Otitis media (silent): a potential cause of childhood meningitis.

Sixteen temporal bones from 8 infants with otitis media, who died of meningitis, and 6 controls from infants with only otitis media, were studied histologically. All bones contained middle ear effusion and residual mesenchyme, but, unlike the controls, the meningitic cases showed considerable histopathological tissue changes of chronic and acute otitis media and chronic inflammatory cells in the round window membrane and within the perilymph, the modiolus, and the cochlear aqueduct, suggesting the latter as likely portals from the inner ear to the meninges. Since all tympanic membranes were intact and 3 were histologically normal, this silent route of infection warrants medical vigilance.

The relations of the mastoid segment of the facial canal to surrounding structures in congenital middle ear malformations.

The authors investigated the relations between the mastoid segment of the facial canal and the temporomandibular joint, the posterior wall of the cavum tympani and the external wall of the mastoid process in 19 cases with congenital ear malformations and 10 cases with normal ears. A significantly reduced distance was found between the facial canal and the temporomandibular joint as well as between the facial canal and the posterior wall of the cavum tympani in the groups with malformed ears as compared to the control group with normal ears.

Anatomical variations and relations of the bony portion of the eustachian tube.

The bony portion of the Eustachian tube was examined, using anatomical and histological methods, on 200 temporal bones of adults. This part of the tube averages 11.38 mm in length, its tympanic opening has an average diameter of 5.20 X 3.95 mm, and its lumen can be of an irregular (45%), rectangular (35%) or triangular (20%) shape. The dimensions of the bony portion of the tube diminish gradually toward the isthmus, so that in the middle the average diameter is 4.02 X 3 mm and at the level of the isthmus, 2.5 X 1.5 mm. The outer wall forms the tympanic plate of the tympanic bone, which in 65% of the cases is compact and in 35% finely pneumatized. On this wall bony trabeculae often appear, which more or less block the lumen of the tube. The medial part of the upper wall forms the bony septum toward the m. tensor tympani and the lateral represents the tegmen. The average distance from the lumen of the tube to the dura at the level of the tegmen is 3.62 mm. The tegmen above the tube may be pneumatized (45%) or compact (55%). The lower wall in 20% of the cases is represented by a shallow groove, and if formed is usually convex into the tube's lumen, but is less often concave. The jutting out of the lower wall is usually caused by its pneumatization.

Anatomical variations and relations in the medial wall of the bony portion of the eustachian tube.

The medial wall of the bony portion of the Eustachian tube was examined, by anatomical and histological methods, in 150 temporal bones of adults. This wall consists of two parts: posterolateral (labyrinthine) and anteromedial (carotid), whose shapes, sizes and relations depend upon the position of the a. carotis interna. If it is located nearer the tympanic opening of the tube, the labyrinthine part of the wall is smaller and has a triangular shape. The further the artery is removed from the tympanic opening of the tube, the greater and more rectangular the shape of this part of the wall. The part of the medial wall which corresponds to the a. carotis interna can differ in each case and in 69% of the cases this part extended more or less into the lumen of the tube. The average thickness of this part of the wall is 1.5 mm (minimum is wafer-thin and maximum is 3 mm). In 2% of the cases the bony wall above the a. carotis interna was missing, so that the artery projected into the protympanum. Through a bone defect, aneurysm of the artery can develop. In one case, during an operation, it was established that the protrusion of the a. carotis interna into the tympanic cavity was due to a defect in the medial wall of the Eustachian tube.

X-ray diffraction analysis of the auditory ossicles in chronic otitis.

An X-ray diffraction analysis was carried out on 10 healthy mallei and incudes which were taken from cadavers and on 50 diseased mallei and incudes taken peroperatively from patients with atticoantral otitis. X-ray powder diagrams of normal ossicles were shown as a granular hydroxyapatite. In diseased ossicles, changes were found in the crystallinity of hydroxyapatite which can be divided into four groups: (i) with characteristics of a diagram of normal bones giving peaks of maximum intensity of a granular hydroxyapatite; (ii) with less hydroxyapatite crystallinity; (iii) characterized by the occurrence of an amorphous phase of bone; (iv) characterized by the absence of all types of crystallization. The occurrence of different phases of crystalline hydroxyapatite in various forms of atticoantral otitis does not depend on the type of pathological process, i.e., with or without cholesteatoma.

Hensen's cell cyst of the organ of Corti.

The temporal bone collection at the Massachusetts Eye and Ear Infirmary contains the bones of two subjects with bilaterally symmetrical cyst formations in the Hensen's cell areas of the organs of Corti. In both subjects the cysts are located in the 8-14-mm regions of the cochlear ducts. Both cochleas of one subject show pressure atrophy of the outer hair cells, demonstrating that the cysts may have the potential for producing high-tone hearing loss. While the genesis and contents of the cysts are unknown, it is postulated that they may represent the coalescence of lipid droplets extruded from Hensen's cells.

Fibrous dysplasia of the temporal bone and maxillofacial region associated with cholesteatoma of the middle ear.

Fibrous dysplasia of the temporal bone is a rare disease which may lead to progressive stenosis of the external auditory canal and the development of cholesteatoma. We present a case in which minimal symptoms were present despite a massive temporal bone fibrous dysplasia. Cholesteatoma resulted most probably secondary to external auditory canal stenosis. Retroauricular fistula developed as a result of destructive effect of cholesteatoma, that influenced previous diagnosis and treatment of this clinically silent disease.

Facial neuroma in the internal auditory canal.

Authors presented two cases of facial neuromas in the internal auditory canal, one without facial palsy and the other with facial palsy. In both cases neuromas were occult and undiagnosed. Although in the first case neuroma was greater than the other, facial palsy was not developed. The mechanism of the facial palsy due to neuromas could not be clearly clarified.

Surgical anatomy of the hypotympanum.

Anatomical characteristics of the hypotympanum were tested on 50 temporal bones. The hypotympanum has the shape of an irregular bony groove which is surrounded by five walls. The outer wall is formed by the tympanic part of the temporal bone. In 65 per cent of the cases the inner wall is formed by part of the petrous bone which extends under the promontory; in 25 per cent it is formed only by the lower part of the promontory; and in 10 per cent it corresponds to the juncture of the promontory and the petrous bone. The lower wall is clearly defined in 48.2 per cent of cases and corresponds to the juncture of its inner and outer walls. In 65 per cent of cases a recess of the inferior hypotympanic sinus is found on the floor of the hypotympanum. In 25.3 per cent of cases the jugular bulb protrudes into the tympanic cavity. In 73.4 per cent of cases the front wall is formed by part of the petrous bone which extends from its floor towards the tympanic opening of the protympanum, and in 26 per cent of the cases it is formed by the wall of the internal carotid artery. On the front wall, in 22.4 per cent of cases, a recess of the anterior hypotympanic sinus is found. The back wall is formed by elements of the styloid complex and in five per cent of the cases a recess or posterior hypotympanic sinus is found on it.

Anatomical characteristics of the fossula fenestrae vestibuli.

Anatomical characteristics of the fossula fenestrae vestibuli were tested and analysed precisely on 200 samples of temporal bones. The fossula is usually ovoid and shallow but can be, exceptionally, elongated, narrow and deep. It is surrounded by four walls. In 45.5 per cent of cases the upper wall is formed only by the facial canal and in 54.5 per cent of cases a bony lamella is found beneath the facial canal; the promontory forms the lower wall; the front wall is formed by the bony lamella and part of the processus cochleariformis; the back wall is clearly defined in only 22.8 per cent of cases and is formed by the bony lamella of the medial wall of the tympanic cavity. In 13.2 per cent of cases the floor of the fossula partially covers the prominence of the facial canal and in two per cent the eminentia pyramidalis. Bony recesses in this region occur fairly frequently: sinus subfacialis in 60 per cent, sinus retrofenestralis in 77.2 per cent, and sinus subrostralis in 25 per cent of the cases. These anatomical variations can influence the result of surgical intervention.

Anatomical variations and relations of the medical and lateral portions of the attic and their surgical significance.

The medial and lateral attics were examined in 150 specimens of temporal bones of adults using anatomical and histological methods. The medial attic varies in shape and size, depending upon the position of the auditory ossicles, the degree of prominence of the lateral semicircular canal and the direction in which the tympanic segment of the facial canal extends. The latero-medical diameter of this attic at the level of the body of the incus averages 1.7 mm., but is somewhat smaller at the level of the head of the malleus. The medial attic always communicates with the mesotympanum through an opening between the prominence of the tympanic part of the facial canal and the superstructures of the auditory ossicles. The lateral attic is always of smaller dimensions than the medial attic and its latero-medial diameter averages less than 1 mm. This attic very seldom communicates with the mesotympanum.

The value of computerized tomography (CT) in the evaluation of the anatomic structure of the attic.

By the use of computerized tomography (CT) the authors have examined and precisely defined the radiological anatomical characteristics of the attic and its relation to other structures of the middle and inner ear. The identification of individual morphological structures has been made on axial, semi-axial and frontal CT sections. Each type of original CT section has been compared with the corresponding original anatomical section.

[Anatomical variations and anomalies of the musculus stapedius tendon. Study by scanning electron microscopy]. / Les variations anatomiques et les anomalies du tendon du muscle de l'étrier. Etude en microscopie électronique scanning.

The authors used scanning electronic microscopy to investigate and define morphological characteristics of the musculus stapedius tendon: the opening through which the tendon protrudes at the eminentia pyramidalis and it can be found at its base. Fibers of the tendon may directly be attached to the bony surface of the stages or its prolongation of various forms and dimensions. In some cases the tendon fibrous bundles are more or less ossified. In one patient who was operate we found a congenital malformation manifested as absence of the tendon and deformation of the stapes. The tendon absence is found in 0.5% of cases.

[Variations of the position of the stapes in the fossula of the round window and their surgical value]. / Variations de la position de l'étrier dans la fossette de la fenêtre du vestibule et leur importance chirurgicale.

The authors studied variations of the position of stapes in the fossula of ovale window on 300 preparations of temporal bones, under operating microscope. They noted three possible positions of the stapes: most commonly downwards to the promontorium (76%), much less frequently (15%) towards the bottom of the fossula, and rarely upwards to the facial canal (9%). Knowledge of these anatomic variations is of great importance in surgical procedures performed in this region.

[Histopathological characteristics of degenerative modifications of the incudomalleolar joint]. / Les caractéristiques histopathologiques des modifications dégénératives dans l'articulation incudo-malléolaire.

The authors studied histopathologic features of degenerative changes in the incudomalleolar articulation in adults. In 40% of the cases signs of degenerative changes manifesting as atrophy, fibrosis, hyalinization and calcification were recorded. In some cases obliteration of the articular space was noted. In 60% of the cases the articulation manifested normal structure.

[Anomalies of the mastoid portion of the facial canal and their surgical importance]. / Anomalies de la portion mastoïdienne du canal facial et leur importance chirurgicale.

Examination of 150 sagittal sections of temporal bone showed that anomalies of mastoid part of facial canal could be divided into 3 groups: abnormal deviations of the vertical portion, the curves or the nerve bifurcation. Deviations of the vertical pathway of facial nerve can be of three types in relation to the frontal plane: the nerve, after its second bend travels towards the tympanic cavity (9 of 150 cases); it curves forward passing through the hypotympanum (1 of 150 cases); it turns backwards in the direction of the sigmoid sinus (15 of 150 cases). Abnormal or supplementary bends were noted in 10% of cases (15 of 150), in more than half of the cases the latter developing 2-3 mm from the second bend, and more rarely in the inferior wall of the tympanic cavity. A bifurcation of the nerve after its second bend was observed in only one case.

[Pathological changes of the pyramidal eminence in chronic suppurative otitis media]. / Les changements pathologiques de l'éminence pyramidale en cas d'otite chronique suppurée.

Temporal bones of patients with chronic suppurative otitis media were used for evaluation of possibility of penetration of the infection from the cavum tympani into the facial nerve via the pyramidal eminence. The infection can spread to the facial nerve in two ways: via the natural opening on the pyramidal eminence through which tendon of the musculus stapedius is passing, without bone lesions of the eminence and via the sites of bone destruction on the eminence.

[Labyrinth fistula in chronic otitis with cholesteatoma]. / Fistules labyrinthiques en cas d'otite chronique avec cholestéatome.

The authors studied 116 surgically treated patients with labyrinthine fistulae due to cholesteatoma. The fistulae were most commonly localized on the lateral semicircular canal (75%) and much less frequently involved only the oval window area (7%) and the promontory (4%). The multiple fistulae were found in 14% patients. The closed technique was used, while the open technique was adopted only when the ear was deaf preoperatively, in cases of multiple fistulae and associated intracranial complications. The cholesteatoma matrix was not removed from the fistula of the oval window area or the promontory or in the cases of multiple fistulae and large fistulae of the lateral semicircular canal if the cholesteatoma matrix had penetrated into the labyrinth. The fistulae on the lateral semicircular canal were covered by a piece of fascia. Postoperatively deafness occurred only very exceptionally.

Characteristics of a pathological process in the destroyed tympanic part of the facial canal in chronic otitis media with cholesteatoma.

The authors examined the histopathological characteristics at the sites of destruction of the tympanic part of the facial canal in chronic otitis media with cholesteatoma. Two types of pathological process were observed. The first is characterized by the cholesteatoma at the sites resorption and the second is characterized by pronounced granulation or fibrocystic tissue.

[Congenital malformation of the ear associated with secretory otitis media]. / Malformation congénitale de l'oreille associée à une otite sécrétoire moyenne.

The authors presented a child with congenital malformation of the ear in whom secretory otitis media (SOM) was discovered during an operation. Histological analysis of the mucous membrane showed an advanced phase of the disease.