Bilateral Temporal Bone Research Articles

Primary eosinophilic granuloma presenting as bilateral otitis media and mastoiditis

Background: Simultaneous bilateral involvement of the temporal bones is a rare manifestation of eosinophilic granuloma, a disease characterized by solitary or multiple foci of osteolytic damage. Case Presentation: A young child initially presented with bilateral otitis media, with subsequent rapidly developing bilateral masses in the mastoid region. Computed tomography demonstrated extensive bony destruction which, after a course of vinblastine, methotrexate and prednisolone improved dramatically on follow-up scans. Conclusion: We present an unusual case of bilateral temporal bone destruction due to eosinophilic granuloma in a young child along with the literature review.

Effect of otitis media with effusion and its clinical intervention on the development of mastoid in children

Conclusion: Otitis media with effusion (OME) can affect the development of mastoid in children. For younger children (<12 years old), surgical intervention may promote the development of mastoid. It is highly recommended that patients with severe tympanic membrane retraction have tympanostomy tubes to improve the circulation in the middle ear as early as possible. Objective: To investigate the effect of OME and its clinical intervention on the development of mastoid in children. Methods: A total of 46 children with OME were divided into 2 groups according to their ages. In group 1, 26 cases (0–6 years old) were treated for approximately 2 months, while in group 2, 20 cases (7–15 years old) were treated for 10 months. The treatments included tympanic effusion incision or catheterization, and adenoidectomy and/or bilateral tonsillectomy. Before and 6 months after treatments, patients were examined by bilateral temporal bone CT scanning, pure-tone audiometry, and tympanometry. 3-D volumetric reconstruction was then performed to determine the morphological properties of each patient's mastoid. Results: After a 2-month comprehensive treatment, the volume of mastoid was close to that in normal children, indicating that it could return to normal level if the treatment was completed within 2 months. In group 2, the results suggested that if the treatment lasted more than 6 months, the development of mastoid would be stalled.

Cochlear Implantation Versus Auditory Brainstem Implantation in Bilateral Total Deafness After Head Trauma

To determine the effectiveness of cochlear implant (CI) in hearing restoration after temporal bone (TB) fractures and investigate the adequacy of auditory brainstem implant (ABI) indication for TB fractures. Retrospective clinical study; a systematic review of the literature in PubMed was also performed to identify all published cases of bilateral TB fractures or bilateral deafness after head trauma treated by means of CI or ABI. Quaternary otology and skull base surgery referral center. Eleven consecutive patients presented with bilateral severe-to-profound sensorineural hearing loss after head trauma. CI as primary intervention or following a previous treatment. CI performances were evaluated in the auditory-only condition in both closed-set and open-set formats. Fourteen CI were placed, 11 as primary treatment and 3 after ABI failure. At the last follow-up, all patients gained useful open-set speech perception. In secondary CI, all patients obtained better auditory results with the CI if compared with ABI. CI performance did not decrease with time in any case. Cochlear implantation after TB fractures has proved to have excellent audiometric results. The aim of the initial evaluation of a patient with bilateral anacoustic ears from head trauma should always be to rehabilitate their hearing with a CI. The incidence of labyrinthitis ossificans, negative electrophysiologic testing, the risk of postoperative meningitis or facial nerve stimulation should not be the determinant factors that favor ABI placement.

Maternal to fetal transmission of cervical carcinoma

Reported cases of metastases to the placenta are uncommon, and maternal transmission of tumor to the fetus is even more infrequent. However, vertical transmission of tumor can occur and should be considered as a potential etiology of malignancy in newborns and infants born to mothers with a history of cancer during gestation. Here, we present the imaging findings and clinical course of an unusual case of maternal cervical neuroendocrine carcinoma presenting as bilateral petrous temporal bone lesions in an infant.

A Case of Cochlear Implantation Targeting Preserved Cerebral Cortex in Severe Traumatic Brain Injury

Temporal bone fracture and blunt head trauma was once considered as contraindication for the surgery. Increasing numbers of successful cochlear implantation are being reported. However, the outcome of cochlear implantation in severe damaged brain is unclear. A multichannel cochlear implant was successfully implanted in a 33-year-old man who had both sensorineural deafness, left hemiplegia due to bilateral transverse temporal bone fractures and severe right brain damage after a traffic accident.

Bilateral Temporal Bone Fracture Resulting in Expedited Simultaneous Bilateral Cochlear Implantation

Temporal bone fractures following blunt force trauma can result in significant morbidity including complete hearing loss. We present the case of a 15 year-old male who suffered traumatic bilateral transverse temporal bone fractures through both cochleae, resulting in profound bilateral hearing loss. Having met criteria for cochlear implantation, he was successfully managed with expedited, simultaneous bilateral cochlear implantation preceded immediately by evoked auditory brainstem response testing. The auditory brainstem response demonstrated weak wave V activity with high-level stimulation, and placement of the cochlear implants albeit it challenging secondary to early ossification of the cochlea, was successfully performed 5 weeks post-trauma. This case underscores the importance or early diagnosis and expedited implantation following otic capsule fractures to optimize chances for meaningful hearing rehabilitation prior to ossification of inner ear structures.

Bilateral Temporal Bone Langerhans Cell Histiocytosis: Radiologic Pearls

Langerhans cell histiocytosis (LCH) is a rare histiocytic disorder with an unpredictable clinical course and highly varied clinical presentation ranging from single system to multisystem involvement. Although head and neck involvement is common in LCH, isolated bilateral temporal bone involvement is exceedingly rare. Furthermore, LCH is commonly misinterpreted as mastoiditis, otitis media and otitis externa, delaying diagnosis and appropriate therapeutic management. To improve detection and time to treatment, it is imperative to have LCH in the differential diagnosis for unusual presentations of the aforementioned infectious head and neck etiologies. Any lytic lesion of the temporal bone identified by radiology should raise suspicion for LCH. We hereby describe the radiologic findings of a case of bilateral temporal bone LCH, originally misdiagnosed as mastoiditis.

Width of the normal facial canal measured by high-resolution cone-beam computed tomography

Conclusions: In the facial canal, discrepancies between left and right side measurements at each point may be useful in the assessment and diagnosis of facial canal-related pathologies. Objectives: This study was performed to obtain accurate and high-resolution images of the normal facial canal and measure its widths on cross-sections of the canal at anatomically and clinically important sites using high-resolution cone-beam computed tomography (CBCT). Methods: CBCT volume data of bilateral temporal bones were obtained from 28 healthy adult volunteers. The widths of the bony facial canals were measured at the meatal foramen, the cochleariform process, the stapes, the pyramidal eminence, and the point of emergence of the chorda tympani in the vertical segment. Results: The widths of the facial canal at each point were similar bilaterally (r = 0.54–0.85, p < 0.01), but showed regional differences and site-specific variations. The narrowest of the five sites was the level of the meatal foramen (p < 0.05), as reported previously. The second narrowest site was the level of the stapes (p < 0.01) followed in order by the level of the cochleariform process, the pyramidal eminence, and the point of emergence of the chorda tympanis (p < 0.01).

Auditory Brainstem Implants: How Do They Work?

This review covers the design, structure, and function of auditory brainstem implants. Auditory brainstem implants (ABIs) are auditory prostheses initially designed to treat deafness in patients with neurofibromatosis type 2 (NF2). NF2 typically results in deafness due to disruption of the cochlear nerves. When the tumors are removed the auditory nerve is usually cut or nonfunctional anymore. In these cases, patients cannot benefit from peripheral devices such as cochlear implants (CI). Another cause of VIII nerve loss is bilateral temporal bone fracture. Worldwide, more than 500 persons have received an ABI after removal of the tumors that occur with NF2. More recently, some extensions of indications have been proposed to include subjects who would not benefit enough from a cochlear implant (i.e. cochlear ossification). The ABI is similar in design and function to a CI, except that the electrode is placed on the first auditory relay station in the brainstem, the cochlear nucleus (CN). The ABI electrode array is a small paddle that contains plate electrode contacts. The CN has not a single linear tonotopic organization from base to apex like the cochlea but different tonotopic subunits. The CN comprises multiple neuron types that are characterized by specific properties (morphology, regional distribution and cell-membrane characteristics), synaptic input and responses to acoustic stimuli. As the ABI electrode array is placed along the surface of the CN, each electrode likely activates a variety of neuron types, possibly with different characteristic frequencies. Patients undergoing ABI have variable benefit with regard to sound and speech comprehension. For the majority of patients, this improvement is essentially obtained by an augmentation of lip reading performances. Speech comprehension without lip-reading is not as good as with cochlear implants.

Pipeline embolization device and subsequent vessel sacrifice for treatment of a bleeding carotid pseudoaneurysm at the skull base: a case report

An attempt at parent vessel reconstruction with Pipeline embolization devices to treat a mycotic pseudoaneurysm of the internal carotid artery at the skull base is presented. A 50-year-old woman with...

Synchronous bilateral inverted papilloma of the temporal bone: Case report and review of the literature

Temporal bone inverted papilloma (IP) is an extremely rare tumor. Its etiology is unknown and represents a source of debate. Only 2 previous cases of bilateral temporal bone IP have been reported. A case report and review of the literature via PubMed database search are presented. A 52-year-old African-American man who initially underwent medial maxillectomy for right-sided nasal IP returned with bilateral temporal bone IP 7 months later without evidence of extension through the Eustachian tubes. Despite multiple resections and adjuvant radiation, the tumor transformed into squamous cell carcinoma and progressed to involve the intracranial dura, temporal lobe, and cervical dura. Multiple origins may exist for temporal IP: direct extension, iatrogenic seeding, or development from ectopic Schneiderian epithelium. Temporal bone IP appears to represent a much more aggressive tumor than its nasal counterpart, necessitating aggressive early surgical intervention to decrease recurrence and transformation risk.

Cochlear Implantation in Posttraumatic Bilateral Temporal Bone Fracture

Temporal bone (TB) fractures can cause loss of audiovestibular function. Four cases of profound hearing impairment following bilateral TB fracture are presented in this report. All patients received a cochlear implant. All 4 patients became regular users of their implants. None of the patients experienced facial nerve stimulation. Implant-aided audiometry demonstrated a hearing threshold of 28 dB HL. The performance in speech understanding was comparable to standard postlingual adult patients implanted. We believe that cochlear implantation in patients suffering from profound sensorineural hearing losses secondary to TB fractures can be an effective tool for rehabilitation.

A case report of bilateral temporal bone fractures associated with bilateral sixth and seventh nerve palsies

A case report of bilateral temporal bone fractures associated with bilateral sixth and seventh nerve palsies

Cochlear implantation following temporal bone fracture.

Patients with bilateral temporal bone fractures frequently suffer profound hearing loss. These patients may benefit from cochlear implantation. Displaced fracture lines and ossification of the cochlea might complicate insertion of the electrode array. In the present paper we present a case of a failed cochlear implantation due to ossification of the cochlea, followed by a successful one on the opposite side in a patient who sustained bilateral temporal bone fractures. Preoperative imaging may identify these factors, help guide the appropriate surgical approach and choose which side to implant. We aim to highlight the necessity of imaging and discuss the reliability of computed tomography (CT) scanning in predicting cochlear patency in cases of temporal bone fracture. Possible management options in the case of complex cochlear implantation are also described.

Bilateral Clinical Pathology of the Temporal Bone

Objectives/Hypothesis: The aim of this study is to indicate anatomic and immunologic peculiarities of the temporal bone which leave it vulnerable to traumatic, infectious and neoplastic insult. Study Design: Seven patients' cases are described in which the clinical pathology of the temporal bone was bilateral. The bilaterality of these cases serves to illustrate the anatomic points which are the focus of this study. Methods: This is a case series. Results: The seven paradigmatic cases are described and the relevant anatomy is explored. These are bilateral tuberculosis of the middle ear and mastoid, bilateral histiocytosis X, bilateral external canal amyloidosis, bilateral middle ear polyposis in Samter's triad, bilateral temporal bone fractures, bilateral middle cranial fossa encephaloceles, and bilateral congenital enlarged superior vestibular nerve canals. The thinness of the skull base, the many fluid-filled and tissue-filled canals which enter the temporal bone and the thinness of the tissues investing all the surfaces contribute to the temporal bone's vulnerability to trauma, infection and neoplasm. Conclusion: Cases of bilateral temporal bone pathology demonstrate the temporal bone's structural and immunologic weaknesses.

Histiocytosis X with Bilateral Temporal Bone Involvement

Histiocytosis X with Bilateral Temporal Bone Involvement

Cochlear Implantation in Patients With Bilateral Severe Sensorineural Hearing Loss After Major Blunt Head Trauma

To highlight issues that impact on cochlear implant candidacy and performance in individuals who have severe bilateral sensorineural hearing loss after major blunt head trauma. Retrospective case review. Tertiary level neurotology center. Twenty-five patients treated at our institution for severe hearing loss after blunt head trauma Assessment of cochlear implant candidacy criteria and postimplant outcomes in patients presenting with severe hearing loss after major blunt head trauma Cause of injury, pure tone audiology, open set speech perception (preimplant and postimplant), promontory stimulation, and imaging results. Of the 25 patients with severe hearing loss, 11 ultimately underwent cochlear implantation. Fall from a height was the most common cause of injury. Five patients experienced bilateral temporal bone fractures. Seventeen patients satisfied candidacy criteria for implantation. For those patients who did undergo cochlear implantation, the mean postimplant open set speech recognition score was 71. Issues related to cochlear implant candidacy and outcomes for implantation will be discussed. Severe hearing loss after major blunt head trauma presents a number of unique clinical challenges. A significant number of these patients are not suitable for cochlear implantation for a variety of reasons. Clinicians working in the area of cochlear implantation should be aware of the various problems that can impact on effective cochlear implantation in such patients.

A non-lethal bilateral temporal bone fracture in a 4 month old infant

Temporal bone fractures in the pediatric age group account for 6–22% of all temporal bone fractures cases. It is extremely rare in infants, and will usually result in a lethal outcome. Complications of temporal bone fractures include cerebro-spinal fluid leaks, ossicular disruption, hearing loss and acquired cholesteatomas. We present the case report of a 4 month old baby who survived a motor vehicle accident, but sustained bilateral temporal bone fractures, with ossicular disruption and dislocation, and cholesteatoma formation. A cerebro-spinal fluid leak and brain herniation were averted courtesy of the head of the incus tamponading the defect in the skull base. We also present a short review of the current management of temporal bone fractures and its complications in children.

Binaural cochlear implantation after bilateral temporal bone fractures

In this clinical note we discuss the indications, feasibility, and outcomes of binaural simultaneous cochlear implantation (CI) following bilateral transverse temporal bone (TB) fractures. A 41-year-old male, totally deaf after a bilateral TB fracture, underwent an audiological, electrophysiological, and imaging investigation in order to assess the integrity of the VIIIth cranial nerves. Five months later he received a simultaneous bilateral CI. Speech perception tests were conducted at different time points. A significant advantage by dichotic listening was observed since the beginning of the habilitation program. The patient achieved a 100% word and sentences recognition in quiet at 12 months. His listening skills in noisy conditions were improved by the use of two implants. A CI in TB fractures is feasible if the VIII nerve is intact and the cochlea is spared by the fracture rim. The early timing of the procedure probably contributed to its success by preventing cochlear fibrosis and ossification.SumarioEn esta nota clínica discutimos las indicaciones, la factibilidad, y los resultados de la implantación coclear (CI) bilateral simultánea posterior a fracturas transversas bilaterales del hueso temporal (TB). Un varón de 41 años de edad, totalmente sordo después de una fractura bilateral del TB, fue sometido a una investigación audiológica, electrofisiológica y por imágenes, para evaluar la integridad de ambos octavos nervios craneales. Cinco meses después, el sujeto recibido IC bilaterales simultáneos. Se realizaron pruebas de percepción de lenguaje en diferentes momentos. Se observó una ventaja significativa en la audición dicótica desde el inicio del programa de habilitación. El paciente logró un 100% de reconocimiento de palabras y frases en silencio a los 12 meses. Sus habilidades para escuchar mejoraron con el uso de dos implantes. Una IC en fracturas del TB es factible si el VIII par está intacto y la cóclea no está involucrada en el trazo de la fractura. La oportuna realización del procedimiento probablemente contribuyó al éxito al prevenir la fibrosis coclear y la osificación.

Midfacial distraction using a transfacial pinning technique for syndromic craniosynostosis with obstructive respiratory disorders

Syndromic craniosynostosis is known to be associated with various obstructive respiratory disorders including sleep apnoea. We performed early midfacial distraction using a transfacial pinning technique in five syndromic craniosynostotic patients with obstructive respiratory disorders. Here, we report good results, indications and usefulness of this procedure. The subjects were five young children aged 7 months to 2 years who had respiratory disorders since birth due to midface hypoplasia. All subjects underwent midfacial distraction to avoid tracheotomy. The method involved Le Fort III osteotomy followed by the use of our original transfacial pinning system. This system consisted of devices connecting (1) transfacial pins penetrating the bilateral zygomatic bones and (2) Kirschner wires, which were passed through plates fixed on the bilateral temporal bones. The maxilla was distracted anteriorly at least 20 mm. Distraction was evaluated by comparing the pre- and postoperative polysomnography (PSG) and cephalograms. All patients had markedly improved respiratory conditions after distraction, and a tracheotomy was avoided. Postoperative PSG and cephalograms also showed great improvements compared with preoperative findings. A transfacial pinning system was considered useful and can be the most suitable method for early midfacial distraction in syndromic craniosynostosis with obstructive respiratory disorders.