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To publish a rare case of Kimura's Disease in Temporal Bone. A 27 year-old male presenting with history of right ear pain and discharge for 2 months was thoroughly evaluated by clinical evaluation, hematological, radiological and histopathological study. Clinical examination revealed a bulge in posterior-inferior quadrant right side of tympanic membrane. HRCT temporal bone revealed a heterogeneous attenuating focal lesion is noted in the region of right middle ear cavity, mastoid antrum mastoid air cells in continuation with the superior aspect of right jugular foramen with erosions and bone destructions, involving the mastoid air cells and sinus plate. Patient was managed surgically with right side canal wall down mastoidectomy and Type 1 Tympanoplasty. Histopathological examination showed focal ulcerated stratified epithelium, dilated elongated congested blood vessels and hemorrhage. Diagnosis was made as Kimura's disease.
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Vertigo is an illusion of motion, either of one self or of the environment. Vertigo in BPPV is a very devastating experience for the patient who experiences it. However, it can be reversible with vestibular rehabilitation, with very good results. A study on 72 patients attending Otoneurology clinic in our hospital, diagnosed as BPPV with history and examination were subjected to DHI (Dizziness Handicap Index) questionnaire prior to and after intervention and results were analyzed. BPPV is more commonly seen in elderly individuals above 45 yrs, females and posterior semi circular canal. A significant improvement was noted in all the three components of DHI index in patients treated with CRM (Canalolith Repositioning Manoeuver) when compared to the patients who received only reassurance. CRM is a very safe and effective treatment of BPPV which has the added advantage of being noninvasive procedure, with excellent results.
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To highlight a new radiological feature in a patient with labyrinthine malformation presenting with bilateral spontaneous high pressure cerebrospinal fluid (CSF) otorhinorrhea. Study design-retrospective case review. Setting-academic, tertiary cochlear implant center. A cochlear implantee with Incomplete Partition Defect (Type 1) presented with meningitis and CSF otorhinorrhea for which she initially underwent medical treatment. High resolution computed tomography (HRCT) of the temporal bone with CT cisternography was performed for identifying the site of the CSF leak. HRCT and CT cisternography revealed a defect in the region of the stapes foot plate and marked thinning/deossification of the cochlear promontory. These two findings were absent in the pre-implant imaging of the patient done 3 years ago. Surgery by endaural approach was undertaken to close the site of CSF leak. Intraoperatively, marked thinning of the cochlear promontory was observed, corresponding to 'blue lining' of the labyrinth in otologic surgery. This intraoperative finding indicating high intralabyrinthine CSF pressure correlated well with the imaging findings. Primary surgical repair resulted in successful CSF leak closure followed by theco-peritoneal shunting to prevent recurrence of the leak. The patient is using her cochlear implant and doing well with auditory verbal therapy. She is asymptomatic till date. Thinning and deossification of the otic capsule on HRCT is an important indicator of high CSF pressure in patients with labyrinthine malformations. Our case study highlights the need for heightened radiological and clinical vigilance in this subgroup of patients to predict complications and ensure prompt intervention.
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Introduction Facial nerve has the longest and complex course in its bony canal. The anatomical variations make the nerve prone to injury during mastoid surgeries. Having a thorough anatomical knowledge and its variations is must for the surgeons to avoid injury to this vital structure and for the safe surgery. The objective of the study was to describe the anatomical variations of intratemporal portion of facial nerve. Materials and methods The study was conducted in the department of otorhinolaryngology in the temporal bone dissection laboratory of a tertiary health care centre. Fifty wet temporal bones were dissected by the same team of surgeons for the duration of one year to study the various anomalies of the intratemporal course of the facial nerve and its relations with the other important middle ear structures. Results The mean length of the labyrinth, tympanic and mastoid segment of the facial nerve was 4.1 mm (±0.6 mm), 9.34 mm (±1.12 mm) and 12.8 mm (±1.8 mm), respectively. The mean distance between the horizontal segment and posterior edge of the oval window was 3.1 mm (±1.03 mm). Dehiscence in the tympanic segment was observed in three temporal bones (6%). Two (4%) specimens had bifurcation of the mastoid segment of the facial nerve. In all dissected temporal bones, the chorda tympani travelled in an ascending path. Conclusion The most common site for facial nerve anomaly is the tympanic portion. Anomalous conditions that can place the nerve at risk of being injured by the surgeons are highlighted here.
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To test whether there are variations in cochlear orientation with respect to age and sex, and its relevance in cochlear implant surgery. Implant otologists rely upon the anatomic landmarks including the facial recess and round window niche and round window membrane for accessibility and placement of electrode array into scala tympani of basal turn of cochlea. Anecdotally, surgeons note variations in cochlear orientation with respect to age. Cochlear orientation studied radiologically by pre-operative CT scan of temporal bone can guide a Surgeon's approach to cochlear implantation. To investigate the changes in cochlear orientation with respect to age and sex; and its relevance in cochlear implantation. A retrospective analytical study was performed on CT scans of temporal bones in patients (of our hospital from July 2013 to January 2015 i.e. for a period of 18 months) with no congenital or radiological abnormalities of cochlea. The basal turn angulations of cochlea varied with age and majority of change occurred during early age. The basal turn angulations of cochlea in difficult situations during cochlear implantation were correlated with the data. There is a significant variation in cochlear orientation as measured radiologically by basal turn angulations relative to midsagittal plane. The more obtuse and acute basal turn angulations have implications like difficulty in cochleostomy and electrode placement during cochlear implantation.