Acute coalescent mastoiditis in a 16-month-old child due to Streptococcus pneumoniae infection

Rationale:Acute otitis media is a common disease in early childhood,and is usually caused by Streptococcus pneumoniae(S.pneumoniae).Acute mastoiditis is a complication of acute otitis media and can involve not only the mucoperiosteum of the middle ear but can also spread to the periosteum by destroying the mastoid bone(acute coalescent mastoiditis).In addition,the infection can extend through the surrounding bones or the emissary veins beyond the mastoid’s air cells,leading to subperiosteal abscesses.Patient’s Concern:A 16-month-old female patient was hospitalized due to the purulent discharge of the left ear and the symptoms of right mastoiditis(swelling and redness of the skin).Diagnosis:Bilateral acute coalescent mastoiditis caused by S.pneumoniae infection.The computer tomography revealed bilateral bone destruction of the mastoid and abscesses found behind the auricle on both sides.Interventions:The patient underwent intravenous antibiotic therapy and surgical treatment.Outcomes:The patient was discharged 14 days after hospitalization with an improved condition.Lessons:Improperly treated acute coalescent mastoiditis can lead to extracranial and intracranial complications,sometimes serious and even life-threatening.Complications are prevalent in children under 2 years,in whom the disease progresses more rapidly and severely.The vaccination with a 13-valent vaccine may not result in sufficient immunity against S.pneumoniae,a predominant pathogen in children affected by acute coalescent mastoiditis.

Effects of Drilling in Mastoid Cavity over Hearing in the Contralateral Ear

In advanced otological surgeries, powered instruments form an indispensable part. The risk of deterioration to hearing in the operated ear is a commonly discussed issue, however, there remains a possibility of affecting the hearing in the contralateral ear due to transcranial vibration. So in this study we aimed to assess the possibility of the non-operated ear being affected by the noise generated during ear surgeries and whether it is temporary or permanent in nature. Methodology: This study included 63 patients diagnosed with unilateral disease who underwent mastoid surgery. Preoperatively all the patients were subjected to Pure tone audiometry (PTA), Transient evoked otoacoustic emission (TEOAE) and Distortion product otoacoustic emission (DPOAE). Patients were operated using both cutting and diamond burrs of ranging from sizes 1 - 6 mm. Total drilling time was recorded. Results: Post-operative hearing evaluation was done at 1 week, 4 weeks and 12 weeks. The sound emitted by various burrs was recorded by Sound Level Meter. Out of the total 58 patients that followed up, 46 showed change in at least one of the hearing parameters. Patients showing changes had a higher drilling time as compared to those with no changes. Of these, the changes associated with the total drilling time and with cutting burr time were found to be significant. The hearing changes seen on PTA, TEOAE and DPOAE were transient in nature with only one patient having a persistent decreased high frequency threshold at the end of 12 weeks. It was also found that cutting burrs produce more sound as compared to diamond burrs and a larger size burr of a type produces more sound than a smaller one of its type. Conclusion: The drilling of mastoid bone during ear surgeries can transiently impair the hearing in the contralateral ear which is of great significance in patients with only one hearing ear.

Mastoid obliteration and reconstruction techniques:A review of the literature

Objective To review the published literature related to the different obliteration and reconstruction techniques in the management of the canal wall down mastoidectomy.Methods A PubMed(Medline)and LILACS databases as well as crossed references search was performed with the following Mesh terms:“cholesteatoma”,“cholesteatoma-middle ear”,“otitis media”,“otitis media,suppurative”,“mastoiditis”,“mastoidectomy”,“canal wall down mastoidectomy”,“radical mastoidectomy”,“mastoid obliteration”and crossed references.Inclusion criteria were adult patients subject to mastoid cavity obliteration and posterior canal wall reconstruction.The technique and materials used,anatomic and functional results,complications,recurrence rates,and changes in quality of life,were analyzed.A total of 94 articles were screened,38 were included for full-text detailed review.Results Twenty-one articles fulfilled the inclusion criteria.Techniques and materials used for canal wall reconstruction,tympanoplasty,and ossiculoplasty were varied and included autologous,biosynthetic,or both.Auditory results were reported in 16 studies and were inconsistent.Three studies reported improvement in the quality of life using the GBI scale.Follow-up time ranged from 1 to 83 months.Eleven articles used imaging studies to evaluate postoperative disease recurrence.The highest recurrence rate reported for cholesteatoma after obliteration was 19%.The most frequently reported complications were retraction pockets and transient otorrhea.Conclusion Plenty of techniques combining grafts and other materials have been used to overcome mastoidectomy cavity problems.So far,it is still not possible to standardize an ideal procedure.The available level of evidence for this topic is low and limited.

Does preoperative bacterial culture have bearing on healing of mastoid cavity:A prospective study

Objective： To study the bacteriological profile in a healing mastoid cavity. Methods： This study was a single centre prospective study. Culture swabs from granulations in the mastoid cavity were sent in 40 consecutive patients with squamosal chronic otitis media undergoing mastoidectomy. Cultures were processed for both aerobic and anaerobic bacteria. Results： Preoperatively： specimens from 26 out of 40 （60.5%） had growth on culture, with 22 （55%） showing only one organism while 4 showing multiple organisms. The commonest organism isolated was pseudomonas aeruginosa （n=15）. At 1 month after mastoidctomy, 11 patients had sterile culture while 29 had growth, of which 26 had aerobic growth and 3 had anaerobic growth. Pseudomonas was seen in 22 patients and staphylococcus aureus in 2 patients. The mean Merchant score was 2. At 3 months： 29 patients （72.5%） had sterile culture from mastoid cavity while 11 patients （27.5%） had growth on culture. All positive cultures were aerobic, including pseudomonas （n=9） and proteus （n= 2）. The mean Merchant score was 1.03. Of the 40 patients, 16 （40%） had a different organism cultured postoperatively compared to preoperative swabs. Conclusion： Pseudomonas and proteus seem to be the most common organisms responsible for persistent otorrhea after mastoidectomy. Persistent sterile otorrhea was seen in 4 patients （10%） in this group at the end of 3 months. Sterile cultures of preoperative swab are more likely to remain sterile in the postoperative period.

Postoperative surgical site infection in cholesteatoma surgery with and without mastoid obliteration, what can we learn?

Introduction:This study aims to describe the occurrence of postoperative complications related to cholesteatoma surgery and to determine factors influencing the most common complication,i.e.postoperative surgical site infection(SSI)in cases with and without mastoid obliteration.Materials and methods:Retrospective analyses were performed on surgically treated cholesteatomas in our hospital between 2013 and 2019.Patient characteristics,peri-and postoperative management and complications were reviewed.The cases were divided into two groups based on whether mastoid obliteration was performed or not.Results:A total of 336 cholesteatoma operations were performed,of which 248 cases received mastoid obliteration.In total 21 complications were observed,of which SSI was the most common(15/21).No difference in occurrence of any postoperative complication was seen between the obliteration and noobliteration group(p=0.798),especially not in the number of SSI(p=0.520).Perioperative and/or postoperative prophylactic antibiotics were not associated to the development of an SSI in both groups.In the no-obliteration group a younger age(p=0.015),as well as primary surgery(p=0.022)increased the risk for SSI.In the obliteration group the use of bioactive glass(BAG)S53P4 was identified as independent predictor of SSI(p=0.008,OR 5.940).Discussion:SSI is the most common postoperative complication in cholesteatoma surgery.The causes of SSI are multifactorial,therefore further prospective research is needed to answer which factors can prevent the development of an SSI in cholesteatoma surgery.

A large basal cell adenoma extending to the ipsilateral skull base and mastoid in the right parotid gland: A case report

BACKGROUND Basal cell adenoma (BCA) is a rare benign tumour that has unique histological characteristics and primarily arises in the parotid glands. According to published reports, nearby tissue destruction by BCA seems impossible. CASE SUMMARY We presented a case of a 54-year-old woman with a mass in the deep lobe of the right parotid gland involving the ipsilateral skull base and mastoid. The patient exhibited gradual right facial swelling but no other obvious symptoms. Combined resection of the total right parotid gland and partial skull base excision were performed. The biopsy conducted before the surgery and sections cut from intraoperatively obtained tissues were not definitive for identifying the character of the neoplasm. A final diagnosis of tubular BCA without malignant elements was established based on postoperative pathology results and immunohistochemical analysis. The tumour did not recur during the 12-mo follow-up period. CONCLUSION A diagnosis of BCA can only be established based on a histopathological examination after an excisional biopsy, and tubular BCA should carefully be considered as a destructive type.

Regeneration of Mastoid Air Cells <i>in Vivo</i>Using Autologous Cortical Bone

Purpose: This was a preliminary study to assess surgical construction and regeneration of mastoid air cells in the treatment of cholesteatoma. Methods: Two-stage tympanoplasty with mastoidectomy was performed in four cases of unilateral cholesteatoma with sclerotic mastoid. During the first-stage operation, small fragments of autologous cortical bone were inserted into the cavity after mastoidectomy to form a honeycomb-like structure. Reconstruction of the lateral wall of the mastoid cavity was performed using the mastoid cortical bony plate. Pre- and postoperative mastoid volume was evaluated by three-dimensional reconstruction based on high-resolution computed tomography (HR-CT) images. Results: HR-CT images after the first-stage operation showed that mastoid volume had increased in all subjects. Macroscopic inspection during the second-stage operation revealed that the honeycomb-like structure made of bony fragments and covered by thin mucosa in the mastoid cavity was stable, with no evidence of effusion or granulation tissue. No retraction of the eardrum, middle ear effusion or recurrence of cholesteatoma was observed, and the hearing level on a pure-tone audiogram was improved in any subject 60 - 94 months after the second-stage operation. Conclusion: Surgical construction and regeneration of mastoid air cells using autologous cortical bone can be useful in treatment of cholesteatoma with arrested mastoid pneumatization.

Osteoma of mastoid process obstructing external auditory canal: A case report

Objective: To discuss the surgical treatment of recurrent osteoma of the mastoid process of the temporal bone, that obstructed external auditory canal causing unilateral conductive hearing loss. Setting: The study was carried out in ENT Clinic, University Clinical Center of Kosovo, Prishtina, Kosovo. Design: Retrospective review of a clinical case. Patient, Intervention and Result: We treated surgically with success a 14-year-old boy with osteoma of mastoid process, obstructing the external auditory canal of the left ear and causing conductive hearing loss. Axial and coronal computed tomography scans revealed an compact bone lesion that obstructed the canal. Complete removal of the lesion was achieved by a retroauricular approach. Conclusion: In order to achieve complete removal of the osteoma, drilling of the lesion must be performed not through the tumor, but around the osteoma, in the surrounding bone tissue.

Micro-column enhanced boiling structure and its ramification

Enhanced boiling experiments of two different enhanced structures were carried out in a thermosyphon loop evaporator chamber. One was micro-columns array structure (MCAS), which was fabricated on copper plate surface with interaction high speed wire electrode discharge machining (HS-WEDM). The other was the ramification of MCAS, named micro-column-array and sintered-copper compound structure (MSCS), which was fabricated with sintered method on micro-column array structure. Considering the wall superheat and critical heat flux (CHF), comparisons were made between them. The results show that both MCAS and MSCS can enhance the boiling heat transfer. It is also found that the enhanced boiling heat transfer ability of MSCS is changed obviously while the porosity of the sintered copper layer is changed.

Chordoma of petrosal mastoid region:A case report

BACKGROUND Chordoma is a rare low-grade malignant tumor originating from embryonic notochordal tissue mainly occurring in the axial bone,mostly in the sphenooccipital junction and sacrococcyx,which accounts for approximately 1%of all malignant bone tumors and 0.1%–0.2%of intracranial tumors.Chordoma in the petrous mastoid region is rare.CASE SUMMARY We describe a 36-year-old male patient with chordoma in the left petrous mastoid region.The main clinical manifestations were pain and discomfort,which lasted for 2 years.Magnetic resonance imaging showed a lobulated mass in the left petrous mastoid with an unclear boundary and obvious enhancement.The tumor was completely removed after surgical treatment,and a histological examination confirmed that the tumor was a chordoma.During 5 years of follow-up,no clinical or radiological evidence of recurrence or metastasis was found.CONCLUSION Chordoma in the petrosal mastoid region is rare but should be included in differential diagnosis of petrosal mastoid tumors.

Acute Mastoiditis Clinical Course and Management in Patients Presented to Khartoumar Ear, Nose and Throat Hospital during the Period from November 2017 to November 2019

Introduction: Acute mastoiditis is the most common complication of Acute Otitis Media (AOM) and it’s the cause of serious morbidity. There is no standard universally agreed-upon management approach to acute mastoiditis. This study aims to view the clinical presentation and management approaches in Khartoum Ear, Nose and Throat Hospital. Methodology: This is a prospective case series and a hospital-based study conducted at Khartoum Ear, Nose and Throat Hospital during the period from November 2017 to November 2019. A total of 61 patients were included in the study. Results: The median age at presentation is 5 years old, males are more affected than females with a ratio of 1.35:1, and the mean duration of symptoms prior to hospital admission was 9.6 days. The most common presenting symptoms were otalgia (83.3%), ear discharge (83.3%) and post-auricular swelling (83.3%), and the most common signs at admission were tenderness over the mastoid (95.1%), retroauricular swelling and protrusion of the auricle (82%), and redness over the mastoid (77%). The abnormal tympanic membrane was found in all patients with central perforation being the commonest finding (73.8%), and bulging tympanic membrane (21.3%). 34.4% of patients received oral antibiotics before admission and the mean duration of symptoms prior to admission increased significantly in those who received antibiotics 12.7 days in comparison to those who didn’t 8.3 days. Only 52.5% of patients had a past history of recurrent acute otitis media, and 8.2% had a past history of acute mastoiditis. All the patients with recurrent mastoiditis had a past history of recurrent acute otitis media. Computed Tomography (CT) scans were obtained for 50.8% and 83.9% of those scans showed coalescent mastoiditis. Further evidence of intracranial extension was found in 6.5% and Magnetic Resonance Imaging (MRI) was obtained for them. Of the study group, 67.2% presented with subperiosteal abscess, 4.9% with facial nerve palsy and 3.3% with brain abscess. Thirteen patients with no complications were managed initially with injectable and topical antibiotics and were successful in only 6 of them (46%), abscess incisions and drainages were needed in 46 patients and were successful in 34 of them (73.9%). Eighteen patients (29.5%) needed mastoidectomy and all of them were managed successfully (100%). One patient (1.6%) was referred for intracranial abscess drainage in a specialized hospital, also one patient (1.6%) initially presented with intracranial abscess died on the second day of admission and 96.8% were discharged in good condition. The mean duration of hospital stay was 7.5 days. Conclusion: Patients present to the hospital after a prolonged period with a higher rate of complications, and the delayed presentation increased significantly in patients who received oral antibiotics prior to admission. Conservative medical treatment in non-complicated acute mastoiditis was ineffective in more than half of the patients and abscess incision and drainage and/or mastoidectomy are often necessary for the management.

Persistent Pseudomonas Infection Mastoiditis—Local Antibiotic Treatment Is Superior than Systemic

Mastoiditis is a common complication of acute otitis media. It is common in younger age compared to adulthood. Mastoiditis occurs when an otitis media infection spread directly to involve the bone of mastoid air cell causing osteitis. Cholesteatoma can contribute to the development of mastoiditis. This typically leads to breakdown of some of the fine bony trabeculae of mastoid cells producing a coalescent mastoiditis with an emphyema in mastoid antrum. Cholesteatoma can contribute to the development of mastoiditis. The common treatment for mastoiditis is intravenous antibiotic. Our cases show that local antibiotic treatment is superior compared to systemic antibiotic in treating multi-drug resistant chronic. Pseudomonas mastoiditis compared to intravenous antibiotic. However, if it presents together with cholesteatoma the main treatment is still early mastoidectomy.

Complicated Fusobacterium necrophorum mastoiditis–More than meets the eye

Otitis media is common in children and Fusobacterium species are an emerging causative pathogen.These species have virulence factors which increase the risk of complicated otitis media.We discuss a case of F.necrophorum infection resulting in significant intracranial disease to highlight the epidemiology of these infections,risk factors for complicated disease and signs and symptoms to guide diagnosis and investigation.

骨振子对良性阵发性位置性眩晕残余症状的疗效评估

目的 探讨骨振子乳突振荡治疗手法复位成功后的良性阵发性位置性眩晕(benign positional paroxysmal vertigo,BPPV)患者残余症状的疗效。方法 前瞻性选取2022年5月至12月贵州省人民医院听力科门诊确诊为特发性BPPV并成功进行手法复位后有残余症状的93例患者,通过计算机随机分为治疗组47例和对照组46例。治疗组采用骨振子乳突振荡治疗,对照组不予任何治疗。门诊随访1周,采用眩晕障碍量表(dizziness handicap inventory,DHI)、前庭症状指数(vestibular symptom index,VSI)评价骨振子乳突振荡治疗手法复位成功后的BPPV患者残余症状的疗效。结果 复位前,对照组和治疗组DHI评分及VSI评分比较,差异无统计学意义(P>0.05);复位后,对照组和治疗组DHI总分、躯体分值、情感分值、功能分值、VSI评分低于复位前,且治疗组明显低于对照组,差异均有统计学意义(P<0.05)。结论 复位成功后应用骨振子乳突振荡能进一步改善患者的残余症状,缓解患者恐惧心理,提高生活质量。

许芝银教授从中焦气机论治非哺乳期乳腺炎经验

总结许芝银教授从中焦气机论治非哺乳期乳腺炎经验,认为非哺乳期乳腺炎病变脏腑在肝脾胃,与中焦气机失调关系密切,根据临床表现分为肿块期、脓肿期和瘘管期,主要病机为肝郁脾虚,痰阻乳络;日久郁热,热盛肉腐;气虚邪滞,缠绵阻遏。治疗上应根据疾病不同时期明辨病机,药随机转,以调畅中焦气机为关键分期化裁论治,肿块期辛开苦降,抑木扶土;脓肿期降浊升清,泻火平木;瘘管期运转中州,培土荣木,从而获得满意疗效。

耳内镜下中耳乳突胆脂瘤手术55例

目的探讨经外耳道耳内镜下中耳乳突部胆脂瘤切除术的效果。方法外耳道内C形切口,分离外耳道皮瓣,暴露鼓环,若松弛部穿孔,掀开鼓环;若紧张部大穿孔,保留前下方鼓环,暴露鼓室,清除鼓室内肉芽组织。持续灌流模式下磨除上鼓室外侧壁骨质,清除上鼓室胆脂瘤、听小骨周围病变,磨除乳突表面骨质,清除乳突腔胆脂瘤。内置明胶海绵支撑,视听小骨破坏程度置入不同类型人工听骨,乳突腔及上鼓室表面放置耳屏软骨,外覆软骨膜或生物膜。耳屏软骨膜内置法或耳屏软骨-软骨膜夹层法修补鼓膜,铺平外耳道皮瓣,术腔填塞。结果术前气导听阈中位数52.0(33.8~67.5)dB HL,显著高于术后6个月25.0(15.0~50.0)dB HL(Z=-6.454,P=0.000);术前气骨导距中位数35.0(21.2~52.5)dB HL,显著高于术后6个月15.0(3.8~27.5)dB HL(Z=-6.453,P=0.000)。55例术后2周,1、3、6个月复诊,以后每隔3个月进行一次复诊,随访24个月,55例鼓膜愈合良好,2例术后1年复发,均无面瘫、感音神经性耳聋等并发症。结论结合持续与非持续灌流模式,耳内镜下经外耳道入路行中耳乳突部胆脂瘤手术,鼓膜愈合良好,并发症少,术后患者听力改善明显,是一种微创、安全有效的手术方式。

硅胶伪造指印识别方法研究

研究硅胶伪造指印识别要点,为识别硅胶伪造指印提供依据。分别制作硅胶伪造指纹膜,然后用硅胶仿生指纹膜和同一手指在相同情况下蘸取印泥,在A4纸上垂直按压形成印泥指印,比较硅胶伪造指印与真实指印的特征差异。结果表明,真实指印的单根乳突纹线颜色深浅之间有过渡,有立体感,或者有细微漏白,而硅胶伪造指印没有以上特征;真实指印中汗孔的反映性不稳定,有时也没有反映,而硅胶伪造指印中,汗孔特征一般无法反映;纹线粗细、纹线间隔、空白特征和细节特征等受捺印力度等因素的影响,两者之间没有明显差异。在识别硅胶伪造指印过程中,可以将单根乳突纹线墨迹分布特征和汗孔特征作为识别硅胶伪造指印的主要依据,其他特征可以作为重要参考,应从多方面综合分析需检指印。

结核性中耳炎的HRCT特征

目的 评估结核性中耳炎(TOM)的HRCT特征。方法 回顾性收集经病理证实的TOM病人22例(24耳),其中男8例(36.4%),女14例(63.6%)。分析其临床资料以及HRCT上颞骨气化程度、软组织分布及骨质特点。结果 24耳中,以气化型多见(21耳,87.5%)。中耳软组织表现以完全充满气房(19耳,82.6%)、鼓室(21耳,87.5%)、乳突窦(23耳,95.8%)多见;多数堵塞咽鼓管鼓室口(22耳,91.7%),并可见突入或延伸至外耳道(21耳,87.5%)。蜂房间隔增厚(20耳,86.9%)或模糊多见(17耳,73.9%);骨质破坏也不少见(11耳,45.8%),表现为蜂房间隔中断(7耳,30.4%)、乳突骨皮质破坏(2耳,8.3%)、听骨链破坏(3耳,12.5%)、盾板破坏(2耳,8.3%)、外耳道壁破坏(1耳,4.2%)以及死骨形成(1耳,4.2%)。结论 TOM病人颞骨气化程度好,中耳软组织分布广且易累及咽鼓管和外耳道,蜂房间隔增厚模糊,部分可见骨质破坏。

乳突导静脉的研究进展

乳突导静脉是没有瓣膜的小血管,连接颅内的乙状窦或横窦及颅外的枕静脉或耳后静脉。乳突导静脉的形态、走形在不同个体各有不同。近些年由异常扩大的乳突导静脉引起的搏动性耳鸣是耳科领域的一个研究热点,其发生率呈逐年增加的趋势。同时随着耳显微外科的飞速发展,涉及乳突区的手术越来越多。在手术中出现误伤乳突导静脉而导致意外出血、栓塞的情况时有发生。因此有必要对乳突导静脉作更深入的研究。本文就乳突导静脉的起源、解剖学及其临床意义等诸方面作一探讨。

电针乳突四穴联合甲钴胺治疗特发性耳鸣的临床效果

目的探讨特发性耳鸣患者采用电针乳突四穴联合甲钴胺治疗的临床效果。方法选取2021年10月至2023年10月山东省慢性病医院收治的90例特发性耳鸣患者作为研究对象,采用随机数字表法将其分为对照组(45例)和研究组(45例)。对照组给予甲钴胺治疗,研究组给予电针乳突四穴联合甲钴胺治疗。比较两组临床疗效、中医证候积分、耳鸣程度及不良反应。结果研究组患者的治疗总有效率高于对照组,差异有统计学意义(P<0.05);两组患者治疗后的中医证候积分低于本组治疗前,研究组患者治疗后的中医证候积分低于对照组,差异有统计学意义(P<0.05);两组患者治疗后的耳鸣评价量表(TEQ)评分、耳鸣残疾量表(THI)评分低于本组治疗前,研究组患者治疗后的TEQ评分、THI评分低于对照组,差异有统计学意义(P<0.05);两组患者的不良反应总发生率比较,差异无统计学意义(P>0.05)。结论特发性耳鸣患者采用电针乳突四穴联合甲钴胺治疗的临床疗效较高,能够有效降低中医证候积分,减轻耳鸣程度,且不会增加不良反应。