Temporal Bone Cholesteatoma Research Articles

Residual cholesteatoma of the temporal bone in a patient with granulomatosis with polyangiitis

A case of residual temporal bone cholesteatoma in a patient with granulomatosis with polyangiitis (Wegener) (GPA) is presented. At the onset of the disease, the patient developed a symptom complex, which included, along with sinonasal manifestations, left-sided purulent otitis media, refractory to traditional therapy. A separate atticoanthrotomy on the left temporal bone, performed in the active phase, before the diagnosis of vasculitis, did not lead to a clinical improvement in the condition of the middle ear. Despite the subsequent implementation of adequate immunosuppressive therapy and drug remission of GPA, the continuously recurrent course of purulent otitis media of the operated ear contributed to the development of residual cholesteatoma of the temporal bone with the spread of the process to surrounding structures. The presence of cholesteatoma was confirmed by MRI of the temporal bones in the non-EPI DWI mode. During the period of drug remission of GPA, repeated sanitizing surgery was performed on the middle ear with tympanoplasty and obliteration of the parathympanic spaces, which made it possible to achieve remission of purulent otitis media. The development of residual middle ear cholesteatoma in a patient with GPA could be due to the untimely initial diagnosis, the late onset of specific immunotherapy, the rapidly progressive and recurrent nature of the course of the disease, and surgical treatment in the phase of high disease activity. The insufficient volume of primary surgical treatment contributed to the formation of laced cavities and the development of residual cholesteatoma of the temporal bone. The use of MRI in the non-EPI DWI mode for diagnosis made it possible to identify the development of cholesteatoma of the left temporal bone in a patient with GPA and track the results of surgical treatment in the postoperative period. The non-EPI DWI MRI method proved effective both for detecting temporal bone cholesteatoma and tracking changes in the postoperative period of a patient with GPA. Tympanoplasty with surgical obliteration of the parathympanic spaces allowed to stop the inflammation of the middle ear in a patient with a systemic autoimmune disease.

Diffusion Analysis of Intracranial Epidermoid, Head and Neck Epidermal Inclusion Cyst, and Temporal Bone Cholesteatoma.

Intracranial epidermoid tumors, temporal bone cholesteatomas, and head and neck epidermoid inclusion cysts are typically slow-growing, benign conditions arising from ectodermal tissue. They exhibit increased signal on DWI. While much of the imaging literature describes these lesions as showing diffusion restriction, we aimed to investigate these qualitative signal intensities and interpretations of restricted diffusion with respect to normal brain structures. This study aimed to quantitatively evaluate the ADC values and histogram features of these lesions. This retrospective study included children with histologically confirmed diagnoses of intracranial epidermoid tumors, temporal bone cholesteatomas, or head and neck epidermoid inclusion cysts. Lesions were segmented, and voxelwise calculation of ADC values was performed along with histogram analysis. ADC calculations were validated with a second analysis software to ensure accuracy. Normal brain ROIs-including the cerebellum, white matter, and thalamus-served as normal comparators. Correlational analysis and Bland-Altman plots assessed agreement among software tools for ADC calculations. Differences in the distribution of values between the lesions and normal brain tissues were assessed using the Wilcoxon rank sum and Kruskal-Wallis tests. Forty-eight pathology-proved cases were included in this study. Among them, 13 (27.1%) patients had intracranial epidermoid tumors, 14 (29.2%) had head and neck epidermoid inclusion cysts, and 21 (43.7%) had temporal bone cholesteatomas. The mean age was 8.67 (SD, 5.30) years, and 27 (52.9%) were female. The intraclass correlation for absolute agreement for lesional ADC between the 2 software tools was 0.997 (95% CI, 0.995-0.998). The intracranial epidermoid tumor, head and neck epidermoid inclusion cyst, and temporal bone cholesteatoma median ADC values were not significantly different (973.7 versus 875.7 versus 933.2 ×10-6 mm2/s, P = .265). However, the ADCs of the 3 types of lesions were higher than those of 3 normal brain tissue types (933 versus 766, × 10-6 mm2/s, P < .0001). The ADC values of intracranial epidermoid tumors, temporal bone cholesteatomas, and head and neck epidermoid inclusion cysts are higher than those of normal brain regions. It is not accurate to simply classify these lesions as exhibiting restricted diffusion or reduced diffusivity without considering the tissue used for comparison. The observed hyperintensity on DWI compared with the brain is likely attributable to a relatively higher contribution of the T2 shinethrough effect.

Diagnosis and treatment of congenital temporal bone cholesteatoma

Congenital temporal bone cholesteatoma is a rare lesion in otolaryngology.The disease is locally invasive and may lead to significant complications,including hearing loss（conductive or sensorineural）, temporal bone destruction and intracranial invasion. This article reviews the characteristic symptoms of congenital temporal bone cholesteatoma, testing and imaging of the disease, stage and the current treatment options in order to promote awareness to this rare disease entity and perform early surgical treatment, effectively avoid the destruction of the temporal bone and its surrounding structures, thereby reducing the occurrence of complications. By improving the understanding of the disease and performing early surgical treatment, the destruction of the temporal bone and its surrounding structures can be effectively avoided, thereby reducing the occurrence of complications.

Способ хирургической санации холестеатомы височной кости при врожденной атрезии наружного слухового прохода

This article presents a technique of surgical debridement of temporal bone cholesteatoma in congenital atresia of the external auditory canal and a description of a clinical case. In the presence of congenital atresia of the external auditory canal with cholesteatoma, surgical treatment with posterior transcortical access is most often performed with the formation of a large trephined cavity, followed by myringoplasty and, if necessary, ossiculoplasty. We have described a clinical case of surgical treatment of congenital atresia of the external auditory canal by the type of separate atticoanthromastoidotomy with myringoplasty and formation of the external auditory canal with simultaneous rehabilitation of temporal bone cholesteatoma. This method allows performing cholesteatoma surgery in congenital atresia of the external auditory canal with the formation of the canal of the external auditory canal, while maintaining the spatial ratio of all its walls. This reduces the risk of developing restenosis of the external auditory canal and improves the patient’s hearing.

Comparison of High-Resolution Computed Tomography and Surgical Findings in Patients with Temporal Bone Cholesteatoma

Objective: The present study aims to investigate the role of high-resolution computed tomography (HRCT) in temporal bone cholesteatoma. Materials and Methods: Eighty-two patients with a pathological diagnosis of chronic otitis media with cholesteatoma were included in this retrospective study. All patients had a complete preoperative otorhinolaryngologic examination, audiological assessment, and HRCT. Preoperative radiological findings were evaluated together with the findings obtained during surgery. Results: In HRCT, cholesteatoma was most common in pars flaccida (36.25%). The most common localization of cholesteatoma was holotympanic (36.25%). Erosion was most common in all ossicles (43.75%), but solitary erosion was most common in the incus (35%). The facial nerve canal was intact in 58 (72.5%) of the patients. The diagnostic sensitivities of HRCT in cholesteatoma cases were 97.6% for tissue mass, 97.6% for localization, 100% for malleus erosion, 84.8% for incus erosion, 100% for malleus and incus erosion, 40% for incus and stapes erosion, 94.6% for the erosion of all ossicles, and 100% for facial nerve canal erosion. Conclusion: Preoperative HRCT evaluation in patients with cholesteatoma may be considered indispensable for the location of the disease and the detection of destructive structures.

Performance of 2D BLADE turbo gradient- and spin-echo diffusion-weighted imaging in the quantitative diagnosis of recurrent temporal bone cholesteatoma

BackgroundDiffusion-weighted imaging (DWI) has become an important tool for the detection of cholesteatoma. The purpose of this study was to explore the value of 2D BLADE turbo gradient- and spin-echo imaging (TGSE BLADE) DWI in the quantitative diagnosis of recurrent temporal bone cholesteatoma (CS).MethodsFrom March 2018 to October 2021, 67 patients with suspected recurrence of temporal bone CS after assessment by clinical otorhinolaryngologists who had undergone previous ear surgery for CS were prospectively evaluated by magnetic resonance imaging (MRI). Two radiologist assessed images independently. Quantitative parameters such as signal intensity ratio (SIR) calculated using, as a reference, the inferior temporal cortex (SIRT) and the background noise (SIRN), apparent diffusion coefficient (ADC) value, and ADC ratio (with pons as reference) measured on TGSE BLADE sequences were assessed. Using receiver operating characteristic (ROC) curve analysis, the optimal threshold and diagnostic performance for diagnosing recurrent CS were determined. Pair-wise comparison of the ROC curves was performed using the area under the ROC curve (AUC).ResultsFinally, 44 patients were included in this study, including 25 CS and 19 non-cholesteatoma (NCS). Mean SIRT and mean SIRN on TGSE BLADE DWI were significantly higher for CS than NCS lesions (p < 0.001). Meanwhile, mean ADC values and mean ADC ratios on ADC maps were significantly lower in the CS group than in the NCS group (p < 0.001). According to ROC analysis, the diagnostic efficacy of quantitative parameters such as SIRT (AUC = 0.967), SIRN (AUC = 0.979), ADC value (AUC = 1.0), and ADC ratio (AUC = 0.983) was significantly better than that of qualitative DWI (AUC = 0.867; p = 0.007, 0.009, 0.011 and 0.037, respectively).ConclusionsResidual/recurrent temporal bone CS can be accurately detected using quantitative evaluation of TGSE BLADE DWI.

Detection of cholesteatoma: 2D BLADE turbo gradient- and spin-echo imaging versus readout-segmented echo-planar diffusion-weighted imaging.

This study is to compare the accuracy of 2D BLADE turbo gradient- and spin-echo imaging (TGSE BLADE) diffusion-weighted imaging (DWI) with that of readout-segmented echo-planar (RESOLVE) DWI in the detection of primary and residual/recurrent temporal bone cholesteatoma. The prospective study population consisted of 58 patients who were underwent magnetic resonance (MR) imaging for the evaluation of suspected temporal bone cholesteatoma. Two radiologists independently evaluated the two sequences. Kappa (k) statistics, the intra-class correlation coefficient (ICC), and a paired t test were used for statistical analysis. Of the 58 patients included, all had histo-pathologically confirmed cholesteatomas. In ≤ 3mm group (n = 13), TGSE BLADE sequence correctly identified all cases except one that was recorded as equivocal on both sequences because of high signal intensity on T1WI; while on RESOLVE sequences, 6 were positive, 4 were equivocal, and 3 were false negative. For > 3mm group (n = 45), detection performance was similar between the two sequences. The mean ADC of cholesteatoma on TGSE BLADE DWI was 0.923 × 10-3 mm2/s, and the mean ADC of cholesteatoma on RESOLVE DWI was 0.949 × 10-3 mm2/s, with no significant difference in the mean ADC values of cholesteatoma measured on the two sequences (p = 0.9216). TGSE BLADE outperforms RESOLVE in the detection of small temporal bone cholesteatoma ≤ 3mm.

Temporal Bone Cholesteatoma: Typical Findings and Evaluation of Diagnostic Utility on High Resolution Computed Tomography.

BackgroundPre-operative assessment of middle ear cholesteatoma is a must for assessing the disease's location, extent, and complication, and high-resolution computed tomography (HRCT) is the modality of choice. Therefore, this study aims to assess the common signs of cholesteatoma on HRCT and its diagnostic ability. MethodsFifty patients with suspected cholesteatoma were considered for the study, which was carried out on an Ingenuity Core 128 slice CT scanner (Philips, Amsterdam, Netherlands). The bilateral temporal bones of 50 patients were assessed for soft tissue density and associated findings. The number of temporal bones with soft tissue density was then correlated with intra-operative and histopathological examinations (HPE). ResultsOut of 100 temporal bones, 63 were diseased, and 37 were normal temporal bones. Epitympanum/Prussak's space was the most involved site with soft tissue density seen in 60/63 (95.2%) diseased temporal bones, followed by aditus ad antrum and mesotympanum, which was seen in 51/63 (80.9%) diseased temporal bones. The majority of the soft tissue lesions were non-dependent, accounting for 43/63 (68.2%) of the diseased temporal bones. Bony erosions were seen in 54/63 (85.7%) and bony expansion in 35/63 (55.5%) of the diseased temporal bones. HRCT showed a sensitivity of 100%, specificity of 88.1%, a positive predictive value (PPV) of 92.1%, a negative predictive value (NPV) of 100%, and accuracy of 95% for detection of cholesteatoma. ConclusionHRCT of the temporal bone precisely demonstrates cholesteatoma's location, extent, and bony changes. Therefore, it has exceptional sensitivity, high specificity, and accuracy in diagnosing cholesteatoma.

Endoscopic transnasal approach in surgical treatment of petrous temporal bone cholesteatoma extending towards the clivus. Three clinical observations and literature review

To demonstrate the possibilities of endoscopic transnasal approach in surgery for clival and petrous cholesteatoma. This article presents 3 clinical cases: 2 patients with apical cholesteatoma of petrous part of temporal bone extending to the clivus and 1 patient with massive petrous temporal bone cholesteatoma extending towards the clivus according to the classification of Sanna M. All patients underwent endoscopic transnasal surgery. In our opinion, endoscopic transnasal approach is optimal for resection of similar neoplasms. Total and subtotal resection was performed in 2 and 1 case, respectively. However, there are certain limitations of this approach in accessing the most lateral parts of the neoplasm. Nevertheless, endoscopic transnasal approach ensures resection of petrous temporal bone cholesteatoma extending to the clivus without the risk of damage to acoustic-facial cranial nerves. It is especially significant in patients without their baseline dysfunction.

Modified classification of infralabyrinthie cholesteatoma and scale of cholesteatoma extention

Introduction. Petrous temporal bone (PTB) cholesteatoma is an epidermal cyst, which is the result of uncontrolled growth of keratinizing squamous epithelium in the petrous part of the temporal bone. Cholesteatoma is classified into congenital, acquired, and iatrogenic.Objective. To discuss the classification of infralabyrinthine petrous bone cholesteatoma (PBC), add modified classificationand to propose adequate differential surgical management.Methods. The setting was a National Medical Scientific Center of Otorhinolaryngology FMBA (Russia). The data of 14 patients who underwent surgery for different variations of infralabyrinthine PBC from 2017 till 2020 were analyzed and included into the study (with respect to localization type of the approach used, complications, recurrences and outcome). The follow-up period ranged from 6 to 34 months with a median of 18 months.Results. Based on preoperative CT scans and intraoperative findings a Scale of Cholesteatoma extension CLIF(APO) and Modified classification of infralabyrinthine cholesteatoma (in relation to mastoid segment of the facial nerve) are proposed. The scale includes the main anatomical structures of the temporal bone and the adjacent parts of the occipital and sphenoid bones, which may be involved in the cholesteatoma process: cochlea, vestibule and semicircular canals, internal auditory canal, jugular foramen, bony chanal of the internal carotid artery, petrous apex, occipital condyle. Based on the modified classification and scale we present an algorithm for decision making and surgical approach choosing.Conclusion. The implementation of the Scale of Cholesteatoma Extension in Otology and Radiology practice will allow to preoperatively diagnose the extension of PBC, unify the data of the localization of cholesteatoma; allows standardization in reporting and continuity at all stages of treatment. The modified classification proposed by us in this article facilitate the algorithm for selecting the type of surgical approach and determine whether to perform less aggressive combined microscopic approaches with endoscopic control.

The value of turbo spin-echo diffusion weighted imaging in the diagnosis of temporal bone cholesteatoma

Objective:The aim of this study is to evaluate the diagnostic value of turbo spin-echo（TSE） diffusion weighted imaging（DWI） in temporal bone cholesteatoma. Method:A prospective evaluated of 76 patients with suspected sacral cholesteatoma was performed using a Philips Ingenia 3.0T superconducting magnetic resonance scanner and a 32-channel head coil with turbo spin-echo diffusion weighted imaging（TSE-DWI） sequence and conventional magnetic resonance scan, and underwent surgery within the next two weeks. The pathological result is the gold standard, and the imaging diagnosis and surgery are performed. The intraoperative observation and pathological results were compared. The diagnostic accuracy, sensitivity, specificity, positive predictive value and negative predictive value of TSE-DWI sequence in the diagnosis of temporal bone cholesteatoma were calculated. Result:Of the 76 patients with suspected temporal bone cholesteatoma, TSE-DWI scan was performed, 44 cases were diagnosed as cholesteatoma and 32 cases were non-cholesteatoma. Based on the pathology results, 46 cases were diagnosed as cholesteatoma, 30 cases were non-cholesteatoma. The accuracy of TSW-DWI sequence in the diagnosis of cholesteatoma was 89.47%, 3 cases were false negative and 5 cases was false positive. The sensitivity, specificity, positive predictive value and negative predictive value of TSE-DWI in the diagnosis of temporal bone cholesteatoma were 89.13%, 90.00%, 93.18%, and 84.38%, respectively. Conclusion:The TSE-DWI sequence has high signal-to-noise ratio and can improve the diagnostic accuracy and specificity. TSE-DWI sequence is of great value in clinical diagnosis and treatment.

Массивная холестеатома височной кости у пациентов, перенесших санирующую операцию открытого типа

Potential recurrence is a key challenge of the surgical interventions for temporal bone cholesteatoma. It manifests with the residual or recurrent cholesteatoma. Open surgical techniques reduce the recurrence of cholesteatoma due to the better visualization of temporal bone cavities both intraoperatively and postoperatively and also prevent otogenic intracranial complications. However, even despite open-cavity surgeries, cholesteatoma recurrences are still common in ENT practice while their asymptomatic course often results in the late diagnosis. This article describes three case reports of cholesteatoma recurrences with significant destructive lesions of the temporal bone and intracranial complications after prior open-cavity surgical interventions. These case reports are of interest due to the latent course of cholesteatoma and the lack of disease recurrence signs revealed by the standard ENT examination using otomicroscopy and endoscopy. Finally, these case reports highlight the importance of diffusion-weighed magnetic resonance imaging of the middle ear in patients with temporal bone cholesteatoma both in the preoperative and postoperative period. KEYWORDS: cholesteatoma, middle ear, temporal bone, surgical strategy, trephination, radical mastoidectomy. FOR CITATION: Anikin I.A., Khamgushkeeva N.N., Knyazev A.D., Bokuchava T.A. Massive cholesteatoma of the temporal bone after opencavity surgery. Russian Medical Inquiry. 2020;4(4):247–253. DOI: 10.32364/2587-6821-2020-4-4-247-253.

Characteristics of diagnosis and surgical treatment of various forms of congenital temporal bone cholesteatoma

Characteristics of diagnosis and surgical treatment of various forms of congenital temporal bone cholesteatoma

Characteristics of diagnosis and surgical treatment of various forms of congenital temporal bone cholesteatoma

To conduct a retro- and prospective analysis of the clinical characteristics and results of surgical treatment of patients with congenital temporal bone cholesteatoma. On the basis of the SPb Scientific Research Institute of ENT of the Ministry of Health of Russia 23 patients were diagnosed with congenital temporal bone cholesteatoma for the period from 2011 to 2018. There were 11 men (47.8%), 12 women (52.2%), the age of patients - from 2 to 44 years. The M.J. Levenson criteria were used to verify congenital middle ear cholesteatoma. (1986). According to intrasurgery findings, we identified congenital cholesteatoma of the middle ear stages according to the ChOLE classification. Other types of congenital temporal bone cholesteatoma included the patients with congenital atresia of the external auditory opening, combined with congenital temporal bone cholesteatoma; we found a patient with exostoses obstructing the external auditory canal combined with congenital cholesteatoma of the middle ear; and a patient with congenital cholesteatoma of the temporal bone pyramid. An increase in the incidence of congenital temporal bone cholesteatoma was noted, which is probably due to increased awareness of specialists and the wider use of imaging research methods. A relationship was revealed between the stage of congenital cholesteatoma according to the ChOLE classification and the necessary volume of surgical intervention. Of the total number of cases of congenital temporal bone cholesteatoma, 26.1% were the patients with anomalies in the development of the outer and middle ear. All patients with suspected congenital temporal bone cholesteatoma require a temporal bone MSCT and middle ear MRI in DWI mode.

The value of turbo spin-echo diffusion-weighted imaging apparent diffusion coefficient in the diagnosis of temporal bone cholesteatoma

To explore the value of the applying the apparent diffusion coefficient (ADC) to the quantitative diagnosis of temporal bone cholesteatoma. Seventy-one patients clinically suspected of temporal bone cholesteatoma were enrolled prospectively. These patients underwent ear magnetic resonance imaging (MRI) and turbo spin-echo diffusion-weighted imaging (TSE-DWI) using a Philips Ingenia 3 T superconductive MRI system, and their ADCs were measured. Subsequently, all enrolled patients underwent surgery within 15 days of the MRI. Using receiver operating characteristic (ROC) curve analysis, the optimal threshold and diagnostic performance for diagnosing temporal bone cholesteatoma were determined. Logistic regression modelling was used to combine ADCs and T1-weighted imaging (T1WI) sequences and calculate the combined diagnostic performance. Based on the pathology results, patients were categorised into the cholesteatoma group (CS group, n=43) and the non-cholesteatoma group (NCS group, n=28). In the CS group, ADCs were significantly lower (mean, 0.87±0.31×10-3 mm2/s) than in the NCS group (mean, 1.87±0.49×10-3 mm2/s; p<0.001); the area under the ROC curve (AUC) was 0.915. Based on the optimal threshold of ADC, ≤1.23×10-3 mm2/s, the diagnostic performance was high; the sensitivity and specificity for diagnosing cholesteatoma were 95.35% and 85.71%, respectively. By combining the ADC and T1WI sequence, AUC increased to 0.953, and the sensitivity and specificity were 90.7% and 96.43%, respectively. ADC quantitative analysis has a high value in the preoperative diagnosis of cholesteatoma, and the combination of ADC and T1WI sequences can improve the diagnostic accuracy and specificity and thereby facilitate clinically effective diagnosis.

Evaluation of Temporal Bone Cholesteatoma with High Resolution Computed Tomography (HRCT)

Evaluation of Temporal Bone Cholesteatoma with High Resolution Computed Tomography (HRCT)

Congenital Cholesteatoma of Mastoid Temporal Bone and Posterior Cranial Fossa Treated with Transmastoid Marsupialization

A congenital cholesteatoma is a benign mass formed from the keratinizing stratified squamous epithelium. It usually occurs in young children’s anterosuperior part of the middle ear. A congenital cholesteatoma which originates from mastoid temporal bone or expands to posterior cranial fossa is rare. Standard treatment of an intracranial cholesteatoma is surgical removal with craniotomy. A 69-year-old woman was diagnosed with a congenital cholesteatoma of mastoid temporal bone that expanded to the posterior cranial fossa, which was successfully treated with transmastoid marsupialization without craniotomy. This is a first documented case of a congenital cholesteatoma of mastoid temporal bone that expanded to posterior cranial fossa, which was successfully treated with transmastoid marsupialization without craniotomy. Key words: Cholesteatoma ㆍ Epidermoid tumor ㆍ Occipital bone ㆍ Posterior cranial fossa ㆍ Temporal bone

High Resolution Computed Tomography in the Evaluation of Temporal Bone Cholesteatoma

High Resolution Computed Tomography in the Evaluation of Temporal Bone Cholesteatoma

Outer auditory canal cholesteatoma

Outer auditory canal cholesteatoma (OACC) is a rare form of cholesteatoma of temporal bone, and it accounts for 0.1%–0.5% of new patients at clinics of otolaryngologist. We are presenting here a rare case of cholesteatoma of OAC where excision was done with canal wall down mastoidectomy with preservation of tympanic membrane and structure medial to it and reconstruction of OAC with conchal cartilage. Complete disease removal with soft wall reconstruction is a viable method for OACC.

The surgical management of temporal bone cholesteatoma involving into jugular foramen

The surgical management of temporal bone cholesteatoma involving into jugular foramen