Mastoid Air Cell System Research Articles

Middle ear morphology and mastoid pneumatization: a computed tomography study.

Mastoid pneumatization is subject to numerous influencing factors including race, sex, and surrounding structures of the middle ear. This study aims to determine the mastoid air cell system (MACS) volume and its relationship with middle ear structures, and the influence of sex. A cross-sectional study was performed analyzing computed tomography (CT) scans in which MACS volume and the Estachian tube length (ETL) were visible. MACS volume, ETL, and width and height of the aditus ad antrum were obtained. A total of 100 CT were included with a mean age of 38.5 ± 15.3 years, of which 56 were women and 44 were men. The mean right and left MACS volume were 5.43 ± 3.15 cm³ and 5.54 ± 3.43 cm3 respectively , with a ETL of 24.55 ± 3.07 mm in right side and 24.24 ± 2.60 mm on left side. A aditus ad antrum width of 2.98 ± 0.65 in right and 2.98 ± 0.58 on the left and height of 4.51 ± 1.05 and 4.32 ± 0.85, on right and left side respectively. There were statistical differences between sexes in left ETL, and in MACS volume bilaterally. A low positive correlation between aditus ad antrum height and MACS volume was identified. Mastoid pneumatization was bigger in men than women. There was a low positive correlation between mastoid volume and ETL on both sides, and a significant correlation between right mastoid volume and aditus ad antrum height. This could lead us to believe that the length of ETL does not affect the pneumatization of MACS.

Factors related to the surgical outcomes of type I tympanoplasty for tympanic membrane perforation in children

Background Factors related to surgical outcomes of type I tympanoplasty for tympanic membrane (TM) perforation in children are controversial. Objectives To investigate factors related to anatomical results of type I tympanoplasty for TM perforation 1 year after surgery. Material and methods We examined 68 ears. Anatomical results were determined based on the presence or absence of re-perforation, atelectasis, and otitis media with effusion. We retrospectively analyzed factors based on age (≤8 and >8 years), cause and size of TM perforation (<50% and ≥50%), history of asthma and cleft palate, and size of mastoid air cell system in bilateral ears before tympanoplasty. Audiological prognosis was evaluated in ears with anatomical success 1 year after surgery. Results Anatomical success was achieved in 80.9% (55/68) of the ears. No significant differences were observed between these factors and anatomical results. All children with cleft palate had anatomical success. Mean pure-tone average (0.5–4 kHz) was 16.25 dB HL for ears with both TM perforations <50% and ≥50%. Conclusion and significance We observed no significant relationship between factors considered and surgical outcomes. However, audiological prognosis was favorable for anatomical success regardless of TM perforation size. Accordingly, type I tympanoplasty is considered useful for TM perforation in children.

Sex Estimation From Measurements of the Mastoid Triangle and Volume of the Mastoid Air Cell System Using Classical and Machine Learning Methods: A Comparative Analysis.

Previous studies on the sexual dimorphism of the mastoid triangle have typically focused on linear and area measurements. No studies in the literature have used mastoid air cell system volume measurements for direct anthropological or forensic sex determination. The aims of this study were to investigate the applicability of mastoid air cell system volume measurements and mastoid triangle measurements separately and combined for sex estimation, and to determine the accuracy of sex estimation rates using machine learning algorithms and discriminant function analysis of these data. On 200 computed tomography images, the distances constituting the edges of the mastoid triangle were measured, and the area was calculated using these measurements. A region-growing algorithm was used to determine the volume of the mastoid air cell system. The univariate sex determination accuracy was calculated for all parameters. Stepwise discriminant function analysis was performed for sex estimation. Multiple machine learning methods have also been used. All measurements of the mastoid triangle and volumes of the mastoid air cell system were higher in males than in females. The accurate sex estimation rate was determined to be 79.5% using stepwise discriminant function analysis and 88.5% using machine learning methods.

Automated model for identification on mastoid of temporal bone image

Mastoiditis occurs due to inflammation that can affect the structure of the mastoid bone. The mastoid bone consists of the mastoid air cell system (MACS) which protects the ear structures and regulates air pressure in the ear and has different sizes and characteristics, making it very difficult to identify precisely. This study aims to identify and find the right MACS size by developing an automatic identification model and obtaining the optimal threshold value in the segmentation process using the extended adaptive threshold (eAT) method. The research dataset uses computed tomography (CT)-scan images of 308 slices of 12 patients indicated for mastoiditis. The results of this study provide identification that has the right MACS accuracy and size. Overall, the optimal segmentation process obtained the smallest threshold value of 57 and the largest threshold value of 63, the smallest MACS size is 4.025 cm2 and the largest is 8.816 cm2 with an accuracy rate of 93.4%. The smaller MACS size indicates inflammation in the mastoid area and these patients require more intensive treatment.

Synchronous bilateral idiopathic external auditory canal cholesteatoma: a case report and review of the literature

BackgroundExternal auditory canal cholesteatoma (EACC) is a rare pathological condition representing 0.1% of all new otologic cases. Bilaterality manifests in 10% of EACC cases. Similar disease processes include keratosis obturans (KO) and benign necrotizing otitis externa (BNOE). Diagnostic differentiation may not always be unexacting but does however influence management and eventual outcome. This study aims to briefly review the literature, describe an unusual case of synchronous bilateral primary EACC, and simplify the diagnostic challenges surrounding this disease.Case presentationA 66-year-old man with no relevant family history, no concurrent or intercurrent illnesses, having undergone no relevant surgery, and had visited the Department of Otorhinolaryngology regarding right-sided otorrhoea and aural pruritis 9 years ago. At the time, he was diagnosed clinically with KO. Nine years later after having defaulted follow-up, he presented again with the same symptoms. Oto-microscopy now revealed excavation of the posterior canal wall, keratinous desquamation, and an intact tympanic membrane. Oto-endoscopy demonstrated extension posteriorly into the mastoid segment of the temporal bone. Computed tomography evinced a soft tissue attenuating mass within the excavated sub-adjacent bone, with extension into the mastoid air cell system. The contralateral ear had a smaller epithelial defect of the canal floor with underlying tympanic plate erosion. A closed mastoidectomy with the reconstruction of the posterior canal wall was performed on the right ear. The left ear was managed conservatively with micro-suctioning and aural toilette. Six months post-surgery, however, the reconstructed posterior canal wall underwent necrotic breakdown. The contralateral lesion gradually progressed into a Naim et al. (2005) Stage III EACC.ConclusionThis case illustrates the diagnostic challenge presented by EACC and is unusual regarding its bilaterality. The importance of diagnostic differentiation, both in the management of this disease and in the prevention of its progression, is highlighted. The idea of oto-endoscopy as a routine clinical tool is introduced, and endoscopic images are compared to high-definition computed tomography scans of the affected temporal bones.

Automated Identification and Reconstruction of 3D Images on the Mastoid Air Cell System

The mastoid air cell system (MACS) protects the structures in the ear and regulates air pressure in the ear cavity. MACS segmentation is very difficult because of the many overlapping object characteristics in the temporal bone. This study aims to accurately identify and measure MACS areas from CT-scan images of mastoiditis patients. The data tested consisted of 128 CT images from 13 different patients. Images were taken using the Siemens SOMATOM Perspective CT Scanner model 10662260 axially. The extended Adaptive Threshold (eAT) method was developed to produce optimal threshold values for each test image. Furthermore, the eAT results are used to convert the test image into a binary image and then applied to the identification and extraction model automatically for reconstruction from 2D to 3D images. Smaller MACS sizes indicate inflammation of the mastoid bone and require intensive care. Thus, this research can be used to help doctors make the right decisions in carrying out further medical actions.

A case series of cholesteatoma spread in middle ear cleft

Background: This study aimed to describe the spread of cholesteatoma in middle ear cleft. Methods: The 20 patients diagnosed with chronic otitis media, squamosal type (cholesteatoma) who underwent mastoidectomy exploration were included in this study. The main emphasis was to find out the extent and spread of cholesteatoma into the middle ear cleft. Results: The result of the study showed 50% of cases spread to middle ear cavity (20% -meso tympanum, 15%-sinus tympani,15%-facial recess), 20% into the attic, 30% into adits, antrum and mastoid air cell system. Conclusions: All of our patients underwent mastoid exploratory surgery. In half of the cases, the cholesteatoma was restricted to middle ear cavity, while in remaining 50% it has extended to attic, aditus mastoid antrum and mastoid air cells. Disease clearance was effective with no post-operative complication or recurrence in first 50% cases. Other 50% of cases required extensive surgery for disease clearance.

A COMPARATIVE STUDY OF MICROSCOPIC TYMPANOPLASTY VERSUS ENDOSCOPIC TYMPANOPLASTY IN MANAGEMENT OF INACTIVE MUCOSAL VARIETY OF CHRONIC OTITIS MEDIA

Chronic Otitis Media (COM) is defined as the chronic inflammation of the middle ear cleft including the middle ear, mastoid air cell system and the eustachian tube in presence of a permanent abnormality of the pars tensa or flaccida, most likely as a result of earlier acute otitis media, negative middle ear pressure or otitis media with effusion. As COM is not necessarily a result of the gathering of pus, the classic term chronic suppurative otitis media (CSOM) is no longer advocated.

Association of Mastoid Pneumatization with Deviated Nasal Septum: A Clinicoradiological Study

Background: Deviated nasal septum (DNS) has been reported to jeopardizing the nasal aerodynamics. This in turn may affect the pressure dynamics in the nasopharynx and eventually affect the development and pneumatization of mastoid air cells. Few studies done previously have shown a positive correlation between nasal pathologies and mastoid pneumatization. Objectives: This study was undertaken to see for the possible association of mastoid cell pneumatization, with DNS. Materials and Methods: Limited high-resolution computed tomography temporal bone and computed tomography nose and paranasal sinuses were used to calculate the mastoid air cell volume and angle of septal deviation. The degree of septal deviation was graded into mild, moderate, and severe. The mastoid air cell system volume was calculated on the side of the convexity of the septal deviation and the other side. Results: It was found that there is a statistically significant difference in the mastoid volume on the affected side of the DNS vis a vis the unaffected side. Further, the degree of reduction of the volume was not a linear function of the degree of septal deviation. Conclusions: Septal deviation significantly reduces the mastoid air cell volume on the affected side Thus, early correction of pathological DNS in adults, irrespective of the etiology, is important, so as to avoid the chances of developing chronic ear pathologies in later life.

A Cadaveric Study of Anatomical and Radiological Correlation of Mastoid Air Cells System in Relation to its Morphology.

A cadaveric study to know the anatomical and radiological correlation between the mastoid air cell system in relation to its volume and morphology. This is a rare and one of its kind of cadaveric study on temporal bone in which comparison of pre dissection and post cortical mastoidectomy dissection on x-ray mastoid in relation to their dimensions. To study the anatomical and radiological correlation of mastoid air cell system in relation to its morphology using pre and post dissection x-ray measurements and dissection method. 30 adult cadaveric, temporal bone cortical mastoidectomy dissections were performed and X-ray mastoid with a pre and post mastoid dissection measurements using vernier caliper was done. Further 3-D analysis of volume of mastoid cavity compared with a post dissection digital radiographic measurements was carried out. On statistical analysis, mean surface area of MACS, shortest length between sigmoidsinus and posterior wall of EAC, also shortest distance between dural plate and mastoid tip, in pre and post dissection x-ray mastoid and in direct mastoid cavity measurements were not found to be significant. Mastoidectomy being the treatment of choice in day to day practise in many cases this study hopes to add up to the present understanding for the MACS dynamics and assesses the possible anatomical variations that can exist. This study helps us to find the approximate time required for surgery to perform cortical mastoidectomy.

Disease Extension In Active Chronic Otitis Media

Background: Active chronic otitis media present with multiple findings within the middle ear like, granulation tissue and cholesteatoma which has extension and origin from similar pathological conditions within the attic and mastoid air cell system. Objectives: to assess the operativel finding in middle ear cleft including the attic and air cells during mastoid exploration.Study design: Prospective studySetting: E.N.T department Kirkuk Azadi Teaching HospitalsPatient’s selection: 20 Ears; on whom decision of mastoid exploration was taken. Extensions of granulation tissue and cholesteatoma assessed.Results: 60% belonged to active mucosal COM with granulation tissue found in the mastoid cavity.40% belonged to active squamous COM with cholesteatoma and granulation tissue found in the mastoid air cell system.Aural polyp found with extensive mucosal disease, bone erosion and 50% associated with cholesteatoma.Conclusion : Active mucosal chronic oitis media was found more frequently during mastoid exploration in the selected ears for our study

Pneumatization Pattern and Status of the Mastoid Antrum in Chronic Otitis Media: A Review.

Chronic otitis media is generally more prevalent in individuals with a weakly pneumatized temporal bone, whereas acute otitis media has a propensity for pneumatized temporal bone. Antimicrobial drugs are thought to have influenced the incidence and progression of middle ear infections. The mastoid air cell system, a part of the middle ear cleft, has recently been recognized as a crucial factor in the genesis, behaviour, course, and outcome of middle ear inflammatory conditions. Epithelium infiltrates the growing bone and produces epithelium-lined air cell chambers, a process known as pneumatization.Conventional temporal bone radiography, i.e. X-ray mastoid, has not kept up with recent otology breakthroughs. Detailed visualization of the aural structures has advanced significantly with the introduction of high-resolution computed tomography (HRCT). HRCT has a clear edge in the assessment of the temporal bone, especially when thin-section, high-resolution methods are used, resulting in a more precise description of the pneumatization pattern and the anatomical extent of middle ear pathology.Our results of the review indicated that persistent inflammation of the middle ear in children inhibits pneumatization of the temporal bone. Due to its potential to exert a greater negative middle ear pressure, the middle ear volume is insufficient to generate a retraction pocket; thus, the size and state of the antrum is also a significant factor in the establishment of a COM-like retraction pocket in inactive squamosal disease. Numerous factors, including the number of patients, regional, genetic, ethnic and hereditary characteristics, as well as the cellularity of the mastoid, which is impacted by a multitude of factors, may account for the variable reports and inter-study variation in this regard.

A Unified Classification of Middle Ear and Petrous Bone Congenital Cholesteatomas.

Background:The aim of this study was to classify congenital cholesteatoma along an entire spectrum of involvement ranging from the middle ear to petrous apex.Methods: A total of 131 patients (85 adults and 46 children) underwent operations for congenital cholesteatoma over the duration of 27 years.Results: For most cases, middle ear mucosa was normal, the first ossicle eroded by the mass was the stapes, and the mastoid air cell system was well-pneumatized on intraoperative and radiographic views. Totally 34% of patients presented with facial nerve weakness and 45% of these cholesteatomas arose from the supralabyrinthine area (32.8%) and from the petrous apex (12.2%).Conclusion: In this unified classification system, the otologist sees congenital cholesteatoma as a continuum, with facial nerve involvement and anacusis as part of the picture. This system of congenital cholesteatoma accommodates the supralabyrinthine and petrous bone locations of the disease.

Development of Mastoid Air Cell System Extraction Method on Temporal CT-scan Image

Mastoiditis is disease that to infection of the mastoid bone cavity that affects the size of the air cell system of the temporal bone. Visually, the information temporal CT image mastoid bone has can assist medical experts in viewing the mastoid air cell system (MACS), but the fact that medical personnel are experiencing difficulties in determining the size MACS is due to the many different characteristics and objects overlap, so that in the measurement of the area, precise and accurate results have not been obtained. This study aims to separate the object of the MACS with the development of extraction. The proposed method uses Morphology and Regionprops operations. The dataset used in the testing process is 347 of 5 patients indicated for Mastoiditis. The results obtained can calculate the area of MACS for each test image. Based on image testing, the area of the smallest MACS in this study was 0.589 cm2 and the largest was 6.183 cm2. This, the smaller the size of the MACS indicates the severity of infection, so this study can help medical personnel make decisions and take appropriate treatment actions.&#x0D;

Temporal bone pneumatization: A scoping review on the growth and size of mastoid air cell system with age.

The interest in the mastoid air cell system arose from the association between temporal bone aeration and otitis media. Its size and growth have been considered when planning chronic and middle ear surgeries. The objective of this review was to explore the literature on the size of mastoid air cells with age, highlighting various growth rates reported and mapping out areas yet to be fully understood for further research. A three-step systematic search was conducted for available literature on the subject matter viz; Google Scholar, Medline, Cochrane Library, and PubMed. Eligibility criteria guided the study selection, and eligible studies were subjected to appraisal using screening and quantitative criteria of mixed-method appraisal tool. A data extraction form was developed to extract information from eligible studies. Nine studies met the eligibility criteria. 55.6% of the included studies were conducted among the east and south Asian population, 33.3% were conducted among Scandinavians, and 11.1% in South America. Age groupings varied among studies; 33.3% utilized 1-year age grouping, 33.3% utilized 5-year age grouping, 11.1% utilized 10-year age grouping. In reporting the size of mastoid air cells across age groupings, 66.7% utilized area, 22.2% utilized volume, while 11.1% utilized both area and volume. Findings from this review showed that the mastoid air cells’ size with respect to age differs among populations of different origins. The most common measurements were the area of air cells. The highest growth rate was reported up to 30 years. Findings also show the influence of sex on the size of mastoid air cells and growth rate with age, as females were reported to have larger air cells with rapid growth until puberty. However, the male mastoid air cell system continues a steady growth after puberty and becomes larger. Information still lacks in the volume of air cells in pediatric pneumatization.

Comorbidity of Anemia and Otitis Media in Skeletal Remains

Within the clinical literature some researchers have identified a correlation between otitis media (OM) and anemia. OM is an inflammation or infection of the middle ear. Researchers have hypothesized that iron deficiency (anemia) reduces immune response and results in an increase in OM risk. For this study the comorbidity of OM and anemia was evaluated in the Hamann‐Todd Human Osteological Collection (n=20) and the Robert J. Terry Anatomical Skeletal Collection (n=105). The mastoid air cell system (MACS) hypopnuematization and porotic hyperostosis (PH) were used as skeletal markers of OM and anemia, respectively. A chi‐square test of independence between MACS hypopneumatization and PH was significant (p&lt;0.013) (Table 1). These results lend some support to the limited clinical literature that reports anemia as a risk factor of OM, however, the relationship between anemia and OM is not discernable through skeletal remains. In addition, the results highlight the importance of comorbidities in skeletal analyses and anthropological researchers should aim to use a broad range of skeletal markers to answer questions about past populations.

Status of the mastoid antrum and the eustachian tube function in cases of chronic otitis media

Introduction: Chronic otitis media (COM) is now synonymous with chronic suppurative otitis media, which is not actively used since COM is seldom associated with “the collection of pus.” Acute suppuration of the ear which transcends 6 weeks is considered to be COM which suggests an abnormality of the ear drum. With a prevalence incidence of 1%, Eustachian tube (ET) dysfunction is among the most important factors in the development of COM. Recently, mastoid air cells have been acknowledged as an essential compounding factor for the pathogenesis of middle ear disease. Since ET, mastoid air cell system, and nasopharyngeal mass like adenoids can play a pivotal role in the causation and persistence of COM, the current study will be taken to observe the status of ET, mastoid air cells system, nasopharynx in general, and adenoids in particular in patients of COM. Aim: This study aims to study the status of the mastoid antrum on surgical exploration, the status of ET, and nasopharynx for adenoids in patients of large, subtotal perforation, and posterosuperior retraction pockets (PSRPs). Study Design: This study was an observational, cross-sectional study. Study Setting: All the patients with large, subtotal perforation, and PSRPs visiting the Outpatient Department and Inpatient Department of ENT in Acharya Vinoba Bhave Rural Hospital (AVBRH) between 2022 and 2023 will be studied. Methods: All the selected patients of large, subtotal perforation, and posterosuperior retraction pocket (PSRP) in the age bracket of 15–65 years and satisfying the inclusion criteria will be considered and accrued in this study. We plan to look at a sample size of 50 patients (50 ears). Diagnostic nasal video endoscopy to get insight into ET function, size, and grade of adenoids by grading system given by Cassano et al. and pure-tone audiometry by ALPS AD2000 to know the type and amount of hearing loss will be carried out. Status of the mastoid antrum, the extent of the disease, status of ossicles, and associated abnormalities of temporal bone along with any other incidental findings will be noted intraoperatively. Expected Results: The data will be tabulated, analyzed statistically, and will be discussed in the context of existing research. Conclusion: The purpose of the present study is to help the surgeon have a better insight into the status of the mastoid antrum, ET in cases of large and subtotal perforation, and PSRP and nasopharynx in general with significance to adenoids in patients of COM in rural area.

Prognostic factors of early-onset otitis media with effusion in children treated using tympanostomy

Background Predicting the prognosis of early-onset otitis media with effusion (OME) in children is difficult. Objectives To investigate the prognostic factors of OME in children undergoing tympanostomy at 1 year of age. Material and methods We examined 66 children (123 ears) followed up to 6 years of age. OME prognosis was determined by a history of re-tympanostomy at the last examination. We retrospectively analysed the prognostic factors based on the duration of first ventilation tube (VT) placed, history of otorrhea, asthma, adenoidectomy, and mastoid air cell system (MACS) size at 1 year before tympanostomy and at 3 years. Results While 25 ears underwent re-tympanostomy (group 1), 98 did not (group 2). The mean duration of VT placed was 21 months and 25, and the mean MACS size at 3 years was 314 mm2 and 441, respectively, in the corresponding groups. MACS size at 3 years was significantly smaller in group 1 than in group 2. The combination of MACS size at 3 years and duration of VT placed showed the best value of area under the curve. Conclusion and significance The most probable prognostic factor was the combination of the MACS size at 3 years and duration of VT placed.

Does underdeveloped mastoid air cell system increase the risk of pediatric acquired cholesteatoma?

Does underdeveloped mastoid air cell system increase the risk of pediatric acquired cholesteatoma?

Tragal perichondrium as graft material in tympanoplasty: our experience

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; It has been defined as a permanent abnormality of pars tensa or flaccida, as a result of acute otitis media, negative middle ear pressure or otitis media with effusion. It manifests clinically as ear discharge and decreased hearing and may lead to numerous changes in the tympanic membrane, middle ear cleft, and mastoid air cell system. It has been classified into two types: mucosal and squamosal types. Chronic otitis media (COM) is a very common condition in developing countries in both adult and paediatric age groups. This study has been conducted to determine the outcome and graft uptake of tragal perichondrium in type 1 tympanoplasty.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; The prospective analytical study was conducted department of otorhinolaryngology, School of Medical Sciences and Research, Greater Noida, Uttar Pradesh, India over a period of 12months from 01 January 2019 to 31 December 2019. 30 patients according to inclusion criterion underwent tympanolpasty using tragal perichondrium were included in study. The data obtained was analyzed using statistical package for the social sciences (SPSS), version 21.0. P value less than 0.05 was taken as statically significant. &lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; Preoperative mean hearing loss was 38.45±7.01 dB, mean air bone gap was 20.20±3.75 dB, and postoperative air bone gap was reduced to an average of 10.86±3.82 dB. 8.51 dB of hearing gain was achieved and an air bone gap réduction of 8.51 dB was observed.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; Our study concluded tragal perichondrium is a suitable graft material is n mucosal type of COM.&lt;/p&gt;