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Cholesterol granuloma is commonly found in the mastoid air cells but is rare in the paranasal sinuses. The most commonly affected sinuses are the frontal sinus, followed by the maxillary sinus. Cholesterol granuloma can be difficult to diagnose because clinical manifestations and radiologic findings are similar to those of other sinonasal disorders. The authors observed 4 cases of cholesterol granuloma that were preoperatively suspected to be nasal polyps or mucoceles. Here, the authors report on their clinical presentation and their successful treatment using the endoscopic sinus approach. These cases expand the current literature on cholesterol granuloma in the paranasal sinuses.

The objective of this study was to analyze the results of endoscopy-assisted ear surgery for the treatment of chronic otitis media with cholesteatoma, adhesion, or retraction pockets.Fifty-one patients who underwent oto-endoscopy-assisted canal wall up tympanomastoid surgery and/or limited anterior atticotomy with tympanoplasty for chronic otitis media with cholesteatoma, adhesion, or retraction pocket from 2006 to 2013 have been included in this study. Eradication of the disease from the middle ear and mastoid air cells was achieved by combination of the oto-microscobic and oto-endoscopic approaches. Second look surgery was performed 18 months later from the initial surgery in selected patients. Age, gender, pre-/postoperative otoscopy findings/audiograms, type of the used prostheses, and follow-up time were obtained from the patient's file. Anatomic integrity rates of the tympanic membrane, the mean gains of air bone gap, on pure-tone audiogram at 4 frequencies and existence of the residual disease were reviewed parameters. Functional evaluation was made in patients with intact tympanic membrane.Of the 51 patients, the ratios of the chronic otitis media with cholesteatoma and isolated adhesive otitis or retraction pocket cases were 74.5% (38/51) and 25.5% (13/51), respectively. Ossicular chain reconstruction was made with PORP in 27 patients and TORP in 20 patients, whereas the ossicular chain was intact in 4 patients. Anatomic integrity rates of the tympanic membrane were 90.2% (46/51). The overall (n = 46) pre-/postoperative mean ABG obtained at 4 frequencies were 28.3 ± 12.26 and 9.18 ± 5.68 dB (P

RARA rearrangement-negative acute promyelocytic leukemia (APL) is uncommon, and its extramedullary relapse is extremely rare. We report a 5-year-old girl with RARA rearrangement-negative APL, which recurred solely at the external auditory canal and mastoid air cells. She was successfully treated with chemotherapy, local radiotherapy, and unrelated cord blood transplantation. She has maintained complete remission for 24 months after transplantation. The clinical features and our therapeutic strategy in this patient will provide valuable information for extramedullary relapse of RARA rearrangement-negative APL.

The purpose of this study was to determine the role of nasal septal deviation on volume of mastoid air cells and possible relationship to chronic otitis.Between May 2010 and September 2012, paranasal sinus computed tomographic findings of 825 patients (470 male and 355 female subjects) who were treated in Ear Nose and Throat Department of Bozok University Medical Faculty were retrospectively analyzed. By excluding the other coexistent sinonasal pathologies, 100 patients (45 male and 55 female subjects; mean age, 37.7 ± 10.4 yr; range, 18-70 yr) with nasal septal deviations were recruited for the study. The convex side of the septal curvature was accepted as the direction of deviation. The findings were grouped according to the radiologically measured angle of nasal septal deviations. The deviation angle of the nasal septum was described as follows: mild (9 degrees), moderate (9-15 degrees), or severe (≥ 15 degrees). The volume of each mastoid air cells was also calculated using the computer program. Chronic otitis was defined a abnormality criteria of the normal temporal scan. Criteria for a normal temporal bone were as follows: 1) absence of bony destruction or sclerosis; 2) absence of fluid or mass in any of the temporal bone air spaces; and 3) the presence of "normal" air cells.There were 45 male and 55 female subjects (mean age, 37.7 ± 10.4 yr; range, 18-70 yr). Nasal septal deviation angles were found to range between 5 and 28.1 degrees (mean, 14 ± 1.2 degrees). The left-sided deviations included 16 mild (9 degrees, Group I), 15 moderate (9-15 degrees, Group II), and 17 severe (≥ 15 degrees, Group III) subjects. The right-sided deviations included 18 mild (9 degrees, Group I), 16 moderate (9-15 degrees, Group II), and 18 severe (≥ 15 degrees, Group III) cases. We could not demonstrate a statistically significant difference between the right mastoid cell volumes of the Group I and Group II in left-sided deviation cases (p = 0.51). In the same side comparison of Group I to Group III and Group II to Group III, the mastoid cell volume differences were found to be significantly meaningful (p = 0.00 and p = 0.00, respectively). Identical results were yielded in the right-sided septal deviation group related to the mastoid cell volumes of Group I and Group II and Group I to Group III and Group II to Group III comparisons (p = 0.55, p = 0.00, and p = 0.011, respectively). In both right and left deviation groups, ipsilateral and contralateral mastoid cell volume comparisons produced statistically significant results (p = 0.04 and p = 0.003, respectively). The presence of chronic otitis findings were significantly increased in both groups (p = 0.00). Statistical significance was set at p0.05.Our findings suggest that mastoid cell volumes tend to be larger at the contralateral side of the severe septum deviations.

Pneumosinus dilatans is a term used to describe enlargement of one or more paranasal sinuses without radiological evidence of localized bone destruction, hyperostosis, or mucous-membrane thickening. To date, many cases have been reported that involved frontal, ethmoid, sphenoid, and maxillary sinus. However, no case has been reported that involved all paranasal sinuses. Our case involved mastoid air cells as well as all paranasal sinuses. It is named pneumosinus dilatans multiplex by us. This is the first case to be reported in English literature that has this syndromic condition of pneumosinus dilatans multiplex, mental retardation, and facial deformity.

Using a temporoparietal fascial flap and hydroxyapatite ceramics, we treated a patient for complications after a neurosurgical operation for glossopharyngeal neuralgia. These consisted of pneumocephalus and cerebrospinal fluid rhinorrhea resulting from fistulas of mastoid air cells associated with a subcutaneous dead space. By means of the temporoparietal fascial flap, we were able to fill the dead space and reinforce the repaired dural and mastoid lesion as well. Hydroxyapatite ceramics were also useful for closing the mastoid air cell fistulas.

A case of mixed type adenoma of the middle ear and mastoid is presented in which CT showed complete opacification of the middle ear and mastoid air cells with bulging of the tympanic membrane but without ossicular or bony destruction.