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Temporal Bone (temporal + bone)

Distribution by Scientific Domains

Medical Sciences	72%
Life Sciences	24%

Distribution within Medical Sciences

Otolaryngology (Ear, Nose & Throat)	70%
Surgery & Surgical Specialties	15%
3 Other Subdomains	15%

Selected Abstracts

Two Temporal Bone Computed Tomography Measurements Increase Recognition of Malformations and Predict Sensorineural Hearing Loss,

THE LARYNGOSCOPE, Issue 8 2006
Derk D. Purcell MD
Abstract Objectives/Hypothesis: The objectives of this prospective study were to assess the reproducibility of the measurements of the cochlea and lateral semicircular canal (LSCC) and to determine if abnormal measurements predict sensorineural hearing loss (SNHL). Methods: Two readers independently measured the cochlear height on coronal section and the LSCC bony island width on axial section on 109 temporal bone computed tomography scans; audiologic data on these patients were collected independently from medical records. Inter- and intrareader variability was evaluated using intraclass correlation coefficients (ICCs) based on a random-effects model. The positive and negative predictive values of abnormal measurement for hearing loss were determined. Results: There was excellent inter- and intraobserver agreement for both measurements (ICC >80%). The average cochlear height was 5.1 mm (normal range, 4.4,5.9 mm) and average LSCC bony island width was 3.7 mm (normal range, 2.6,4.8 mm). Review of the original radiology reports demonstrated that both cochlear hypoplasia and LSSC dysplasia were overlooked in >50% of patients with both abnormal measurements and SNHL. Cochlear hypoplasia (<4.4 mm) had a positive predictive value of 100% for SNHL, whereas cochlear hyperplasia and bony island dysplasia were less predictive. Conclusion: The measurements of coronal cochlear height and axial LSCC bony width have excellent reproducibility and identify bony labyrinth abnormalities missed by visual inspection alone. In addition, cochlear hypoplasia is highly predictive of SNHL. To reliably identify inner ear malformations, measurement of the cochlear height and LSCC bony island width, in addition to the vestibular aqueduct, should be routinely performed on all temporal bone studies. [source]

Inverting Papilloma of the Temporal Bone

THE LARYNGOSCOPE, Issue 1 2002
Anna M. Pou MD
Abstract Objectives Inverting papilloma of the temporal bone is exceedingly rare. The objective is to familiarize the clinician with the clinical presentation and prognosis of this entity. Study Design Retrospective case study and literature review. Methods Published reports of inverting papillomas originating in the temporal bone were reviewed in conjunction with two cases presenting at the University of Texas Medical Branch (Galveston, TX). Results Inverting papillomas of the temporal bone are frequently associated with persistent middle ear effusion and ipsilateral sinonasal tumors and display a higher incidence of malignancy. Conclusions Successful management of these tumors requires an aggressive surgical resection. Adjuvant radiation therapy is recommended in patients with malignant changes. [source]

Three-Dimensional Anatomy of the Temporal Bone in Normal Mice

ANATOMIA, HISTOLOGIA, EMBRYOLOGIA, Issue 4 2009
J. H. Lee
Summary This study was performed to determine the three-dimensional (3D) structure of the murine temporal bone and to provide a survey atlas of the temporal bone structures in mice. The temporal bones of adult BALB/c mice were examined and 3D high-resolution reconstructions of the temporal bone were obtained using a micro-CT system. Using the system described here, the bony labyrinth and membranous labyrinth could be investigated in a non-destructive manner. The turning rate of the cochlea was two (human rate: two and a half). The shapes of the superior and posterior semicircular canals were more flexed than those in humans. The malleus manubrium was directed anteriorly and was thin and fan-shaped like a Persian sword. The size of the incus relative to the malleus was smaller than that in the human ossicles. The 3D reconstruction of murine temporal bone described in this study provides anatomical information that will be useful in future studies using mouse model. [source]

Topical Application of Calcium Channel Blockers to Reduce the Progression of Experimentally Induced Myringosclerosis and Tympanosclerosis

THE LARYNGOSCOPE, Issue 4 2008
Adin Selcuk MD
Abstract Objectives: This study aimed to evaluate the ability of topically applied calcium channel blockers (diltiazem) to reduce the progression of experimentally induced myringosclerosis and tympanosclerosis. Study Design: Animal model. Experimental prospective study. Methods: The study included 25 adult albino guinea pigs that were bilaterally myringotomized and inoculated with a suspension of Streptococcus pneumonia type 3. The right ears were treated with topical application of diltiazem, and the untreated left ears served as the control group. Otomicroscopy and remyringotomy were conducted every week. One animal was sacrificed after 1 week and the remaining at the end of 6 weeks. Temporal bones were dissected, and tympanic bullae were analyzed with light microscopy. Results: The untreated control ears showed evidence of extensive myringosclerosis on otomicroscopy, and the ears treated with calcium channel blockers did as well although to a lesser degree. Under light microscopy, the lamina propria of both tympanic membranes and middle ear mucosae of the control group exhibited thicker (P < .1 and P < .05, respectively) and larger (P < .01 and P < .01, respectively) sclerotic tissue in comparison with the treatment group. Conclusion: The results suggest that calcium channel blockers had an influence in the prevention of tympanosclerosis. [source]

Primary Ewing sarcoma of the petrous temporal bone: An exceptional cause of facial palsy and deafness in a nursling

HEAD & NECK: JOURNAL FOR THE SCIENCES & SPECIALTIES OF THE HEAD AND NECK, Issue 10 2006
Jens Pfeiffer MD
Abstract Background. Primary Ewing sarcoma affecting the skull base in general and the petrous bone in particular is extremely rare with only 4 reports of Ewing sarcoma arising in the petrous temporal bone in the international medical literature. Methods. The authors report for the first time a case of a primary Ewing sarcoma of the petrous temporal bone in a 5-month-old nursling, which became apparent with a complete peripheral facial palsy and ipsilateral surdity. Results. The neoformation was treated by systemic chemotherapy and radiation of the tumor region. The diagnostic steps, therapy, and development of the child are described in detail; the literature concerning Ewing sarcoma originating from the skull in general and from the petrous temporal bone in particular is reviewed. Conclusions. The highlights of this case are an extremely uncommon location, an unusual age of presentation, as well as a unique set of symptoms. © 2006 Wiley Periodicals, Inc. Head Neck, 2006 [source]

Definitive radiotherapy in the management of chemodectomas arising in the temporal bone, carotid body, and glomus vagale

HEAD & NECK: JOURNAL FOR THE SCIENCES & SPECIALTIES OF THE HEAD AND NECK, Issue 5 2001
Russell W. Hinerman MD
Abstract Purpose To evaluate the results of treatment for 71 patients with 80 chemodectomas of the temporal bone, carotid body, or glomus vagale who were treated with radiation therapy (RT) alone (72 tumors in 71 patients) or subtotal resection and RT (8 tumors) at the University of Florida between 1968 and 1998. Methods and Materials Sixty-six lesions were previously untreated, whereas 14 had undergone prior treatment (surgery, 11 lesions; RT, 1 lesion; or both, 2 lesions) and were treated for locally recurrent disease. All three patients who received prior RT had been treated at other institutions. Patients had minimum follow-up times as follows: 2 years, 66 patients (93%); 5 years, 53 patients (75%); 10 years, 37 patients (52%); 15 years, 29 patients (41%); 20 years, 18 patients (25%); 25 years, 12 patients (17%); and 30 years, 4 patients (6%). Results There were five local recurrences at 2.6 years, 4.6 years, 5.3 years, 8.3 years, and 18.8 years, respectively. Four were in glomus jugulare tumors and one was a carotid body tumor. Two of the four patients with glomus jugulare failures were salvaged, one with stereotactic radiosurgery and one with surgery and postoperative RT at another institution. Two of the five recurrences had been treated previously at other institutions with RT and/or surgery. Treatment for a third recurrence was discontinued, against medical advice, before receiving the prescribed dose. There were, therefore, only 2 failures in 65 previously untreated lesions receiving the prescribed course of RT. The overall crude local control rate for all 80 lesions was 94%, with an ultimate local control rate of 96% after salvage treatment. The incidence of treatment-related complications was low. Conclusions Irradiation offers a high probability of tumor control with relatively minimal risks for patients with chemodectomas of the temporal bone and neck. There were no severe treatment complications. © 2001 John Wiley & Sons, Inc. Head Neck 23: 363,371, 2001. [source]

Diameter of the human internal acoustic meatus and sex determination

INTERNATIONAL JOURNAL OF OSTEOARCHAEOLOGY, Issue 2 2006
N. Lynnerup
Abstract We report the results of testing the diameter of the internal opening of the acoustic canal in the petrous part of the temporal bone for sex determination of skeletal remains. The method involves measuring the diameter using a suite of ordinary drills. The method is very simple and has the great advantage of utilising one of the sturdiest bone elements of the human skeleton. The method may be especially useful for the analyses of very fragmented skeletal remains or cremated bones, where the petrous bone may still be readily recognisable. The method was tested using a forensic sample of 113 left petrous bones with known sex. Intra- and inter-observer testing was also performed. We found a statistically significant difference in diameter between males and females (means: males: 3.7,mm; females: 3.4,mm; P,<,0.009). However, the low predictive value (70%) for correct sexing using two sectioning points (,<,3.0,mm,=,female; >3.5,mm,=,male) was disappointing. No additional accuracy was gained by employing both left and right petrous bones (a bilateral sample of 60 petrous bones was also tested), although left and right side diameter is highly correlated (R,=,0.778; P,=,0.0001). Copyright © 2005 John Wiley & Sons, Ltd. [source]

Age of closure of the foramen of Huschke: an osteological study

INTERNATIONAL JOURNAL OF OSTEOARCHAEOLOGY, Issue 1 2006
L. T. Humphrey
Abstract The foramen of Huschke is a dehiscence in the antero-inferior surface of the tympanic plate, which forms during the normal post-natal development of the temporal bone. Closure of the foramen is generally reported to take place by 5 years of age, although a persistent foramen has been observed in 0,67% of adult crania depending on the population. A persistent foramen of Huschke in adult life may be involved in abnormalities of the external auditory canal and related structures, which can lead to otological complications. This paper examines age-related changes in the development of the tympanic plate from the perinatal to the adult condition using two osteological samples from Britain, and is the first systematic evaluation beyond the age of six years. The results suggest that the widely cited chronology for the closure of the foramen of Huschke is erroneous. Earlier stages of formation may be used for narrowing age estimation in fragmentary remains of juveniles in a skeletal collection of unknown age or in a forensic or clinical context. Copyright © 2005 John Wiley & Sons, Ltd. [source]

Quantifying temporal bone morphology of great apes and humans: an approach using geometric morphometrics

JOURNAL OF ANATOMY, Issue 6 2002
Charles A. Lockwood
Abstract The hominid temporal bone offers a complex array of morphology that is linked to several different functional systems. Its frequent preservation in the fossil record gives the temporal bone added significance in the study of human evolution, but its morphology has proven difficult to quantify. In this study we use techniques of 3D geometric morphometrics to quantify differences among humans and great apes and discuss the results in a phylogenetic context. Twenty-three landmarks on the ectocranial surface of the temporal bone provide a high level of anatomical detail. Generalized Procrustes analysis (GPA) is used to register (adjust for position, orientation and scale) landmark data from 405 adults representing Homo, Pan, Gorilla and Pongo. Principal components analysis of residuals from the GPA shows that the major source of variation is between humans and apes. Human characteristics such as a coronally orientated petrous axis, a deep mandibular fossa, a projecting mastoid process, and reduced lateral extension of the tympanic element strongly impact the analysis. In phenetic cluster analyses, gorillas and orangutans group together with respect to chimpanzees, and all apes group together with respect to humans. Thus, the analysis contradicts depictions of African apes as a single morphotype. Gorillas and orangutans lack the extensive preglenoid surface of chimpanzees, and their mastoid processes are less medially inflected. These and other characters shared by gorillas and orangutans are probably primitive for the African hominid clade. [source]

Computed Tomography of Temporal Bone Fractures and Temporal Region Anatomy in Horses

JOURNAL OF VETERINARY INTERNAL MEDICINE, Issue 2 2010
S. Pownder
Background: In people, specific classifications of temporal bone fractures are associated with clinical signs and prognosis. In horses, similar classifications have not been evaluated and might be useful establishing prognosis or understanding pathogenesis of certain types of trauma. Hypothesis/Objectives: We hypothesized associations between temporal bone fracture location and orientation in horses detected during computed tomography (CT) and frequency of facial nerve (CN7) deficit, vestibulocochlear nerve (CN8) deficit, or temporohyoid osteoarthropathy (THO). Complex temporal region anatomy may confound fracture identification, and consequently a description of normal anatomy was included. Animals: All horses undergoing temporal region CT at our hospital between July 1998 and May 2008. Methods: Data were collected retrospectively, examiners were blinded, and relationships were investigated among temporal bone fractures, ipsilateral THO, ipsilateral CN7, or ipsilateral CN8 deficits by Chi-square or Fischer's exact tests. Seventy-nine horses had CT examinations of the temporal region (158 temporal bones). Results: Sixteen temporal bone fractures were detected in 14 horses. Cranial nerve deficits were seen with fractures in all parts of the temporal bone (petrosal, squamous, and temporal) and, temporal bone fractures were associated with CN7 and CN8 deficits and THO. No investigated fracture classification scheme, however, was associated with specific cranial nerve deficits. Conclusions and Clinical Importance: Without knowledge of the regional anatomy, normal structures may be mistaken for a temporal bone fracture or vice versa. Although no fracture classification scheme was associated with the assessed clinical signs, simple descriptive terminology (location and orientation) is recommended for reporting and facilitating future comparisons. [source]

Secretory meningioma of the middle ear: A light microscopic, immunohistochemical and ultrastructural study of one case

NEUROPATHOLOGY, Issue 1 2008
Giovanna Cenacchi
A 66-year-old woman was referred with left hearing loss. A probable diagnosis of left secretory otitis media with effusion was formulated. A left myringotomy was performed to remove hyperplastic hard tissue from the tympanic cavity. A high resolution CT scan of the temporal bone disclosed a soft-tissue mass completely involving the mastoid and tympanic cavity, surrounding the ossicular chain which appeared spared with no signs of infiltration. The histopathologic, immunohistochemical and ultrastructural response was secretory meningioma, a rare variant of conventional meningothelial meningioma in atypical sites. [source]

Chordoid meningioma: Rare variant of meningioma

NEUROPATHOLOGY, Issue 3 2004
Özlem Özen
Chordoid meningioma is a rare variant of meningioma that bears a striking histological resemblance to chordoma and has greater likelihood of recurrence. Although most meningiomas occur in the intracranial, orbital and intravertebral cavities, rare meningiomas have been reported in extracranial organs; thus, it is important to be able to distinguish them from other neoplasms that have similar histology but different biological behavior and therapies. A case of chordoid meningioma in a 48-year-old woman who did not have Castleman's syndrome is described in the present report. The patient presented with a mass in her left frontoparietal region, and had been suffering from headaches for many years. Magnetic resonance imaging of the brain demonstrated an expansive lytic lesion in the squamous portion of the left temporal bone. The lesion extended in both directions. Histological examination of the surgical specimen revealed a tumor composed of cords and nests of eosinophilic vacuolated cells embedded in a myxoid matrix. A typical meningiomatous pattern was observed focally, and positive staining of the tumor cells for vimentin and epithelial membrane antigen confirmed the diagnosis of chordoid meningioma. [source]

Which cranial regions reflect molecular distances reliably in humans?

AMERICAN JOURNAL OF HUMAN BIOLOGY, Issue 1 2009
Evidence from three-dimensional morphology
Knowledge of the degree to which various subsets of morphological data reflect molecular relationships is crucial for studies attempting to estimate genetic relationships from patterns of morphological variation. This study assessed the phylogenetic utility of six different human cranial regions, plus the entire cranium. Three-dimensional landmark data were collected for 83 landmarks from samples of skulls from 14 modern human populations. The data were subsequently divided into anatomical regions: basicranium, upper face, mandible, temporal bone, upper jaw, cranial vault, and a subset of points from around the entire cranium. Depictions of population molecular distances were calculated using published data on microsatellites for the same or closely related populations. Distances based on morphological variation of each of the anatomical regions were compared with molecular distances, and the correlations assessed. The morphology of the basicranium, temporal bone, upper face, and entire cranium demonstrated the highest correlations with molecular distances. The morphology of the mandible, upper jaw, and cranial vault, as measured here, were not significantly correlated with molecular distances. As the three-dimensional morphology of the temporal bone, upper face, basicranium, and entire cranium appear to consistently reflect genetic relationships in humans, especially with more reliability than the cranial vault, it would be preferable to focus on these regions when attempting to determine the genetic relationships of human specimens with no molecular data. Am. J.Hum. Biol., 2009. © 2008 Wiley-Liss, Inc. [source]

Differential diagnosis of mastoid hypocellularity in human skeletal remains

AMERICAN JOURNAL OF PHYSICAL ANTHROPOLOGY, Issue 3 2009
Stefan Flohr
Abstract Mastoid hypocellularity is frequently used as an indicator of chronic otits media in paleopathological investigations. The condition can be caused by a poor development of air cells during infancy and early childhood (primary hypocellularity) or by obliteration of air cells with bone during later life (secondary hypocellularity). We performed a macroscopic, radiographic, and microscopic study of pneumatization patterns in 151 mastoid processes of individuals from an early-medieval cemetery in Germany, with emphasis on the architecture of the nonpneumatized portion of hypocellular mastoid processes. Two types of primary mastoid hypocellularity were distinguished. The first was characterized by a poorly defined boundary between the pneumatized portion and the nonpneumatized portion and a trabecular thickening in the spongy bone of the latter. The second showed a well-defined boundary between the pneumatized portion and the nonpneumatized portion and normal spongy bone architecture in the latter. The key feature for the diagnosis of secondary hypocellularity was the recognition of the walls of former air cells. Our observations closely match the histopathological findings by Wittmaack (Wittmaack: Über die normale und die pathologische Pneumatisation des Schläfenbeins. Jena: Gustav Fischer [1918]), who developed a concept of the normal pneumatization process of the temporal bone and the pathogenesis of aberrant pneumatization. We agree with Wittmaack's view that two types of primary mastoid hypocellularity can be distinguished morphologically. Regarding the pathogenesis of these types, we, however, conclude that Wittmaack's concept needs to be revised and updated. Further studies are required to establish the relationship between morphological findings in cases of mastoid hypocellularity and the health status of individuals. Am J Phys Anthropol, 2009. © 2009 Wiley-Liss, Inc. [source]

Congruence of individual cranial bone morphology and neutral molecular affinity patterns in modern humans

AMERICAN JOURNAL OF PHYSICAL ANTHROPOLOGY, Issue 2 2009
Noreen von Cramon-Taubadel
Abstract Recent studies have demonstrated that the shape of the human temporal bone is particularly strongly correlated with neutral genetic expectation, when compared against other cranial regions, such as the vault, face, and basicranium. In turn, this has led to suggestions that the temporal bone is particularly reliable in analyses of primate phylogeny and human population history. While several reasons have been suggested to explain the temporal bone's strong fit with neutral expectation, the temporal bone has never systematically been compared against other individual cranial bones defined using the same biological criteria. Therefore, it is currently unknown whether the shapes of all cranial bones possess reliable information regarding neutral genetic evolution, or whether the temporal bone is unique in this respect. This study tests the hypothesis that the human temporal bone is more congruent with neutral expectation than six other individual cranial bones by correlating population affinity matrices generated using neutral genetic and 3D craniometric data. The results demonstrate that while the temporal bone shows the absolute strongest correlation with neutral genetic data compared with all other bones, it is not statistically differentiated from the sphenoid, frontal, and parietal bones in this regard. Potential reasons for the temporal bone's consistently strong fit with neutral expectation, such as its overall anatomical complexity and/or its contribution to the architecture of the basicranium, are examined. The results suggest that future phylogenetic and taxonomic studies would benefit from considering the shape of the entire cranium minus those regions that deviate most from neutrality. Am J Phys Anthropol, 2009. © 2009 Wiley-Liss, Inc. [source]

The petrous bone,A new sampling site for identifying early dietary patterns in stable isotopic studies

AMERICAN JOURNAL OF PHYSICAL ANTHROPOLOGY, Issue 2 2009
Marie Louise S. Jørkov
Abstract Intraskeletal variation in the composition of carbon (,13C) and nitrogen (,15N) stable isotopes measured in collagen is tested from various human bones and dentine. Samples were taken from the femur, rib, and petrous part of the temporal bone from well-preserved skeletons of both adults (n = 34) and subadults (n = 24). Additional samples of dentine from the root of 1st molars were taken from 16 individuals. The skeletal material is from a medieval cemetery (AD 1200,1573) in Holbæk, Denmark. Our results indicate that the petrous bone has an isotopic signal that differs significantly from that of femur and rib within the single skeleton (P < 0.001 and P < 0.001, respectively), with only minor variation seen between femur and rib. On the other hand, there was no significant difference between the petrous bone and the 1st molar. The intraskeletal variation may reflect differences in turnover rate among skeletal elements. The inner periosteal layer of the petrous bone is formed in uterus and does not undergo any further remodelling after the age of 2 years, whereas the rib and femur have a continuous turnover rate of ,5 and 10,20 years, respectively. From the results of this study it is believed the petrous bone may be a new useful bone element and a supplement or a proxy for teeth in the analysis of early dietary patterns as it may reflect diet in fetal stages and early years of life. Am J Phys Anthropol 2009. © 2008 Wiley-Liss, Inc. [source]

Human cranial anatomy and the differential preservation of population history and climate signatures

THE ANATOMICAL RECORD : ADVANCES IN INTEGRATIVE ANATOMY AND EVOLUTIONARY BIOLOGY, Issue 12 2006
Katerina Harvati
Abstract Cranial morphology is widely used to reconstruct evolutionary relationships, but its reliability in reflecting phylogeny and population history has been questioned. Some cranial regions, particularly the face and neurocranium, are believed to be influenced by the environment and prone to convergence. Others, such as the temporal bone, are thought to reflect more accurately phylogenetic relationships. Direct testing of these hypotheses was not possible until the advent of large genetic data sets. The few relevant studies in human populations have had intriguing but possibly conflicting results, probably partly due to methodological differences and to the small numbers of populations used. Here we use three-dimensional (3D) geometric morphometrics methods to test explicitly the ability of cranial shape, size, and relative position/orientation of cranial regions to track population history and climate. Morphological distances among 13 recent human populations were calculated from four 3D landmark data sets, respectively reflecting facial, neurocranial, and temporal bone shape; shape and relative position; overall cranial shape; and centroid sizes. These distances were compared to neutral genetic and climatic distances among the same, or closely matched, populations. Results indicate that neurocranial and temporal bone shape track neutral genetic distances, while facial shape reflects climate; centroid size shows a weak association with climatic variables; and relative position/orientation of cranial regions does not appear correlated with any of these factors. Because different cranial regions preserve population history and climate signatures differentially, caution is suggested when using cranial anatomy for phylogenetic reconstruction. Anat Rec Part A, 2006. © 2006 Wiley-Liss, Inc. [source]

Inheritance of sutural pattern at the pterion in rhesus monkey skulls

THE ANATOMICAL RECORD : ADVANCES IN INTEGRATIVE ANATOMY AND EVOLUTIONARY BIOLOGY, Issue 10 2006
Qian Wang
Abstract Five of the bones that characteristically comprise the cranial vault articulate on the lateral aspect of the skull at or near the cephalometric landmark referred to as the pterion. The pattern of articulation in the sutures associated with these bones varies among and within primate species and has been used as a criterion for classification in taxonomic studies, as well as in archeological and forensic studies. Within species, the sutural patterns found within the region of the pterion have remarkable consistency, which lead to the hypothesis that these patterns have a genetic basis. Sutural pattern variations were investigated at the pterion in 422 skulls from 66 rhesus monkey families with known genealogies from the long-standing colony on Cayo Santiago. Four specific types of articulation patterns were recorded. The results demonstrated that the most common suture pattern at the pterion of Cayo Santiago rhesus monkeys (86%; similar to that seen in some other anthropoid species but not humans and some apes) was characterized by an articulation between the temporal bone and parietal bone. Articulation between the sphenoid and parietal bones (type SP) accounted for 14% of the specimens and was concentrated in a dozen families. Mothers with the SP phenotype had a high incidence of offspring with SP phenotypes. Most non-SP mothers having SP offspring had siblings or family members from previous generations with the SP type. This is the first study to examine variation in sutural patterns at the pterion in pedigrees. Variation of sutural patterns shows familial aggregation, suggesting that this variation is heritable. Future work will be focused on defining the inheritance patterns of variation at the pterion, with the ultimate objective of identifying the specific genes involved and their mechanism of action. Anat Rec Part A, 288A:1042,1049, 2006. © 2006 Wiley-Liss, Inc. [source]

Squamous cell carcinoma of the temporal bone,

THE LARYNGOSCOPE, Issue 6 2010
Paul W. Gidley MD
Abstract Objectives/Hypothesis: To study the survival outcomes of patients with squamous cell carcinoma (SCC) of the temporal bone. A secondary purpose was to evaluate the University of Pittsburgh staging system as a predictor of survival. Study Design: Retrospective review. Methods: We performed a single-institution retrospective review of the medical charts of patients diagnosed with SCC of the temporal bone between 1945 and 2005. We identified the patients' demographic characteristics, presenting symptoms, physical examination findings, tumor histology, disease extent, treatment course, and clinical outcomes. We used the Pittsburgh staging system (2000) to determine the patients' tumor classification and disease state. We then compared the overall and disease-free survival rates between patients with early-stage versus late-stage disease. Results: We identified 124 patients with SCC of the temporal bone. Of these, 71 had incident (untreated) SCC, 26 had recurrent SCC, and 27 had persistent SCC after treatment elsewhere. The 5-year overall survival rate for patients with incident SCC was 38%, and the disease-free survival rate was 60%. The overall survival rate for patients with incident SCC was similar to that for patients with persistent disease and was significantly better than that for patients with recurrent SCC (P = .008). Patients with early-stage tumors (T1 or T2) had longer overall survival than those with late-stage tumors (T3 or T4; P = .004, log-rank). The 5-year overall survival rate was 48% for patients with early-stage disease and 28% for patients with late-stage disease. Furthermore, patients with T1 tumors had significantly longer overall survival than patients with T2 tumors (P = .039) and patients with T3 and T4 tumors (P = .0008). Overall survival (OS) and disease-free interval (DFI) were improved for T2 tumors when radiotherapy was combined with surgery (OS, P = .011; DFI, P = .02). T1 tumors did not benefit in a statistically significant way with combined therapy. T3 and T4 tumors had relatively poor outcomes in spite of combined therapy. Twenty-two patients (31%) experienced a recurrence within 1 year of treatment, whereas only one patient developed recurrence after 1 year. Lymph node metastasis, facial paralysis, or involvement of the carotid artery, jugular foramen, or infratemporal fossa were not significantly associated with overall or disease-free survival. Conclusions: Patients with recurrent SCC of the temporal bone had significantly shorter overall survival and disease-free interval than patients with incident SCC. In addition, patients with early-stage disease (T1 and T2) had significantly longer overall survival and disease-free survival than patients with late-stage tumors. Laryngoscope, 2010 [source]

Gorham-Stout disease of the temporal bone,

THE LARYNGOSCOPE, Issue 3 2010
Sarah Mowry MD
Abstract Gorham-Stout (GS) disease is a rare disease of the bone and is also known as massive osteolysis. Less than 200 cases have been reported in the world literature. A 29-year-old female with a diagnosis of GS disease was identified. She complained of aural fullness and tinnitus bilaterally. Demineralization and moth-eaten changes of the osseous structures of the skull base and posterior fossa were prominent. The left mastoid air cells were opacified and erosion extended to the left jugular foramen, left hypoglossal canal, left stylomastoid process, and left eustachian tube. The radiographic findings and brief literature review are presented. Laryngoscope, 2010 [source]

Comparison of extratemporal and intratemporal facial nerve injury models,

THE LARYNGOSCOPE, Issue 12 2009
Nijee Sharma BS
Abstract Objectives/Hypothesis: The purpose of this study was to compare functional recovery and motor nerve conduction following a distal extratemporal crush injury of the facial nerve to a more proximal intratemporal crush injury. Study Design: Prospective, controlled animal study. Methods: Adult male Sprague-Dawley rats were divided into four experimental groups: 1) extratemporal crush, 2) extratemporal sham-operated, 3) intratemporal crush, and 4) intratemporal sham-operated. Each group had an n of 4,9. The facial nerve was crushed near its exit from the stylomastoid foramen for extratemporal facial nerve injuries and within the facial canal in the temporal bone for intratemporal facial nerve injuries. Recovery times for the return of facial nerve functional parameters were compared between the two injury models. Motor nerve conduction studies were also done weekly to quantify the changes in peak amplitude and latency of evoked response. Results: Rats receiving the extratemporal facial nerve injury recovered full facial function by ,2 weeks postoperative (wpo) and displayed normal peak amplitude and latency recordings by 4 wpo. In comparison, rats receiving the intratemporal facial nerve injury failed to reach complete functional recovery at the end of 8 wpo. Although latency of evoked response returned to normal by 2 weeks following the intratemporal injury, peak amplitude remained ,70% below normal at the end of 8 wpo. Conclusions: An intratemporal crush of the facial nerve leads to significantly delayed functional recovery and decreased motor nerve conduction as compared to an extratemporal crush, indicating that the location of injury strongly influences the recovery outcome. Laryngoscope, 2009 [source]

Secondary Apoptosis of Spiral Ganglion Cells Induced by Aminoglycoside: Fas,Fas Ligand Signaling Pathway,

THE LARYNGOSCOPE, Issue 9 2008
Woo Yong Bae MD
Abstract Objectives/Hypothesis: Hair cell loss results in the secondary loss of spiral ganglion neurons (SGNs), over a period of several weeks. The death of the SGNs themselves results from apoptosis. Previous studies have shown that several molecules are involved in the apoptosis of SGNs that occurred secondary to hair cell loss. However, the precise mechanism of apoptosis of the SGNs remains unclear. The aim of this study was to ascertain the secondary apoptosis of spiral ganglion cells induced by aminoglycoside and to investigate the role of the Fas,FasL signaling pathway using guinea pigs as an experimental animal model. Study Design: Laboratory study using experimental animals. Methods: Guinea pigs weighing 250 to 300 g (n = 21) from 3 to 4 weeks of age were used. Gentamicin (60 ,L) was injected through a cochleostomy site on their left side. At 1 (n = 7), 2 (n = 7), and 3 (n = 7) weeks after gentamicin treatment, their cochleas were obtained from their temporal bone. Hematoxylin and eosin and terminal deoxynucleotidyl transferase-mediated dUTP-biotin nick-end labeling staining were performed to observe apoptosis. To investigate the involvement of the Fas,FasL signaling pathway in the secondary apoptosis of SGNs, we performed reverse transcription-polymerase chain reaction (RT-PCR), western blotting, and immunohistochemistry. Results: A progressive loss of spiral ganglion cells with increasing time after gentamicin treatment was observed on light microscopic examination. Terminal deoxynucleotidyl transferase-mediated dUTP-biotin nick-end labeling staining demonstrated induction of apoptotic cell death in SGNs after gentamicin treatment. Expression of FasL increased over time after gentamicin treatment as determined by RT-PCR and western blotting. On immunohistochemical staining, we observed the localization of FasL in the SGNs. The proapoptotic molecules Bax and Bad were increased, but levels of the antiapoptotic molecule Bcl-2 were decreased at increasing survival times after gentamicin treatment on RT-PCR. The gentamicin-treated group displayed initial activation of caspase-8 and increased the cleavage of caspase-3, caspase-8, and PARP protein in a time-dependent manner. Conclusions: The secondary apoptosis of SGNs could be a result of the apoptotic Fas,FasL signaling pathway. Blocking the Fas,FasL signaling pathway could be considered as a method for preventing secondary degeneration of SGNs, and further studies are needed to confirm this. [source]

Hearing Levels in Patients With Microtia: Correlation With Temporal Bone Malformation

THE LARYNGOSCOPE, Issue 3 2007
Shin-ichi Ishimoto MD
Abstract Objective: To evaluate the relationship between hearing level and temporal bone abnormalities in patients with microtia. Study Design: Retrospective case series study between 1992 and 2004. Setting: Academic, tertiary care referral medical center. Patients: We evaluated 115 ears of 89 patients (68 males, 21 females; mean age, 11 yr; range, 5-44 yr) with microtia. Main Outcome Measures: Hearing level was examined in patients with microtia. Developmental abnormalities of the temporal bone were evaluated by Jahrsdoerfer's computed tomography (CT) scoring system using high-resolution CT (HRCT) scans of the temporal bone. Temporal bone malformation scores were divided into four subgroups: ossicular development, windows connected to the cochlea, aeration of the middle ear cavity, and facial nerve aberration. Patients were divided into the stenosis and atresia groups on the basis of the appearance of the external auditory canal (EAC). We also evaluated the relationships between hearing level and four subtotal scores of the HRCT findings in the stenosis and atresia groups. Results: There was no relationship between hearing level and total points of HRCT scoring system or between hearing level and severity of microtia scored by Marx classification. With regard to subtotal points related to ossicles (4 points), the hearing level in ears with low scores (<2) (64.7 ± 1.6 dB) was significantly different (P = .03) from that in ears with high scores (,2) (54.0 ± 2.8 dB) in the stenosis group. In the atresia group, the hearing level was 64.3 ± 2.2 dB in ears with low scores and 62.3 ± 1.1 in ears with high scores (P > .5). As for subtotal points related to the windows connected to cochlea (2 points), the hearing level was 64.8 ± 2.6 dB in ears with low scores (0) and 55.9 ± 2.4 dB in ears with high scores (> = 1) in the stenosis group. In the atresia group, the hearing level was 67.7 ± 2.3 dB in ears with low scores and 61.5 ± 1.0 in ears with high scores. There was significant difference between ears with low and high scores in the stenosis group (P = .03) and atresia group (P = .009). There was no significant difference between ears with low and high scores with respect to the subtotal points related to aeration of the middle ear cavity and aberration of the facial nerve. Conclusion: The hearing level in microtic ears correlated with the formation of oval/round windows and ossicular development but not with the degree of middle ear aeration, facial nerve aberration, or severity of microtia. The hearing level can also serve as an indictor, such as the HRCT findings, to determine whether a subject's hearing will likely improve after reconstructive surgery. [source]

Using a Virtual Reality Temporal Bone Simulator to Assess Otolaryngology Trainees,

THE LARYNGOSCOPE, Issue 2 2007
Molly Zirkle MD
Abstract Objective: The objective of this study is to determine the feasibility of computerized evaluation of resident performance using hand motion analysis on a virtual reality temporal bone (VR TB) simulator. We hypothesized that both computerized analysis and expert ratings would discriminate the performance of novices from experienced trainees. We also hypothesized that performance on the virtual reality temporal bone simulator (VR TB) would differentiate based on previous drilling experience. Study Design: The authors conducted a randomized, blind assessment study. Methods: Nineteen volunteers from the Otolaryngology,Head and Neck Surgery training program at the University of Toronto drilled both a cadaveric TB and a simulated VR TB. Expert reviewers were asked to assess operative readiness of the trainee based on a blind video review of their performance. Computerized hand motion analysis of each participant's performance was conducted. Results: Expert raters were able to discriminate novices from experienced trainees (P < .05) on cadaveric temporal bones, and there was a trend toward discrimination on VR TB performance. Hand motion analysis showed that experienced trainees had better movement economy than novices (P < .05) on the VR TB. Conclusion: Performance, as measured by hand motion analysis on the VR TB simulator, reflects trainees' previous drilling experience. This study suggests that otolaryngology trainees could accomplish initial temporal bone training on a VR TB simulator, which can provide feedback to the trainee, and may reduce the need for constant faculty supervision and evaluation. [source]

Effect of Inhibitor of Tumor Necrosis Factor-, and Oxatomide on Immune Mediated Otitis Media

THE LARYNGOSCOPE, Issue 9 2006
Yong-Soo Park MD
Abstract Objective: Inflammatory mediators (IMs) play a major role in the production of middle ear effusion (MEE). Tumor necrosis factor (TNF)-, and leukotrienes (LTs) appear to be important in the pathogenesis of otitis media with effusion (OME). The purpose of this study is to determine the effect of TNF-, and LT antagonist on the outcome of experimental immune-mediated OME. Study Design: Prospective. Methods: Otitis media was induced in rats by injecting keyhole limpet hemocyanin (KLH) transtympanically 7 days after systemic immunization. Experimental groups were treated with soluble TNF receptor type I (sTNF RI) or oxatomide simultaneously. Seventy-two hours after transtympanic injection, MEE was aspirated, and temporal bone was taken. Vascular permeability (VP) of the middle ear mucosa was measured using the Evans blue dye technique. Hematoxylin-eosin stain and immunohistochemical stain for leukocyte common antigen was performed. Results: In KLH, sTNF RI, and oxatomide groups, MEE was developed in 83%, 0%, and 66% of the ears, respectively. The sTNF RI group showed significant decrease in effusion production, inflammation, mucosal thickening, and VP compared with the KLH group. These parameters were less significant in the oxatomide group than in the sTNF RI group. Conclusion: Transtympanic administration of sTNF RI and oxatomide appears to suppress the development of immune-mediated MEE. [source]

Two Temporal Bone Computed Tomography Measurements Increase Recognition of Malformations and Predict Sensorineural Hearing Loss,

Clinical Manifestations of Superior Semicircular Canal Dehiscence,

THE LARYNGOSCOPE, Issue 10 2005
Lloyd B. Minor MD
Abstract Objectives/Hypotheses: To determine the symptoms, signs, and findings on diagnostic tests in patients with clinical manifestations of superior canal dehiscence. To investigate hypotheses about the effects of superior canal dehiscence. To analyze the outcomes in patients who underwent surgical repair of the dehiscence. Study Design: Review and analysis of clinical data obtained as a part of the diagnosis and treatment of patients with superior canal dehiscence at a tertiary care referral center. Methods: Clinical manifestations of superior semicircular canal dehiscence were studied in patients identified with this abnormality over the time period of May 1995 to July 2004. Criteria for inclusion in this series were identification of the dehiscence of bone overlying the superior canal confirmed with a high-resolution temporal bone computed tomography and the presence of at least one sign on physiologic testing indicative of superior canal dehiscence. There were 65 patients who qualified for inclusion in this study on the basis of these criteria. Vestibular manifestations were present in 60 and exclusively auditory manifestations without vestibular symptoms or signs were noted in 5 patients. Results: For the 60 patients with vestibular manifestations, symptoms induced by loud sounds were noted in 54 patients and pressure-induced symptoms (coughing, sneezing, straining) were present in 44. An air-bone on audiometry in these patients with vestibular manifestations measured (mean ± SD) 19 ± 14 dB at 250 Hz; 15 ± 11 dB at 500 Hz; 11 ± 9 dB at 1,000 Hz; and 4 ± 6 dB at 2,000 Hz. An air-bone gap 10 dB or greater was present in 70% of ears with superior canal dehiscence tested at 250 Hz, 68% at 500 Hz, 64% at 1,000 Hz, and 21% at 2,000 Hz. Similar audiometric findings were noted in the five patients with exclusively auditory manifestations of dehiscence. The threshold for eliciting vestibular-evoked myogenic potentials from affected ears was (mean ± SD) 81 ± 9 dB normal hearing level. The threshold for unaffected ears was 99 ± 7 dB, and the threshold for control ears was 98 ± 4 dB. The thresholds in the affected ear were significantly different from both the unaffected ear and normal control thresholds (P < .001 for both comparisons). There was no difference between thresholds in the unaffected ear and normal control (P = .2). There were 20 patients who were debilitated by their symptoms and underwent surgical repair of superior canal dehiscence through a middle cranial fossa approach. Canal plugging was performed in 9 and resurfacing of the canal without plugging of the lumen in 11 patients. Complete resolution of vestibular symptoms and signs was achieved in 8 of the 9 patients after canal plugging and in 7 of the 11 patients after resurfacing. Conclusions: Superior canal dehiscence causes vestibular and auditory symptoms and signs as a consequence of the third mobile window in the inner ear created by the dehiscence. Surgical repair of the dehiscence can achieve control of the symptoms and signs. Canal plugging achieves long-term control more often than does resurfacing. [source]

The Mechanism of Hearing Loss in Paget's Disease of Bone,

THE LARYNGOSCOPE, Issue 4 2004
Edwin M. Monsell MD
Abstract Objectives/Hypothesis The mechanism of hearing loss (HL) in Paget's disease of bone was investigated. The present study was a systematic, prospective, controlled set of clinical investigations to test the hypothesis that there is a general underlying mechanism of HL in Paget's disease of bone and to gain additional insights into the auditory and otologic dynamics of this disease. Specific questions were 1) whether the mechanism is cochlear or retrocochlear and 2) whether the bone mineral density of the cochlear capsule is related to hearing levels. Study Design Several double-blinded, cross-sectional, prospective, correlational studies were conducted in a population of elderly human subjects with skull involvement with Paget's disease versus a control population of elderly subjects free of Paget's disease. Demographic and clinical data were recorded. Longitudinal observations were made in subjects under treatment. Methods Subjects were recruited from a Paget's disease clinic. Pure-tone auditory thresholds, word recognition, and auditory brainstem responses (ABRs) were recorded. The dimensions of the internal auditory canals were measured using computed tomographic (CT) images and digital image analysis. The precision, accuracy, and temporal stability of methods to measure the bone mineral density of the cochlear capsule and an adjacent area of nonotic capsule bone were validated and applied. Correlations were sought between hearing levels and cochlear capsule bone mineral density. Results ABRs were recorded in 64 ears with radiographically confirmed Paget's disease involving the skull. Responses were absent in eight ears, all of which had elevated high pure-tone thresholds. ABRs were interpreted as normal in 56 ears; none were abnormal. The mid-length diameter and minimum diameter of the internal auditory canal of 68 temporal bones from subjects with Paget's disease were found to have no statistically significant relationship to hearing thresholds. The Pearson product-moment correlation coefficients (age- and sex-adjusted) in the group with Paget's disease involving the temporal bone were ,0.63 for left ears and ,0.73 for right ears for high-frequency air conduction pure-tone thresholds (mean of 1, 2, and 4 kHz) versus cochlear capsule density. Correlation coefficients (age- and sex-adjusted) between cochlear capsule density and air-bone gap (mean at 0.5 and 1 kHz) for the affected group were ,0.67 for left ears and ,0.63 for right ears. All correlations between hearing thresholds and cochlear capsule density in pagetic subjects were significant at P < .001. The regressions were consistent throughout the ranges of hearing level. There were no significant correlations between cochlear capsule mean density and hearing level in the volunteer subjects. Conclusions The evidence supports the existence of a general, underlying, cochlear mechanism of pagetic HL that is closely related to loss of bone mineral density in the cochlear capsule. This mechanism accounts well for both the high-frequency sensorineural HL and the air-bone gap. Early identification, radiographic diagnosis of temporal bone involvement, and vigorous treatment with third-generation bisphosponates are important to limit the development and progression of pagetic HL. [source]

Chondrosarcoma of the Skull Base

THE LARYNGOSCOPE, Issue 1 2002
Brian Neff MD
Abstract Objectives Sarcomas of the skull base are challenging, potentially lethal tumors. Prognosis is considered poor. The present report reviews treatment options and presents a case of treatment with en bloc resection of the temporal bone and adjacent skull base. Study Design Single case report and literature review. Results Extensive skull base resection for chondrosarcoma can be performed successfully and may be curative. Conclusion There is a role for en bloc resection of large areas of the skull base for treatment of chondrosarcoma. It appears that treatment combining surgery and radiation therapy is most likely to be effective. [source]