Petrous Bone Research Articles

Exclusive endoscopic transcanal approach to lateral skull base lesions: Institutional experience of 3 cases

IntroductionMajority of petrous bone and lateral skull base pathologies are benign in nature. The complex anatomy usually warrants an extensive approach with associated morbidity. Case summaryTwo cases of petrous bone cholesteatoma (1 congenital cholesteatoma with facial palsy and 1 acquired cholesteatoma) and a case of glomus tympanicum were treated with exclusive endoscopic transcanal approach. The cases of petrous cholesteatoma were addressed with trans-promontorial and infra-cochlear approaches. The mean operative time was approximately 140 min. No CSF otorrhoea was noticed in the post-operative period. The average period of hospital stay was 3.7 days. ConclusionIn the subset of cases with limited benign disease an endoscopic trans-canal approach is a better alternative to an external approach. It decreases operative time, blood loss, chance of meningitis, morbidity and hospital stay. The lack of depth perception is a major hurdle which can be come over by experience in endoscopic middle ear surgery. This approach can create direct access to cochlea/petrous apex/internal auditory canal (IAC)/Supra-geniculate ganglion region.

Internal Auditory Canal Variability: Anatomic Variation Affects Cisternal Facial Nerve Visualization.

The internal auditory canal (IAC) is an important landmark during surgery for lesions of the cerebellopontine angle. There is significant variability in the position and orientation of the IAC radiographically, and the authors have noted differences in surgical exposure depending on the individual anatomy of the IAC. To test the hypothesis that IAC position and orientation affects the surgical exposure of the IAC and facial nerve, especially when performing the translabyrinthine approach. The authors retrospectively reviewed magnetic resonance imaging studies of 50 randomly selected patients with pathologically confirmed vestibular schwannomas. Measurements, including the anterior (APD) and posterior (PPD) petrous distances, the anterior (APA) and posterior (PPA) petro-auditory angles, and the internal auditory angle (IAA), were obtained to quantify the position and orientation of the IAC within the petrous temporal bone. The results quantitatively demonstrate tremendous variability of the position and orientation of the IAC in the petrous temporal bone. The measurement ranges were APD 10.2 to 26.1 mm, PPD 15.1 to 37.2 mm, APA 104 to 157°, PPA 30 to 96°, and IAA -5 to 40°. IAC variability can have a substantial effect on the surgical exposure of the IAC and facial and vestibulocochlear nerves. Specifically, a horizontally oriented IAC with a small IAA may have significant impact on visualization of the facial nerve within its cisternal segment with the translabyrinthine approach. The retrosigmoid approach is less affected with IAC variability in position and angle.

Individual geographic mobility in a Viking-Age emporium-Burial practices and strontium isotope analyses of Ribe's earliest inhabitants.

Individual geographic mobility is a key social dynamic of early Viking-Age urbanization in Scandinavia. We present the first comprehensive geographic mobility study of Scandinavia’s earliest emporium, Ribe, which emerged around AD 700 in the North Sea region of Denmark. This article presents the results of strontium isotope analyses of 21 individuals buried at Ribe, combined with an in-depth study of the varied cultural affinities reflected by the burial practices. In order to investigate geographic mobility in early life/childhood, we sampled multiple teeth and/or petrous bone of individuals, which yielded a total of 43 strontium isotope analyses. Most individuals yielded strontium isotope values that fell within a relatively narrow range, between 87Sr/86Sr = 0.709 to 0.711. Only two individuals yielded values >87Sr/86Sr = 0.711. This suggests that most of these individuals had local origins but some had cultural affinities beyond present-day Denmark. Our results raise new questions concerning our understanding of the social and cultural dynamics behind the urbanization of Scandinavia.

Petrous apex pneumatisation in children: a radiological study.

This study aimed to investigate petrous apex pneumatisation in children, as an understanding of petrous apex pneumatisation is useful in the diagnosis and surgical management of middle-ear disease. Computed tomography head scans from 1700 patients aged 0-16 years were assessed. Petrous apex bone and air cell volumes were calculated to determine the degree of petrous apex pneumatisation. Scans were analysed for communicating tracts between the middle ear and petrous apex. Petrous apex pneumatisation was found in 21.0 per cent of patients. Positive relationships were found between age and petrous apex pneumatisation prevalence (rs = 0.990, p < 0.001), and between age and degree of petrous apex pneumatisation (rs = 0.319, p < 0.001). Petrous apex pneumatisation prevalence did not significantly differ by sex or ethnicity. Communicating tracts were identified in 84.3 per cent of patients with petrous apex pneumatisation, most commonly anterior to the otic capsule. In children, the prevalence and degree of petrous apex pneumatisation increases with age, but prevalence is not affected by sex or ethnicity.

Haemangioma of the temporal bone

IntroductionHaemangiomas of the temporal bone are rare tumours and haemangiomas involving the middle ear are even rarer. The exceptional nature of these lesions makes their management particularly complicated. Case reportThe authors report the case of a 16-year-old girl, who presented with an osteolytic lesion of the left petrous temporal bone that proved to be a haemangioma with extension to the middle ear, causing conductive hearing loss. DiscussionSurgical biopsy is essential to establish the diagnosis of haemangioma because imaging alone only rarely provides a definitive diagnosis. Surgery is the reference treatment to prevent recurrence. Arteriography is an essential part of the preoperative assessment in order to limit the risk of bleeding.

Gradenigo’s Syndrome a Rare Complication of Acute Otitis Media: Case Report and Literature Revue

Introduction: Gradenigo's syndrome is a rare complication of otitis media and mastoiditis involving the apex of the petrous temporal bone. This syndrome is characterized by a clinical triad of deep facial pain, sixth cranial nerve palsy, and acute otitis media (AOM).Case report: We report a case of a six-year-old girl, with no past medical history, who presented with a sudden diplopia following six days of headache and otorrhea. The diagnosis of gradenigo's syndrome was confirmed by clinical examination and imaging. She made a full recovery after 9 weeks of antibiotics.Discussion: Gradenigo's syndrome is a rare but life threatening complication of AOM.The inflammatory process starts in the middle ear, and spreads from the base to the top of the petrous portion of the temporal bone, producing several diagnostic symptoms.Careful clinical history and physical examination, including imaging, are necessary to make the diagnosis.Appropriate management requires antibiotic treatment and possible surgical intervention

Modified Translabyrinthine Approach for Massive Petrous Bone Cholesteatoma Removal and Cochlear Preservation Using Latent Spaces Anterior to the Cochlea

Microsurgery is the reference standard treatment of petrous bone cholesteatoma (PBC). In most cases, radical removal of an extensive PBC can only be achieved at the cost of sacrificing the cochlea. Such treatment will result in the impossibility of future cochlear implantation for hearing rehabilitation purposes. To address this issue, a modification of the traditional translabyrinthine (TL) approach with endoscopic assistance has been developed for radical removal of extensive PBC with preservation of the cochlea. From June 2017 to December 2017, 3 patients with a massive PBC underwent surgical removal using the modified TL approach by the senior author in our department. We reviewed the patient characteristics and retrospectively studied the surgical outcomes and postoperative complications. In the present report, we have described our modified TL approach in detail. Complete resection of the PBC and successful cochlea preservation were achieved in all 3 patients. No recurrence had developed during the follow-up period. However, various degrees of cochlear ossification were observed in 2 patients postoperatively. This modified TL approach provides the possibility of fully exposing the whole petrous apex without removing the cochlea in selected cases. However, the development of long-term cochlear ossification requires further investigation to allow for successful cochlear implantation.

A Puzzling Exam: Kernohan’s Notch Reimaged

•We provide a visual image of the consequeces of massive brainstem shift with oculomotor and peduncle injury.•Acute space occupying lesions may cause ipsilateral hemiparesis – and can be a false localizing sign. Conventional teaching on the neurologic examination suggests findings can be attributed to specific regions – which improves timely diagnosis and treatment, particularly in life threatening situations. Rarely, puzzling patient presentations can wrongly lead to false localization. A 36-year-old man was found comatose. Head CT demonstrated an acute right convexity subdural hematoma, causing a nearly 2 cm midline shift. Initial neurologic examination was confounded by paralytic agents; however, there was a dilated-light fixed right pupil. The patient was taken for a right hemicraniectomy and hematoma evacuation (Fig. 1). Post-operative examination demonstrated right-sided oculomotor palsy and hemiplegia with preserved left-sided strength—consistent with a false localizing sign. An MRI on POD#1 revealed abnormal T2-signal hyperintensity involving the left anterolateral midbrain and cerebral peduncle, indicative of compression of the contralateral crus cerebri against the contralateral tentorial incisura (“notch”). The descending corticospinal tracts travel from the motor cortex through the ipsilateral crus cerebri into the inferior brainstem where they decussate-transmitting motor stimuli to the contralateral hemibody. Correspondingly, right-sided lesions above the decussation produce left-sided deficits. In the present case, the expected deficits would have been in the left hemibody. However, in rare circumstances involving a significant midline shift the contralateral peduncle is injured via compression at the tentorium. The oculomotor at the same side of the hematoma is as expected and either caused by strech of the nerve or direct compression of the uncus. This false localizing sign has been honored by the eponym "Kernohans Notch"..[[1]Kernohan J.W. Woltman H.W. Incisura of the crus due to contralateral brain tumor.Arch NeurPsych. 1929; 21: 274-287https://doi.org/10.1001/archneurpsyc.1929.02210200030004Crossref Scopus (117) Google Scholar] More deserving of the distinction is Groeneveld [[2]Dammers R Volovci V and Kompanje EJOThe History of the Kernohan Notch Revisited.Neurosurgery. 2016; 78: 581-584https://doi.org/10.1227/NEU.0000000000001097Crossref PubMed Scopus (0) Google Scholar] and Schaltenbrand who explained the injury as a knife-like stab (“Messerähnlichen Wirkung”) from the tentorium and possibly petrosal bone. There is a fascination with the Kernohan's notch phenomenon as evidenced by an ongoing flurry of case reports in the literature. Our patient clearly visualizes what has previously only been described in text and provides better proof of its existance. Picture Quiz: A 36 year-old male found down is noted on neurologic examination to have right hemiplegia and right oculomotor nerve palsy, with intact left upper and lower extremity function. Based on the exam, what is the most likely level of the lesion? A. Left motor cortex B. Right basal ganglia C. Left cerebral peduncle D. Right upper medulla Answer on page 336. LPC, AP, RCP, PCR, JLF, and EFW all provided substantial direct medical or surgical care pertaining to the diagnosis and treatment of the patient; LPC, AP, and CSG gathered the data and wrote manuscript/created the figure, PJR obtained formal patient consent and edited the manuscript, JLF and EFW supervised the project and made final manuscript editorial edits and approvals. None. The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper. A Puzzling Exam: Kernohan’s Notch ReimagedJournal of Clinical NeuroscienceVol. 80PreviewThe Answer is: C. Left cerebral peduncle. Full-Text PDF

Skull Base Defect Associated with Spontaneous Intraventricular Pneumocephalus in a Patient with Ventriculo-peritoneal Shunt

We report the case of an 81-year-old male patient who presented severe spontaneous intraventricular pneumocephalus after two months of ventriculoperitoneal shunt placement for adult chronic hydrocephalus associated with neurologic progressive deterioration and a recent history of hypoacousia. During the process of diagnosis, on simple and fine-cut Computerized Tomography a porencephalic cyst was discovered in association with an osteodural defect in the petrous bone. A surgical revision was scheduled and an approach to the tegmen tympani was performed, covering the defect with fasciomuscular flap and fibrin glue. There were no complications and a remarkable clinicoradiologic improvement was achieved.

Provenance analysis of cremated skeletal remains by stable isotopes.

Cremated human remains are a rather neglected research substrate in physical anthropology; its investigation is still mainly restricted to the osteological level. The application of archaeometric methods to cremations is limited because the organic skeletal components are fully combusted at high temperatures. Stable isotope ratios of heavy elements such as strontium and lead, however, are thermally stable and permit research targeting questions of mobility, migration, and trade. In many cremations, neither dental remains nor the petrous bone are preserved. In such case, no skeletal element that retains the isotopic signature of childhood is available and compact bone has to be chosen instead. This raises interpretive problems, since due to its slow remodeling rate, compact bone integrates the element uptake over many years prior to death. This can generate a mixed isotope ratio in migrants. Such mixed ratios are no longer compatible with the place of origin, and not yet with the place of recovery. Provenance analysis with a single isotope ratio (mostly 87Sr/86Sr) therefore has its limits. A combination of strontium and lead stable isotopes in cremations generates a multi-dimensional isotopic fingerprint that is however more difficult to interpret. Data mining methods that permit a similarity search are a promising approach. In this paper, possibilities and limitations of stable isotope analysis of cremated finds are discussed together with the substrate-specific methodological and interpretive problems. The research potential is demonstrated by use of selected examples.

CASCADE: A Custom-Made Archiving System for the Conservation of Ancient DNA Experimental Data

The field of ancient genomics has undergone a true revolution during the last decade. Input material, time requirements and processing costs have first limited the number of specimens amenable to genome sequencing. However, the discovery that archaeological material such as petrosal bones can show increased ancient DNA preservation rates, combined with advances in sequencing technologies, molecular methods for the recovery of degraded DNA fragments and bioinformatics, has vastly expanded the range of samples compatible with genome-wide investigation. Experimental procedures for DNA extraction, genomic library preparation and target enrichment have become more streamlined, and now also include automation. These procedures have considerably reduced the amount of work necessary for data generation, effectively adapting the processing capacity of individual laboratories to the increasing numbers of analyzable samples. Handling vast amounts of samples, however, comes with logistical challenges. Laboratory capacities, equipment, and people need to be efficiently coordinated, and the progress of each sample through the different experimental stages needs to be fully traceable, especially as archaeological remains of animals or plants are often provided and/or handled by many different collaborators. Here we present CASCADE, a laboratory information management system (LIMS) dealing with the specificities of ancient DNA sample processing and tracking, applicable by large and small laboratories alike, and scalable to large projects involving the analysis of thousands of samples and more. By giving an account of the specimen’s progress at any given analytical step, CASCADE not only optimizes the collaborative experience, including real-time information sharing with third parties, but also improves the efficacy of data generation and traceability in-house.

New insights on Neolithic food and mobility patterns in Mediterranean coastal populations.

The aims of this research are to explore the diet, mobility, social organization, and environmental exploitation patterns of early Mediterranean farmers, particularly the role of marine and plant resources in these foodways. In addition, this work strives to document possible gendered patterns of behavior linked to the neolithization of this ecologically rich area. To achieve this, a set of multiproxy analyses (isotopic analyses, dental calculus, microremains analysis, ancient DNA) were performed on an exceptional deposit (n = 61) of human remains from the Les Bréguières site (France), dating to the transition of the sixth to the fifth millennium BCE. The samples used in this study were excavated from the Les Bréguières site (Mougins, Alpes-Maritimes, France), located along the southeastern Mediterranean coastline of France. Stable isotope analyses (C, N) on bone collagen (17 coxal bones, 35 craniofacial elements) were performed as a means to infer protein intake during tissue development. Sulfur isotope ratios were used as indicators of geographical and environmental points of origin. The study of ancient dental calculus helped document the consumption of plants. Strontium isotope analysis on tooth enamel (n = 56) was conducted to infer human provenance and territorial mobility. Finally, ancient DNA analysis was performed to study maternal versus paternal diversity within this Neolithic group (n = 30). Stable isotope ratios for human bones range from -20.3 to -18.1‰ for C, from 8.9 to 11.1‰ for N and from 6.4 to 15‰ for S. Domestic animal data range from -22.0 to -20.2‰ for C, from 4.1 to 6.9‰ for N, and from 10.2 to 12.5‰ for S. Human enamel 87 Sr/86 Sr range from 0.7081 to 0.7102, slightly wider than the animal range (between 0.7087 and 0.7096). Starch and phytolith microremains were recovered as well as other types of remains (e.g., hairs, diatoms, fungal spores). Starch grains include Triticeae type and phytolith includes dicotyledons and monocot types as panicoid grasses. Mitochondrial DNA characterized eight different maternal lineages: H1, H3, HV (5.26%), J (10.53%), J1, K, T (5.2%), and U5 (10.53%) but no sample yielded reproducible Y chromosome SNPs, preventing paternal lineage characterization. Carbon and nitrogen stable isotope ratios indicate a consumption of protein by humans mainly focused on terrestrial animals and possible exploitation of marine resources for one male and one undetermined adult. Sulfur stable isotope ratios allowed distinguishing groups with different geographical origins, including two females possibly more exposed to the sea spray effect. While strontium isotope data do not indicate different origins for the individuals, mitochondrial lineage diversity from petrous bone DNA suggests the burial includes genetically differentiated groups or a group practicing patrilocality. Moreover, the diversity of plant microremains recorded in dental calculus provide the first evidence that the groups of Les Bréguières consumed a wide breadth of plant foods (as cereals and wild taxa) that required access to diverse environments. This transdisciplinary research paves the way for new perspectives and highlights the relevance for novel research of contexts (whether recently discovered or in museum collections) excavated near shorelines, due to the richness of the biodiversity and the wide range of edible resources available.

Microendoscopic Surgery of Middle Ear and Petrous Bone: Benefits Analysis.

Endoscopy has become routinely used in middle ear surgery. The aim of this study is to analyze where this tool may complement the traditional microscopic approach. This is a retrospective study done in single tertiary hospital. We reviewed 342 middle ear/petrous bone surgical procedures performed between 2005 and 2015. Only cases in which both microscopic and endoscope-assisted techniques were used have been included. Sixty-six patients received this double-technique surgery: 51 (77.2%) had middle ear/mastoid and petrous bone cholesteatomas (46 middle ear and mastoid and 5 acquired/congenital petrous bone cholesteatomas), 5 (7.5%) had glomus tympanicum tumors (GTT), 4 (6%) had an ossicular chain dislocation, 3 (4.5%) had purulent chronic otitis media, 2 (3%) had tympanosclerosis, and 1 (1.5%) had an ossicular chain malformation. The endoscope was helpful to remove disease remnants not accessible by microscope in 41 (62%) of the cases; 37 (90%) were cholesteatomas, 3 (7%) were GTT, and only 1 (3%) was an open tympanosclerosis. In the remaining 25 (37.8%) cases, the endoscope was useful only to visualize the cavity since the microscope had already been successful in removing the entire lesion. The endoscopy can add valuable information and support to the usual microscope approach alone. The consensus of a single best technique does not yet exist, but the physician should choose the best modality or combination of modalities in order to cure the patient and prevent any possible complications or recurrence of the pathology.

Comblement de cavité d’évidement après pétrectomie

Petrosectomy is a debilitating intervention, consisting of a resection of the bone forming the external auditory canal, the middle ear and sometimes the internal ear as well. The cavity formed after this surgery can lead to infectious complications. Reconstruction is an essential element for patients' rehabilitation. Most cases require local rotation flaps such as temporal muscle flap. However, when the remaining defect is too large or when the structures have been altered by radiotherapy, free flaps are the most adequate solution for repair. Upon review of the literature, there are very few articles providing options regarding reconstruction possibilities post-petrosectomy. Plastic surgeons are often unfamiliar with this indication, therefore, it is essential to call their attention in order to provide the best options of care in these difficult and complicated cases where possibilities are limited. That is why, it is important for us to share our experience in this domain through the example of our patient presenting with a large osteoradionecroses of the petrous bone, requiring resection and immediate reconstruction using a free flap.

Skull and cervical spine fractures

Injuries of the skull and the cervical spine are common trauma sequelae and prompt diagnosis is of utmost importance to prevent neurologic complications. The different imaging modalities for the diagnosis of skull and cervical spine fractures are presented and discussed in the context of the current literature. Common fractures of the skull and cervical spine and their classification systems are described. Indications for imaging are discussed within the context of the literature. Fractures of the head can affect the cranial vault, the base of the skull, and the petrous bone. Injuries to the dura are associated with an open craniocerebral trauma. Fractures of the cervical spine can be subdivided into fractures of the craniocervical junction and subaxial fractures. The imaging modality of choice in the acute setting is computed tomography (CT). Skull fractures can be differentiated into open and closed craniocerebral traumas and accompanying intracranial trauma sequelae must be recognized. In the case of petrous bone fractures, attention must always be paid to the middle and inner ear structures. In cervical spine fractures, decisive is whether the fracture is stable or unstable and whether there has been an accompanying injury to the myelon.

The petrous bone: Ideal substrate in legal medicine?

Over the last few years, palaeogenomic studies of the petrous bone (the densest part of the temporal bone) have shown that it is a source of DNA in both larger quantities and of better quality than other bones. This dense bone around the otic capsule has therefore been called the choice substrate in palaeogenomics. Because the practice of forensic genetics responds to different imperatives, we implemented a study aimed at (i) understanding how and why the petrous bone is an advantageous substrate in ancient DNA studies and (ii) establishing whether it is advantageous in forensic STR typing.We selected 50 individual skeletal remains and extracted DNA from one tooth and one petrous bone from each. We then amplified 24 STR markers commonly used in forensic identification and compared the quality of that amplification using the RFU intensities of the signal as read on the STR profiles. We also performed histological analyses to compare (i) the microscopic structure of a petrous bone and of a tooth and (ii) the microscopic structure of fresh petrous bone and of an archaeological or forensic sample.We show that the RFU intensities read on STR profiles are systematically higher in experiments using DNA extracted from petrous bones rather than teeth. For this reason, we were more likely to obtain a complete STR profile from petrous bone material, increasing the chance of identification in a forensic setting. Histological analyses revealed peculiar microstructural characteristics (tissue organization), unique to the petrous bone, that might explain the good preservation of DNA in that substrate. Therefore, it appears that despite the necessity of analysing longer fragments in forensic STR typing compared to NGS palaeogenomics, the use of petrous bones in forensic genetics could prove valuable, especially in cases involving infants, toothless individuals or very degraded skeletal remains.

Colloid cyst: unusual location of petrous temporal bone

Colloid cysts are benign, thin walled spherical neoplasms, composed of a collagenous capsule, underlying epithelium that arises from brain’s epidermal embryonic remnants and a viscous centre. They are shown to approximate 0.5% of all intracranial tumours with no recorded evidence of the petrous temporal bone involvement. Colloid cyst of the petrous temporal bone often presents with clinical symptoms of headache, hearing loss, facial palsy and imbalance/vertigo. Which is diagnosed on radiological and histological findings. Histologically, they are lined by ciliated cuboidal to pseudo stratified columnar epithelium resting on an eosinophilic basement membrane. Imaging Techniques are helpful in early diagnosis and preventing further complications. Here we will be discussing about a 24-year-old female, a known case of petrous apex osseous haemangioma presenting with unstable gait and tingling sensation on one side of face leading to an incidental finding of a colloid cyst on petrous temporal bone through histological examination.

Prevalence of incidentally discovered findings on brain MRI in adult Egyptian population

BackgroundApparently, asymptomatic intracranial anomalies of potential clinical significance are becoming problematic, especially with the increase of use of brain MRI by clinicians and researchers. Performing MRI at higher resolution and stronger magnetic field and with more selective sequences has led to the detection of subtle brain anomalies that were not detected previously. Incidental findings are defined as previously undetected anomalies of potential clinical relevance that are unexpectedly detected and not related to the indication of the scan.Knowing about their existence would help clinicians to inform their patients of the potential risks and plan for long-term follow-up when indicated.ResultsSeven hundred fifty-three neurologically healthy subjects (389 males and 364 females) who underwent MRI scanning of the brain were screened for the presence of incidental findings, and the prevalence of each finding was recorded. Incidental findings were recorded in 11.7% of the subjects with meningiomas being the most commonly encountered finding (2.5%) followed by vascular malformations (aneurysms, cavernomas) in about 2% of the subjects. Meningiomas, cavernomas, and aneurysms had significantly higher prevalence in females than in males. The prevalence of neoplastic incidental findings increased with age, while the detection of non-neoplastic findings seemed to decrease with age.ConclusionIncidental findings were relatively common in the adult Egyptian population. The most common findings were meningiomas, followed by vascular malformations and arachnoids cysts. Knowing about their existence will help directing patients towards the proper specialist and plan for appropriate follow-up to avoid potential clinical hazards. It also raises the awareness of the importance of screening the brain scans while scanning the patient for other purposes like scanning the paranasal sinuses, orbits, and petrous temporal bones.

Periotic congenital cholesteatoma – A rare case report

Congenital cholesteatoma is a rare entity and cholesteatoma surrounding the entire otic capsule and involving petrous apex is even rarer. The condition may remain hidden for a long duration destroying the temporal bone and might present as an intracranial space-occupying lesion, loss of hearing, facial nerve palsy without significant otoscopic findings. We report a case of thirty-three years old female who presented with facial palsy and hearing loss for 7 months without any history of ear discharge. Possibility of congenital cholesteatoma was sorted based on clinical and radiological features. Transotic approach was done for clearing the disease. Congenital cholesteatoma should be considered as a differential diagnosis in any patient with unexplained otological signs and symptoms. Radical excision is the mainstay of treatment. Keywords: Congenital cholesteatoma, Facial nerve palsy, Hearing loss, Petrous bone.

Ear infection prevalence in prehistoric and historic populations of the southern Levant: A new diagnostic method

AbstractStudying infectious diseases in ancient times is of significant importance to our understanding of past populations' ways of life. Otitis media (OM) is beneficial for this purpose because it is frequent and influenced by environmental conditions. The aims of the current study were to create a reliable criterion for identifying OM in skeletal material, and to follow trends regarding the prevalence of OM throughout the terminal Pleistocene–Holocene Levant.Complete petrous bones of 229 individuals from six populations of the terminal Pleistocene–Holocene Levant (14,900 cal bp–1,917 ad) were included in the study. The promontory of the middle ear was examined using a flexible videoscope and a microscope. The observations were validated by micro‐computed tomography (CT) images. The absence or presence of bone remodelling on the promontory surface was registered as well as the appearance of the promontory sulcus (open or covered). Kappa tests were carried out to examine intra‐ and inter‐observer variation. Chi‐squared tests were carried out to examine the association between promontory appearance and period as well as the association between the presence of bone remodelling and the sulcus type.The suggested criteria were found to be reliable. A fluctuation in the prevalence of bone remodelling on the promontory surface was found during the studied period. The highest prevalence (80%) was among the protohistoric populations, followed by the prehistoric populations (~60.6%), and finally, the historic populations (~50.4%). The types of promontory sulcus remained relatively stable during the studied period. Moreover, no significant association was found between the presence of bone remodelling on the promontory surface and the sulcus type.To conclude, bone remodelling on the promontory surface is a new, simple, and reliable method to identify OM in skeletal material. However, promontory sulcus type is most likely not associated with OM. The fluctuations in OM prevalence during the Holocene Levant were probably due to habitation type and climate conditions.