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PubMed1998

Cause of posterior canal wall retraction after surgery from the viewpoint of mastoid conditions.

OBJECTIVE: To determine the relationship between preservation of the mastoid mucosa during ear surgery and retraction of the attic or posterior wall of the external auditory canal (EAC) and mastoid aeration after surgery. METHODS AND DESIGN: Retraction of the posterior EAC wall and mastoid aeration were evaluated after surgery in 48 individuals (50 ears) with cholesteatoma, adhesive otitis media, or chronic suppurative otitis media, in whom the posterior bony EAC walls were removed with or without preservation of mucosa and reconstructed with soft tissues alone (EAC skin and temporal fascia) during surgery. RESULTS: Postoperative computed tomography showed that in ears with notable retraction of the posterior EAC wall appearing like an open mastoid cavity, there was no air in the mastoid, whereas in ears with no or only slight retraction there was computed tomographic evidence of mastoid aeration. Second, notable retraction of the posterior EAC wall occurred in a significantly smaller percentage of ears in which at least the epitympanic mucosa had been able to be preserved during surgery than in those that had undergone removal of all mucosa (mastoidectomy). CONCLUSIONS: These results indicate that 1) preservation of epitympanic mucosa during surgery is an important factor for prevention of retraction of the posterior EAC wall and for reaeration of the mastoid after surgery, and 2) the intact canal wall technique seems to be indicated whenever at least the epitympanic mucosa can be preserved, and when no mucosa can be preserved the canal wall down procedure seems to be indicated.

Adult↗

PubMed1995

Nontuberculous mycobacterial mastoiditis.

Although nontuberculous mycobacterial (NTM) infections are recognized as an important cause of cervicofacial lymphadenopathy in children, NTM mastoiditis is rare. Further, NTM mastoiditis may be difficult to distinguish clinically from tuberculous mastoiditis since both may present with chronic, painless otorrhea and exuberant middle ear granulation tissue. The treatment of tuberculous mastoiditis is antituberculosis chemotherapy; however, most NTM infections are resistant to antituberculous agents, and the preferred treatment of NTM mastoiditis is mastoidectomy. We report a recent case of mastoiditis caused by Mycobacterium avium complex in an infant who presented with a temporal bone mass.

Child↗

PubMed1999

Factors affecting recovery of mastoid aeration after ear surgery.

Fifty-six patients after tympanomastoid surgery were examined to determine recovery of mastoid aeration and various pre- and intraoperative factors such as eustachian tube (ET) function, how the mastoid mucosa had been treated during surgery and whether or not a large silastic sheet had been placed in the middle ear or a ventilation tube used. Mastoid aeration recovery was confirmed by computed tomography in 27 of the 57 cases (47%) within 12 months of surgery. Among the factors examined, preservation of the epitympanic mucosa was found to be most important in mastoid aeration recovery. Use of a large silastic sheet to cover the area from the bony ET and tympanic cavity to epitympanum, aditus ad antrum or antrum was found to be of some help in recovery mastoid aeration after complete resection of the mucosa and mastoid air cells. Preoperative ET function, anterior tympanotomy and use of a ventilation tube did not influence recovery.

Adolescent↗

PubMed2000

Experimental results do not support a gas reserve function for the mastoid.

The mastoid is an aerated extension of the middle ear gas pocket whose state of development was shown to be an indicator of past and future otitis media experience. While the function(s) of the mastoid is not known, a number of hypotheses has been advanced to explain the reported association between mastoid size and middle ear disease. These include the hypotheses that, with respect to the middle ear, the mastoid functions as a pressure buffer, a gas reserve, and/or a pressure regulator. In this paper, a physical model of the mastoid is presented that makes specific predictions against which the validity of the hypothesized gas reserve function could be tested. Data from three published clinical experiments were evaluated for consistency with the predictions of the model, and the hypothesis was rejected. Also, when reinterpreted within the context of the model, the published data do not support a pressure-regulating function for the mastoid.

Ear, Middle↗

PubMed2003

Day-case paediatric mastoid surgery.

OBJECTIVE: Children have traditionally been kept in hospital overnight after mastoid surgery, but evidence from the US in adults suggests that a substantial number of patients may be suitable for discharge on the day of surgery. We sought to ascertain the proportion of our children having mastoid operations between February 1994 and December 2000 who were suitable for same-day discharge. We also evaluated some of the factors that prevented discharge the same day. METHODS: A standard proforma was used to record relevant data in 35 children (mean age 10 years 6 months) undergoing consecutive mastoid operations at Mayday University Hospital, London, UK. Operative findings, duration of anaesthesia and time back on ward were recorded as well as details regarding admission, follow-up findings and complications. A bed was booked preoperatively but there was intent to discharge the patient if feasible. RESULTS: Nine out of twelve patients (75%) operated between 1998 and 2000 were suitable for discharge on the day of surgery. The pre-1998 discharge rate was 20%. Only one of the former group of patients underwent a modified radical mastoidectomy in comparison with ten such procedures pre-1998. There was a significant relationship between extent of surgery and in-patient admission. The outcomes of day-case mastoid surgery, in terms of complications rates and overall success rates, were comparable with surgery performed on an in-patient basis. Using correlation analysis, no relationship could be found between duration of anaesthesia and time of arrival back on the ward and in-patient admission. CONCLUSION: Children can undergo mastoid procedures safely and effectively on a day-case basis but should still have a bed booked pre-operatively as the majority will require admission. The main factor related to admission was the mastoid procedure performed. With improvements in surgical and anaesthetic techniques and other advances, operations such as atticotomy may become standard day-case procedures in paediatric patients.

Ambulatory Surgical Procedures↗

PubMed2003

Rate of nitrous oxide exchange across the middle ear mucosa in monkeys before and after blockage of the mastoid antrum.

OBJECTIVES: We tested the hypothesis that mastoid volume buffers the rate of change in middle ear pressure caused by transmucosal, inert gas exchange. STUDY DESIGN: Twelve monkeys were randomly assigned to group 1 or group 2. Right ears of group 1 had sham surgery and of group 2 had obstruction of the mastoid antrum. Before and after surgery, the time constant for transmucosal N(2)O exchange was estimated from N(2)O breathing experiments. The hypothesis predicts that the postoperative time constant measured for right ears of group 2 but not group 1 is greater than that measured before surgery. RESULTS: Mastoid antrum block significantly decreased right middle ear volume but did not affect the time constant for transmucosal N(2)O exchange. CONCLUSION: A mastoid gas-reserve function is not supported by the experimental data. SIGNIFICANCE: These results for monkeys and the theory developed to explain the effect of mastoid volume on transmucosal inert gas exchange suggest that the results for previous experiments in humans interpreted as evidencing a mastoid gas-reserve function are consistent with alternative explanations.

Animals↗

PubMed1995

Mastoid oscillation: a critical factor for success in canalith repositioning procedure.

The canalith repositioning procedure has recently gained controversial recognition as a treatment for benign paroxysmal positional vertigo. Some authors contend that the canalith repositioning maneuver is no more effective than no treatment at all. Unfortunately, its technique has not been uniformly applied and its outcomes have not been uniformly assessed. I have found the use of mastoid oscillation to be critical in the success of this procedure. Another important factor is the time interval between diagnosis and relief of symptoms. Because it is well known that benign paroxysmal positional vertigo can spontaneously resolve after many months, the time frame for comparison should be short. A 1-week time interval was chosen for study purposes. Sixty patients were randomly assigned to three initial groups. The control group (n = 23) was not given any treatment. A second group (n = 27) was given treatment with the canalith repositioning maneuver with mastoid vibration. A third group (n = 10) was assigned to receive the canalith repositioning maneuver without mastoid vibration. Resolution was defined as no symptoms and negative Dix-Hallpike test results. The results showed that none of the control group's symptoms resolved completely in 1 week. Although 60% of those who received the canalith repositioning maneuver without mastoid vibration felt improved, none was free of nystagmus. An overwhelming 92% of those who received the canalith repositioning maneuver with mastoid vibration felt improved, and 70% were free of rotatory nystagmus after only one treatment. A review of all patients diagnosed with benign paroxysmal positional vertigo and treated with the canalith repositioning maneuver with mastoid vibration was also undertaken. In a series of 67 patients with a minimum of four weeks of follow-up, only two have not responded to the canalith repositioning maneuver, yielding a 97% rate of symptom control.

Humans↗

PubMed1992

Correlation between temporal bone pneumatization, location of lateral sinus and length of the mastoid process.

The relationship between temporal bone pneumatization and the location of the lateral sinus and length of the mastoid process was investigated in 60 fresh frozen adult temporal bones, by plain X-rays, computed tomography and surgical dissection including otomicroscopic findings. Temporal bone pneumatization was classified as small, moderate and large. After drilling, the shortest distances between the middle fossa dura and mastoid tip representing the mastoid length and between the sigmoid sinus and posterior border of external auditory canal were measured and compared to the degree of pneumatization. The distances in the specimens with pathological eardrum and adhesions in the middle ear were compared to the ones without gross pathology. The length of mastoid process was significantly shorter in specimens with small pneumatization than those with large (Mann Whitney P less than 0.001). The specimens with a pathological eardrum and middle ear adhesions had a significantly shorter mastoid length than those without gross pathology. There was no significant difference between degree of pneumatization and the shortest distance between sigmoid sinus and external auditory canal (Mann Whitney P greater than 0.05). It is demonstrated that the 'under-developed' mastoid process can be a consequence of hampered pneumatization.

Adult↗

PubMed1997

Do the complications of mastoid surgery differ from those of the disease?

During mastoid surgery there is a risk to the facial nerve and hearing but at present it is unclear how substantial this risk is. This information is necessary for adequate informed consent to be given, as consent requires information about both the potential risks of the surgery as well as the risks of leaving the disease untreated. The aim of this study is to establish the risks of mastoid surgery and the incidence of complications as a consequence of mastoid disease. The records of all patients undergoing mastoidectomy between 1985 and 1994 were reviewed for preoperative and intra-operative complications. Preoperatively there were 21 (2%) facial nerve palsies, 67 (6.5%) dead ears and 58 (5.7%) intracranial complications of the mastoid disease. If this risk is extrapolated for the population of the Western Cape over a 40-year period (average expected life-span after presentation), the risk of developing a serious complication (facial palsy, dead ear or intracranial) from mastoid disease during this period was 3.8%. The incidence of intra-operative iatrogenic facial nerve palsy was 1.7% (n = 17) and of dead ear was 1.7% (n = 17). Although the comparative risk of developing a severe complication from untreated disease was similar to the risks of surgery (facial palsy, dead ear), the number (58) of intracranial life-threatening preoperative complications presenting in the 10-year period reviewed was significant. These figures provide a base from which otologists can inform patients about the possible risk of mastoid surgery as well as allowing these risks to be compared with the risks of leaving the disease untreated.

Adult↗

PubMed2006

Surgical management of acute mastoiditis with epidural abscess.

The prevalence of intracranial complications of acute coalescent mastoiditis in children has decreased significantly; however, this clinical problem persists, with a relatively high mortality. The common practice for management of acute mastoiditis with epidural abscess is mastoidectomy, drainage and placement of a ventilation tube, which means that the main pathology is confined to the mastoid cavity. We suggest that tympanic exploration is mandatory in certain cases, an example of which we present here. We report one case of acute mastoiditis with epidural abscess, in which mastoidectomy with tympanic exploration was needed to ensure drainage throughout the cavities and to prevent pressure rebuilding in the mastoid and tympanic cavities. We stress that if the tympanic membrane is thickened and no fluid is drained when placing a pressure equalization tube, there could be granulation tissue in the tympanum and tympanic exploration is mandatory, especially in a case of acute mastoiditis with intracranial complications accompanied by prolonged symptoms.

Acute Disease↗

PubMed1998

A miniaturized artificial mastoid using a skull simulator.

A miniaturized artificial mastoid of size and weight that allow calibration and measurement of bone conduction hearing aids in a conventional audiometric soundproof box has been developed. Its level of mechanical impedance corresponds to the standard IEC 373 (1990) within the frequency range 250 Hz to 8 kHz. The miniaturized artificial mastoid consists of three parts: coupler, skull simulator (TU-1000), and an external electrical correction filter. The coupler is a highly damped mass-spring system designed to give the miniaturized artificial mastoid mechanical impedance in accordance with the standard IEC 373 (1990). It was found that the miniaturized artificial mastoid yielded results that are in correspondence with results obtained with the Brüel & Kjaer type 4930 artificial mastoid for frequencies above 450 Hz. Thus, at these frequencies, the miniaturized artificial mastoid can be used for audiometer calibration as well as measurement of bone conduction hearing aids.

Bone Conduction↗

PubMed2004

Regeneration of mastoid air cells: clinical applications.

The objective of this study was to establish a method for regenerating mastoid air cells and their functions for clinical use in incurable otitis media. For this clinical study three patients (one male, two female) were randomly selected from patients with severe cholesteatoma about to undergo staged operations. Hydroxy-apatite in three-dimensional, honeycomb-like structures (3D-HA) were used as artificial pneumatic bones. This 3D-HA is made of calcium phosphate and has a high percentage of micropores (90%). Its surface is coated with collagen. At the first stage of tympanoplasty, collagen-coated 3D-HA was put into the opened mastoid cavity and fixed by fibrin glue. Recovery of mastoid aeration and regeneration of the pneumatic air cells of the mastoid cavity were estimated on CT scan images after the first operation. Aeration was recovered in all cases. The mastoid air cells were regenerated in two cases. In the failed case, subcutaneous connective tissues and granulations invaded into the spaces of the 3D-HA. This study demonstrated that mucosa would grow on the surface of a 3D-HA implant and could provide gas exchange functions in the newly opened mastoid cavity. This tissue engineering method may be a possible treatment for intractable otitis media.

Aged↗

PubMed2001

National differences in incidence of acute mastoiditis: relationship to prescribing patterns of antibiotics for acute otitis media?

BACKGROUND: Operating on the principle that most acute otitis media (AOM) episodes resolve without antibiotics, doctors in the Netherlands usually manage AOM in children with initial observation. Prescription of antibiotics is limited to children with a complicated course of AOM and those categorized as high risk. Consequently only 31% of patients with AOM receives antibiotics, compared with >90% in most other countries. OBJECTIVE: To substantiate the suggestion that this restrictive use of antibiotics leads to a higher incidence of acute mastoiditis. METHODS: A comparative study across several European countries, Canada, Australia and the United States was performed in the period 1991 to 1998. The incidence rate of acute mastoiditis was defined as the total number of patients age 14 years and younger discharged from all hospitals with the primary diagnosis of acute mastoiditis, during a specified period (usually 5 years), divided by the number of person years (py) in that same age range and period. The latter was calculated by totaling the midyear population estimate of children age 14 years and younger of each year. The 95% confidence intervals and incidence rate ratios were calculated to compare the observed rates. RESULTS: The incidence rate of acute mastoiditis in the Netherlands, with a low antibiotic prescription rate for AOM, was 3.8/100,000 py; in Norway and Denmark, with high prescription rates, the incidence rate was comparable at 3.5/100,000 py and 4.2/100,000 py, respectively. In all other countries with very high prescription rates, incidence rates were considerably lower, ranging from 1.2 to 2.0/100,000 py. The incidence rate in the Netherlands was about twice that in the United States (rate ratio, 0.5). CONCLUSION: The incidence rate of acute mastoiditis in the Netherlands is higher than in many countries with higher antibiotic prescription rates. Although the potential benefits of restricted use of antibiotics (i.e. cost reduction, fewer side effects from antibiotics and less antimicrobial resistance) are beyond dispute, such strategy may be associated with a somewhat higher incidence of acute mastoiditis.

Acute Disease↗

PubMedDate not supplied

Mastoid condition and clinical course of cholesteatoma.

This study was carried out to establish which type of cholesteatoma is controllable by conservative treatment from the viewpoint of mastoid ventilation. We examined the area of the air cell system and airspace (aeration) in the mastoid cavity by computed tomography and eustachian tube (ET) function by inflation-deflation test in 20 ears (20 patients) with severe attic retraction for over 12 months (retraction pocket group), 16 ears (16 patients) with cholesteatoma which could be controlled only by conservative treatment for over 12 months (nonsurgical group) and 43 ears (43 patients) which required surgery within a year in spite of similar conservative treatment (surgical group). The size of the mastoid air cell system in the retraction pocket group, nonsurgical group and surgical group was 2.9 +/- 1.3, 1.9 +/- 0.7 and 1.5 +/- 0.9 cm(2) on average, respectively, with no significant difference between both cholesteatoma groups (nonsurgical and surgical group). While aeration was observed in the mastoid in 17 of 20 ears (85.%) in the retraction pocket group and in 12 of 16 ears (75.0%) in the nonsurgical group, aeration was present only in 9 of 43 ears (26.5%) in the surgical group, being significantly less in the surgical group than in the nonsurgical group and the retraction pocket group. In all ears in the retraction pocket and nonsurgical groups, and 19 of 30 ears in the surgical group, ET function was poor, there being no significant difference among the three groups. The present clinical observations suggest that progressiveness of cholesteatoma could be related to the ventilatory conditions in the mastoid rather than ET function, and that conservative treatment may be effective when ears with cholesteatoma have aeration in the mastoid.

Adolescent↗

PubMedDate not supplied

Secretory otitis media and mastoid pneumatization.

The objective of this study is to correlate in children with chronic secretory otitis media the extent of pneumatization with morphological and functional end results after therapy. For this purpose we examined 82 children and adolescents (147 ears), who 5 to 8 years previously were treated with insertion of ventilating tubes for chronic secretory otitis media. We evaluated the morphological and functional end results with otomicroscopy, pure tone audiometry, tympanometry and stapedial reflex testing. Roentgenograms of the temporal bones in a lateral projection were taken initially in 96 ears and at time of control in 145 ears. We judged the size of the mastoid air cell system by visual estimation and classified the mastoids according to the extent of pneumatization into three groups: large, middle-sized and small (sclerotic). Twenty-five percent of the ears had sclerotic mastoids at time of control. Statistically significant correlations exist between arrested pneumatization (sclerotic mastoids), major morphological changes in the tympanic membranes and unfavorable functional results. Also the correlation between sclerotic mastoids and the number of tube insertions required in the course of the disease is statistically significant. But no correlation can be established between the physical properties of secretions and the extent of pneumatization. Arrest of pneumatization leading to a small mastoid air cell system constitutes an unfavorable prognostic factor for the final outcome of chronic secretory otitis media.

Adolescent↗

PubMed2000

Plasmacytoma of the mastoid bone: solitary and systemic.

Plasma cell tumours of the mastoid are rare malignancies of haematological origin. Two patients are described with a plasma cell tumour in the mastoid bone. In one patient it concerned a solitary plasmacytoma of the bone and in the other a focus in the mastoid of a recently diagnosed multiple myeloma. Symptoms in these patients were non-specific. Computed tomography (CT) and magnetic resonance image (MRI) scanning showed a non-specific space-occupying lesion in the mastoid. The diagnosis was made on immunohistological examination, that showed diffuse sheets of monoclonal plasma cells in a clear matrix. When a plasmacytoma lesion is found multiple myeloma should always be excluded. Treatment in case of solitary plasmacytoma of the mastoid bone consists of radiotherapy. In case of localization in the mastoid of multiple myeloma the treatment consists of palliative chemotherapy.

Aged↗

PubMed1996

The pars flaccida middle ear pressure and mastoid pneumatization index.

The degree of pars flaccida retraction and the levels of mastoid pneumatization were assessed and correlated in 388 adults with intact pars tensa. Poorly pneumatized mastoids were found to be associated with retraction of pars flaccida; the poorer the pneumatization, the deeper the retraction. Well pneumatized mastoids were usually associated with normal position of the pars flaccida. The pars flaccida was previously also shown to retract in face of ME negative pressure--and its degree can be seen to be an index of ME negative pressure. Thus, the correlation of deeper degrees of pars flaccida retractions with mastoid hypopneumatization (and vice versa) lends strength to the studies which show the mastoid pneumatic system to have a function of a passive ME pressure buffer. This observation lends further evidence as to why ears with poorly pneumatized mastoids are a priori at risk to develop complications such as SOM in adults, tympanic membrane retractions and perforations, incus necrosis or retraction pocket cholesteatoma. Ears with a large pneumatic system are hardly at such risk.

Ear Diseases↗

PubMedDate not supplied

Morphometric examination of the paranasal sinuses and mastoid air cells using computed tomography.

BACKGROUND: The paranasal sinuses and mastoid air cells vary considerably in size and shape from person to person. The main structures are pneumatic. In this study, we investigated the relationship between right and left sides and evaluated the volume changes according to age and sex. METHODS: Of all patients attending the radiology department, 91 cases without paranasal sinuses and mastoid air cells pathology (i.e., inflammation, operation or trauma) were selected for evaluation. Axial computed tomography (CT) scans were obtained for both paranasal sinuses and temporal bones. In all scans, the volumes of each area (maxillary sinus, frontal sinus, sphenoid sinus and mastoid air cell) were calculated and analyzed statistically. RESULTS: The volumes of paranasal sinuses and mastoid air cells increased with age and women had a lower mean volume. There was a positive correlation between right-left and ipsilateral structures (paranasal sinuses and mastoid air cells). CONCLUSIONS: These results are helpful in understanding the normal and pathological conditions of the paranasal sinuses and the mastoid air cells.

Adult↗