pre- and post-operatively. METHODS: A prospective study evaluating the results of a one-stage surgical procedure to repair the meatal skin defect in five patients with osteoradionecrosis of the outer ear canal. All patients were treated with hyperbaric oxygen both pre- and post-operatively. RESULTS: In four of the five patients, intact canal skin was achieved after surgery and hyperbaric oxygen therapy. One patient needed a second operation to cover a small remaining area of bare bone. In one patient, wound healing was unsatisfactory and an area of bare bone remained. CONCLUSION: In cases of osteoradionecrosis of the outer ear canal, the skin defect can be repaired with an inferiorly pedicled skin flap. Although not yet scientifically proven, the peri-operative application of hyperbaric oxygen may be of additional value to improve wound healing in areas of compromised tissue.

Partial ossicular reconstruction: comparison of three different prostheses in clinical and experimental studies.

OBJECTIVE: To compare the reconstruction results of a long incus process defect using 3 different partial ossicular replacement prostheses (PORP). STUDY DESIGN: Temporal bone experiments and retrospective case review. SETTING: Tertiary referral center. EXPERIMENTAL MATERIAL AND PATIENTS: The experimental study was performed on 18 temporal bones; 66 patients with retraction pockets, chronic otitis media with or without cholesteatoma. INTERVENTIONS: Ossiculoplasty using 3 different PORP: titanium angle prosthesis, autologous incus interposition, and titanium clip prosthesis. MAIN OUTCOME MEASURES: Laser Doppler vibrometry in temporal bones measured transmission properties of the PORP. Patients were retrospectively assessed up to 5 years after surgery. Audiologic data were analyzed for preoperative and postoperative air conduction and air-bone gap at 0.5, 1, 2, 3, and 4 kHz. Statistical analyses compared the outcome in the experimental and clinical setting. RESULTS: Experimentally, the titanium PORP showed similar transmission properties because the overall difference to the intact specimen was -4.14 +/- 0.59 dB for the titanium angle prosthesis and -4.61 +/- 0.57 dB for the titanium clip prosthesis. The transmission after an autologous incus interposition was significantly worse (-9.32 +/- 0.39 dB, p < or = 0.001) compared with the other prostheses. Patients' mean postoperative air-bone gap was 25.5 +/- 1.2 dB and less than 20 dB in at least 66% of cases without any significant differences between the groups. CONCLUSION: In the clinical setting, the confounding factors that influence the acoustic outcome after partial ossiculoplasty obscure the prosthesis-related transmission factors that can otherwise be derived in the experimental setting. The results do not generally favor the use of 1 specific prosthesis, rather they suggest that the correct choice of a prosthesis be based on the anatomic and pathophysiologic conditions found in the individual patient.