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Introduction Chronic mucosal otitis media is one of the common disease prevalent in our society. This study was done to correlate the status of mastoid with outcomes of myringoplasty with cortical mastoidectomy in mucosal otitis media with high risk perforation. MethodsThis prospective, observational study was done at Department of Otorhinolaryngology and Head and Neck Surgery, Tribhuvan University Teaching Hospital. Thirty-four patients of ag|e 15 and above with chronic mucosal otitis media having high-risk perforation undergoing cortical mastoidectomy with myringoplasty were included. The status of middle ear, aditus, and mastoid air cells were assessed. Post-operatively, patients were assessed for graft uptake and hearing after three months. The post-operative graft uptake and hearing results were correlated with the peroperative status. Four patients who had preoperative sensorineural hearing loss were studied in terms of graft uptake only. ResultsThe graft success rate in patients with normal mastoid air cells was 90% whereas in diseased cases was 71.4% which was statistically not significant with p value 0.20. The success rate in terms of hearing was 68.8% in normal mastoid whereas it was 64.3% in diseased mastoid which was statistically not significant with p-value of 1. ConclusionIn correlation with the status of mastoid air cells with graft uptake and hearing result, the observed differences were not statistically significant. However, averages of post-operative air conduction threshold and air-bone gap of all cases were better as compared to preoperative levels.

The new advancing technologies have created a storm in the long-existing canons of anatomic sciences with the bandwagon of recent anatomical discoveries such as the existence and identification of a bilateral foramen in the coronoid process of the mandible. The coronoid process being a thin flat triangular process varies in shape and size and gives attachment to the main muscles of mastication the temporalis and the masseter. The excitement of exploratory anatomic victory on mysteries related to the anatomy of the head-and-neck region specific to the coronoid process was further documented and elaborated as an incidental finding. The following manuscript presents an intriguing case of a pediatric patient aged 7 years with a morphologic variation of coronoid process with presence of foramina bilaterally along with few other variants, further attempting to emphasize its occurrence in the developmental years as a possibility of developmental variant trait.

Objective This study aimed to assess the relationship between increased intracranial pressure (ICP) and mastoid effusions (ME). Methods Between January 2015 and October 2018, patients who underwent intracranial surgery and had ICP monitoring catheters placed were enrolled. ICP was recorded hourly for at least 3 days. ME was determined by the emergence of opacification in mastoid air cells on follow-up brain imaging. C-reactive protein (CRP) levels, presence of endotracheal tube (ETT) and nasogastric tube (NGT), duration of intensive care unit (ICU) stay, duration of mechanical ventilator application, diagnosis, surgical modalities, and presence of sinusitis were recorded. Each factor's effect on the occurrence of ME was analyzed by binary logistic regression analyses. To analyze the independent effects of ICP as a predictor of ME a multivariable logistic regression analysis was performed. Results Total of 61 (53%) out of 115 patients had ME. Among the patients who had unilateral brain lesions, 94% of subject (43/50) revealed the ipsilateral development of ME. ME developed at a mean of 11.1±6.2 days. The variables including mean ICP, peak ICP, age, trauma, CRP, ICU stays, application of mechanical ventilators and presence of ETT and NGT showed statistically significant difference between ME groups and non-ME groups in univariate analysis. Sex and the occurrence of sinusitis did not differ between two groups. Adding the ICP variables significantly improved the prediction of ME in multivariable logistic regression analysis. Conclusion While multiple factors affect ME, this study demonstrates that ICP and ME are probably related. Further studies are needed to determine the mechanistic relationship between ICP and middle ear pressure.

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.

This study revealed the usefulness of volumetric analysis of mastoid air cells (MACs) extracted from postmortem computed tomography (PMCT) images in characterizing individuals. To characterize deceased persons, the MACs volumes of 61 Japanese PMCT images were measured after thresholding in Hounsfield units and based on the number of voxels on the right and left sides and the voxel size for each person. The volume differences between the right and left MACs and sex were examined. Although there were no obvious volume differences between males and females, the order of sizes on the two sides varied for each person. Moreover, deceased persons could be roughly classified using the total volume of MACs. Deceased persons with similar total volumes could be distinguished further by comparing the ratio of volumes in bilateral MACs. Although the identification process is dependent on samples and different sizes of bilateral MACs, our pilot study indicated that 81.9% (50/61) of deceased persons could be distinguished. In conclusion, volumetric analysis of MACs measured using PMCT imaging has the potential to identify individuals and reduce the number of candidates.

Introduction The effectiveness of the 13-valent pneumococcal conjugate vaccine (PCV13) on sepsis, meningitis, pneumonia, and even acute otitis media has been proved in many studies. Nonetheless, the impact of PCV13 on otomastoiditis (OM) in children has barely been reviewed. In the past, we published a 13 years pneumococcal OM study from our hospital. This is a continuation of our active surveillance and is the first Latin American, prospective study examining the effectiveness of this vaccine on pneumococcal pediatric OM. Methods Active surveillance identifying patients < 16 years of age with OM admitted at the “Hospital General de Tijuana” was performed from October 1, 2005, to September 30, 2019. Diagnosis of OM was based on clinical exam (postauricular tenderness, erythema, and swelling causing protrusion of the auricle) and computerized tomographic signs (opacification of the mastoid air cells and middle ear). We used either conventional culturing or PCR to isolate bacterial pathogens, while to further Streptococcus pneumoniae serotype identification we used the Quellung Reaction (Statens Serum Institute®) or PCR. To assess pneumococcal conjugate vaccines effectiveness (VE), we counted cases per month before any pneumococcal conjugate vaccine was implemented (19 months surveillance), during the 7-valent pneumococcal conjugate vaccine (PCV7) use in the pediatric community (61 months surveillance), after PCV13 implementation in children (100 months surveillance), and calculated as follows: VE = 1 -(cases per month with specific pneumococcal conjugate vaccination/cases per month without any pneumococcal conjugate vaccination). Results Following 15 years of active surveillance, we identified 21 cases of OM. At admission the median age of patients was 38 months (six months to 15 years old), the median hospitalization days was 12 (5 to 115). All patients underwent mastoidectomy. Identification of bacterial pathogens was possible in 19 (90.5%), among which. Streptococcus pneumoniae was the leading cause with 15 cases (79%). PCV7 VE was 27.8%, however, after PCV13 introduction, VE increased to 68%, with only one case of pneumococcal OM in the last two years, without incremental OM cases by other bacteriae. Conclusion After 15 years of active/prospective surveillance in our hospital, a continuous and high VE (68%) of PCV13 on pediatric OM caused by Streptococcus pneumoniae has been found, with only one case in the last two years.

Background: The mastoid air cells are considered to develop better in children with congenital cholesteatoma but only a few quantitative studies have examined. Aims/objectives: The present study was undertaken in order to clarify the relationships between the development of the mastoid air cells in children with congenital cholesteatoma and clinical factors. Materials and methods: Mastoid air cell development was evaluated in 53 children with congenital cholesteatoma. The sizes of the mastoid air cells were measured on computed tomography scans of the temporal bone, and clinical factors, including age, the extent of invasion, and whether it was located close to the eustachian tube were evaluated. Results: The cross-sectional area of the mastoid air cells was significantly smaller on the affected side than on the unaffected side, especially in the older patients. The cases involving invasion into the mastoid portion also had smaller mastoid cells. Whether the cholesteatoma was located close to the eustachian tube had no effect. Conclusions and significance: The mastoid air cells on the affected side were less well developed. Our findings indicate that a high age and the presence of cholesteatoma in the mastoid region might be associated with suppressed mastoid pneumatization.

ObjectiveVentilation of the middle ear and mastoid air cells is believed to play an important role in the pathogenesis of chronic ear disease. Traditionally, ventilation is assessed by computed tomography. However, this exposes patients to cumulative radiation injury. In cases with a perforation in the tympanic membrane, tympanometry potentially presents a non-invasive alternative to measure the ventilated middle-ear and mastoid air cell volume. This study hypothesised that total tympanometry volume correlates with ventilated middle-ear and mastoid air cell volume.MethodTotal tympanometry volume was compared with ventilated middle-ear and mastoid air cell volume on computed tomography scans in 20 tympanic membrane perforations.ResultsThere was a high correlation between tympanometry and computed tomography volumes (r = 0.78; p < 0.001). A tympanometry volume more than 2 ml predicted good ventilation on computed tomography.ConclusionThese results may help reduce the need for pre-operative computed tomography in uncomplicated cases with tympanic membrane perforations.

Mastoid air cell fluid is a commonly seen, but often dismissed finding. Given the location of the mastoid portion of the temporal bone and its location adjacent to vital structures, a careful evaluation is important for the emergency radiologist. While occasionally benign, fluid within the mastoid air cells can be an early sign of more severe pathology, and familiarity of regional anatomy allows for early identification of disease spread. This article describes the important anatomy, the common pathologies, and a radiologic approach to assessing the mastoid air cells in order to guide referring clinicians.

Importance Head congestion is one of the most common somatic symptoms experienced by astronauts during spaceflight; however, changes in the opacification of the paranasal sinuses or mastoid air cells in astronauts have not been adequately studied. Objectives To quantify preflight to postflight changes in the opacification of the paranasal sinuses and mastoid air cells in Space Shuttle astronauts and International Space Station (ISS) astronauts and to assess whether there are differences between the 2 groups of astronauts. Design, Setting, and Participants This cohort study examined preflight and postflight head magnetic resonance images (MRIs) of 35 astronauts who had participated in either a short-duration (≤30 days) Space Shuttle mission or a long-duration (>30 days) ISS mission and had undergone both preflight and postflight MRI. Images were obtained before and after spaceflight. Images were evaluated by 2 neuroradiologists blinded to which mission each astronaut had flown and to which images were preflight or postflight images. Exposure Spaceflight on the Space Shuttle or the ISS. Main Outcomes and Measures Measured outcomes included preflight to postflight changes in Lund-Mackay scores for the paranasal sinuses and in scores grading mastoid effusions. Results Most astronauts in both the Space Shuttle group (n = 17; 15 men; mean [SD] age at launch, 47.7 [3.1] years) and the ISS group (n = 18; 14 men; mean [SD] age at launch, 48.6 [4.7] years) exhibited either no change or a reduction in paranasal sinus opacification as seen on postflight MRI scans (Space Shuttle group: 6 [35.3%] had no sinus opacification before or after spaceflight, 5 [29.4%] had less sinus opacification after spaceflight, 3 [17.6%] had the same amount of sinus opacification before and after spaceflight, and 3 [17.6%] had increased paranasal sinus opacification after spaceflight; ISS group: 8 [44.4%] had no sinus opacification before or after spaceflight, 4 [22.2%] had less sinus opacification after spaceflight, 1 (5.6%) had the same amount of sinus opacification before and after spaceflight, and 5 [27.8%] had scores consistent with increased paranasal sinus opacification after spaceflight). Long-duration spaceflight (ISS group) was associated with an increased risk of mastoid effusion relative to short-duration spaceflight (relative risk, 4.72; 95% CI, 1.2-18.5). Images were obtained a mean (SD) 287.5 (208.6) days (range, 18-627 days) prior to and 6.8 (5.8) days (range, 1-20 days) after spaceflight. Astronauts had undergone either a mean (SD) of 13.6 (1.6) days of spaceflight on the Space Shuttle (17 astronauts) or 164.8 (18.9) days on the ISS (18 astronauts). Conclusions and Relevance This study found that exposure to spaceflight conditions on the ISS is associated with an increased likelihood for the formation of mastoid effusions. There was no association between exposure to spaceflight conditions and changes in paranasal sinus opacification. The limitations of this study include lack of information concerning medical history and mission-specific operational experience for individual astronauts. Further studies are indicated to determine the cause and composition of the mastoid effusions.

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

Objective Opening of mastoid air cells (MACs), a complication of lateral suboccipital craniotomy for microvascular decompression (MVD), might cause cerebrospinal fluid (CSF) leakage and meningitis. Only a few studies have investigated the association of degree of MAC development and actual opening of MACs. The present study focused on preoperative risk assessment for predicting the opening of MACs. Patients and methods The study included 204 consecutive patients who underwent MVD at our hospital between January 2014 and December 2018. We retrospectively collected clinical and neuroimaging data from electronic medical charts and discharge summaries. MACs were classified into four types according to neuroimaging data. Postoperative computed tomography (CT) was used to assess patients with and without CSF leakage into MACs. Results No CSF leakage was observed into types 1 and 2 MACs, but it was noted in 14 of 46 patients (30 %) with type 3 and 44 of 58 patients (76 %) with type 4 MACs. Opening of MACs during surgery could not be recognized in 33 (57 %). CSF rhinorrhea was noted in 1 of the 58 patients with CSF leakage into MACs and meningitis was not noted. Conclusion Patients with types 3 and 4 MACs have a high risk of CSF leakage. Complete prevention of mild symptoms, such as ear obstruction, is challenging even if opened MACs are sealed, but serious complications, such as CSF rhinorrhea and meningitis, can be avoided. For cases in which preoperative CT reveals a high risk of opening of MACs, preventive closure should be performed.

BACKGROUND: The nasal septum deviation is the most common deformity of the nasal, and that can be congenital or acquired. Despite many studies exist about the impact of nasal septum deviation on chronic sinusitis and also association between chronic otitis and mastoid pneumatization; few studies exist about the impact of nasal septum deviation on chronic otitis and mastoid pneumatization. AIM: The aim of this study was to evaluate the associations of nasal septum deviation and mastoid pneumatization and chronic otitis. METHODS: In this study review, all CT scans of PNS and Mastoid View in the imaging section from Imam Ali hospital in 2016-2017 years and cases of nasal septum deviation were enrolled. The nasal septum deviation was recorded, and the degree of nasal septum deviation in the coronal plane that showed the maximum deviation of the nasal septum was recorded. The volume of the mastoid cells automatically and directly was calculated using three diameter measurements (2 coronal diameters and 1 axial diameter) by the program. The software of SPSS 22 was used for statistical analysis. RESULTS: There was no relationship between nasal septum deviation severity and incidence of mastoid pneumatization in patients with nasal septum deviation (P > 0.05). There was relationship between nasal septum deviation severity and chronic otitis in patients with nasal septum deviation (P < 0.05). In patients with moderate and severe intensity of nasal septum deviation, the volume of mastoid air cells in deviation side was lower than the front side (P < 0.05). CONCLUSION: Based on the results of the CT scan, in patients with moderate and severe nasal septum deviation intensity, the volume of mastoid air cells in deviation side was lower than the front side. Also, there was a relationship between nasal septum deviation severity and chronic otitis.

Background: Axiolateral projection of mastoid examination with Schuller method using angle range of 25°-30° caudad according to Bontrager (2010). The difference thickness of the human’s head will cause range of angles of axiolateral projection of mastoid examination using Schuller projection. The inappropriate angle will affect the different anatomical information. Axiolateral projection of mastoid examination using Schuller projection in Radiology Installation of dr. Soetomo Hospital used an angle that is 25° for all patients with different thickness of the head. This study aims to determine the differences in anatomical image clarity on radiographic image of axiolateral projection of mastoid examination using Schuller method with an angle that is 25° with variations of head thickness between 12 to 14.5 cm.Methods: This research was a quantitative research with an experimental approach. Subjects of this reearch were 10 respondents. Data analyzed statistically by Kruskal Wallis test and Mann Whitney test.Results: The results showed that there was difference in anatomical image of axiolateral projection of mastoid examination with Schuller method with 25° angle. Result of statistical test to get optimal radiographic image of mastoid using Schuller method showed the significant value, which was 0,000. Differences in anatomical image was also shown on the assessment results from 10 respondents which most of respondents assess anatomical features on a 14.5 cm head thickness was very good.Conclusion: There were differences anotomical information of mastoid radiograph using schuller method with thickness variaton of head. Head thickness of 14.5 cm can show anatomical image of the mastoid air cells, bony labirinth, condyle mandible, temporomandibular joint (TMJ), Aacousticus the external meatus (MAE) and tegmen tympani. The CR angle should be considered based on head thickness.

Otogenic infection is the most common cause of meningitis.Therefore, it should be ruled out during clinical assessment of a patient with any intracranial infection. Masked mastoiditis is a known intratemporal complication of acute otitis media after inadequate antimicrobial treatment. It is defined as inflammation of mucosal lining and bony structures of the mastoid air cells with an intact tympanic membrane. It should be regarded as the source of infection in a patient with meningitis and positive radiological findings of mastoiditis even though the patient does not have any evidence of ear infection clinically. We report a case of bacterial meningitis following masked mastoiditis in an 68-years-old man.Bangladesh Journal of Medical Science Vol.16(3) 2017 p.458-460

Introduction: The environment of middle ear cavity gets regulated mostly by pneumatized mastoid air cell system (MACS). Many theories exist that details the process of pneumatization of this MACS. The nasal septal deviation (NSD) has been shown to be instrumental in influencing pneumatization of paranasal sinuses to varied degrees. The effect of NSD on the pneumatization of MACS remains questionable due to limited literature available. And so this study was done to find the relation between the side of NSD and extent of Pneumatization of MACS on that side by computerized tomographs of Paranasal sinus region. Subjects and Methods: 120 CT images of paranasal region from archives of radiology department were studied for NSD. The NSD was classified according to the nasal septal angle. The extent of pneumatization of mastoid region was studied and classified. The relation between severe NSD and extent of mastoid pneumatization was noted. Results: NSD was found to be right sided in 90% cases studied and 20, 45, 55 were seen belonging to group I, II and III NSD respectively. The mean NSA was found to be 13.5o. Mastoid region was observed to be hypo pneumatized in the side of NSD in 42 cases of group III NSD. Conclusion: The findings of the study puts forth the need for assessment of NSD and planning possible correction of NSD prior to middle ear and mastoid surgeries for successful results.

Objectives To determine the utility of three-dimensional (3D) printed models in individualized petroclival tumor resection planning by measuring the fidelity of printed anatomical structures and comparing tumor exposure afforded by different approaches. Design Case series and review of the literature. Setting Tertiary care center. Participants Three patients with petroclival lesions. Main Outcome Measures Subjective opinion of access by neuro-otologists and neurosurgeons as well as surface area of tumor exposure. Results Surgeons found the 3D models of each patient's skull and tumor useful for preoperative planning. Limitations of individual surgical approaches not identified through preoperative imaging were apparent after 3D models were evaluated. Significant variability in exposure was noted between models for similar or identical approaches. A notable drawback is that our printing process did not replicate mastoid air cells. Conclusions We found that 3D modeling is useful for individualized preoperative planning for approaching petroclival tumors. Our printing techniques did produce authentic replicas of the tumors in relation to bony structures.

Objectives/Hypothesis On the basis of clinical observations, the shape of the osseous external auditory canal (OEAC) has often been seen as an etiological factor in troublesome cavities after modified radical mastoidectomy. Study Design Retrospective analysis of CT scans. Methods To assess the role of the shape of the OEAC in troublesome modified radical cavities using computed tomographic scans of three groups of patients (without pathology and with or without draining cavities), we determined the depth of the pretympanic recess (DPTR) and its anterior curvature (ACPTR). In addition to looking at the shape of the OEAC, we also studied the role of any remaining mastoid air cells in relation to troublesome radical cavities, as well as the consultation frequency. Results The DPTR was significantly deeper in draining cavities than in ears without pathology and dry cavities. No difference in the ACPTR was observed. The presence of remaining mastoid air cells is significantly associated with the presence of a troublesome radical cavity. Conclusions The shape of the OEAC (i.e., the DPTR) is a contributory factor to the drainage of modified radical cavities. Level of Evidence 4. Laryngoscope, 2015

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.

Intracranial gas is commonly detected on neuroimaging. The recognition of this finding can at first blush be unsettling. Being able to localize this gas to a specific compartment: intraarterial, intravenous, intraparenchymal, subdural, epidural, subarachnoid and intraventricular, is the first step in determining the importance of the gas. Determination of the route of entry: through the skull, extension from a paranasal sinus or the mastoid air cells, via the spine, or trans-vascular, is the other important factor in determining potential consequences. Understanding these parameters allows for a confident determination of etiology. More importantly, it generally provides guidance as to what must be done: either to disregard (e.g., subarachnoid gas following lumbar puncture and intravenous gas following IV placement), obtain follow-up (e.g., postoperative gas), or administer emergent treatment (e.g., intraarterial gas and epidural abscess). In this review, we use gas location and route of entry to classify the various causes of pneumocephalus and provide examples of each of these etiologies.

OBJECTIVEThe anterior transpetrosal approach (ATPA) was established in 1984 and has been particularly effective for petroclival tumors. Although some complications associated with this approach, such as venous hemorrhage in the temporal lobe and nervous disturbances, have been resolved over the years, the incidence rate of CSF leaks has not greatly improved. In this study, some varieties of air cell tracts that are strongly related to CSF leaks are demonstrated. In addition, other pre- and postoperative risk factors for CSF leakage after ATPA are discussed.METHODSPreoperative and postoperative target imaging of the temporal bone was performed in a total of 117 patients who underwent ATPA, and various surgery-related parameters were analyzed.RESULTSThe existence of air cells at the petrous apex, as well as fluid collection in the mastoid antrum detected by a postoperative CT scan, were possible risk factors for CSF leakage. Tracts that directly connected to the antrum from the squamous part of the temporal bone and petrous apex, rather than through numerous air cells, were significantly related to CSF leak and were defined as “direct tract.” All patients with a refractory CSF leak possessed “unusual tracts” that connected to the attic, tympanic cavity, or eustachian tube, rather than through the mastoid antrum.CONCLUSIONSPreoperative assessment of petrous pneumatization types is necessary to prevent CSF leaks. Direct and unusual tracts are particularly strong risk factors for CSF leaks.

BackgroundIndications for removal of mastoid air cells and obliterating the mastoid cavity vary considerably from surgeon to surgeon. Various obliteration techniques have been recommended to eliminate open cavity problems. Here we investigated the difference between natural and synthetic filling materials to improve hearing after obliteration of the mastoid cavity.SettingAcademic tertiary care medical centers (Al-Azhar and Ain-Shams University Hospitals).Study designRetrospective comparative study included 60 patients divided into 2 equal groups.MethodsThe study was conducted over 6 years from 2008–14. The mean follow-up time was 3.5 years.ResultsWe found that serviceable hearing (≤30 dB) was obtained after surgery in 52 patients (86.6%). In cases where natural materials were used in reconstruction, the average gain in AC was 25.5 dB and in BC it was 1.1 dB, while in cases where synthetic materials were used the average gain in AC was 26 dB and in BC it was 0.5 dB. There was significant improvement in the mean postoperative AC compared to the mean preoperative AC. However, there was no statistically significant difference between the use of natural and synthetic materials in improving postoperative hearing.ConclusionsBoth natural and synthetic materials help in improvement of hearing after obliteration of the mastoid cavity. There is no statistically significant difference between the materials.

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.

In the setting of posterior fossa dural venous sinus thrombosis, mastoid findings can potentially be mistaken as the cause rather than a secondary effect. Obstruction of the mastoid venous drainage can lead to transudation of fluid into the mastoid air cells. We hypothesize that a continuum of the mastoid manifestations secondary to dural venous sinus thrombosis can be seen on MRI and that the difference in venous drainage between the mastoid and middle ears can assist with this important imaging differential.A retrospective review of acute dural venous sinus thrombosis cases and their follow-up imaging were graded as follows: no involvement; grade 1 mucosal congestion; grade 2, film of fluid; or grade 3, complete opacification. Presence of middle ear fluid was also documented.Of 22 posterior fossa dural venous sinus thrombosis cases without clinical infectious mastoiditis, 19 had mastoid findings: eight with grade 1, eight with grade 2, and three with grade 3. Middle ear fluid was seen in only one case. There was a statistically significant association between posterior fossa dural venous sinus thrombosis and mastoid findings (chisquare test (n = 22), p0.04). Fifteen of 18 cases with follow-up MRI examinations showed lessening of the mastoid findings with resolving dural venous sinus thrombosis.Acute posterior fossa dural venous sinus thrombosis may present with a spectrum of mastoid findings that should not be misdiagnosed as the cause of the thrombosis. This study illustrates that in the absence of clinical findings of mastoiditis, mastoid fluid with a clear middle ear argues that the mastoid changes are the effect of the dural venous sinus thrombosis rather than the cause.

The anatomical relationships of the middle ear, the mastoid air cells, the temporal bone and intracranial structures can lead to invasive infections. Acute mastoiditis is the most common intratemporal complication of acute otitis media. Timely management includes antimicrobial therapy, imaging including ultrasound and/or computed tomography, surgical consultation and intervention. There are insufficient data to provide an evidence-based diagnostic tool for acute mastoiditis. Clinical, laboratory and microbiological differences between children with simple and complicated mastoiditis will be explored after case presentation of a 5-year-old boy with fever and a tender, soft-tissue swelling over the left zygomatic arch.

TTCR emphasizes the importance of preserving uninvolved, functional mastoid air cells, and anatomical reconstruction with cartilage, which may facilitate mastoid aeration and avoid cavity problems.

A 20-year-old man was transferred to this hospital because of recurrent ear pain for 8 months despite antibiotics, with new fever and headache. Imaging showed opacification of the middle ears and mastoid air cells and erosion of the right temporal bone.

Yucel, Serap/0000-0003-1537-9562; WOS: 000388706400014 PubMed: 28005808 Spontaneous epidural pneumocephalus is a rare condition. The authors reported a 35-year-old male patient with tinnutus, dull headache, and swelling on his head. Patient had a history of head trauma and skull fracture from when he was 5 years old. Cranial computed tomography revealed increase in pneumatization of right mastoid air cells and large epidural air in temporoparietal region. Inner table of right temporal bone got thinner, causing communication of mastoid air cells with epidural space. Epidural air had septations and exerted mass effect on the right parietal lobe with minimal midline shift. Thinning of also right parietal bone caused extension of epidural air into the right parietal subcutaneous tissue and hence subcutaneous swelling. There was no obvious fracture line. Spontaneous epidural pneumocephalus is extremely rare condition that may cause severe complications. There are several etiologic factors. Head trauma can be the eliciting factor in the authors' patient. It is important to be familiar with its presentation and imaging findings to make early diagnosis and treatment.