Dragoslava Djeric

Anatomical Variations and Relations in the Medial Wall of the Bony Portion of the Eustachian Tube

The medial wall of the bony portion of the Eustachian tube was examined, by anatomical and histological methods, in 150 temporal bones of adults. This wall consists of two parts: posterolateral (labyrinthine) and anteromedial (carotid), whose shapes, sizes and relations depend upon the position of the a. carotis interna. If it is located nearer the tympanic opening of the tube, the labyrinthine part of the wall is smaller and has a triangular shape. The further the artery is removed from the tympanic opening of the tube, the greater and more rectangular the shape of this part of the wall. The part of the medial wall which corresponds to the a. carotis interna can differ in each case and in 69% of the cases this part extended more or less into the lumen of the tube. The average thickness of this part of the wall is 1.5 mm (minimum is wafer-thin and maximum is 3 mm). In 2% of the cases the bony wall above the a. carotis interna was missing, so that the artery projected into the protympanum. Through a bone defect, aneurysm of the artery can develop. In one case, during an operation, it was established that the protrusion of the a. carotis interna into the tympanic cavity was due to a defect in the medial wall of the Eustachian tube.

Why do treatment failure and recurrences of benign paroxysmal positional vertigo occur

Objective To investigate the potential risk factors associated to the treatment failure and recurrence of benign paroxysmal positional vertigo (BPPV). Study Design Prospective cohort study. Setting Tertiary referral center. Patients Four hundred patients with benign paroxysmal positional vertigo, 119 men and 281 women, aged 27 to 88 years. Intervention Patients were treated once a week, with only one, appropriate, depending on the affected canal, repositioning maneuver (modified Epley, Semont, barbecue/inverted Gufoni, Kim). The control Dix-Hallpike test and the roll test were performed on 7 days. Main Outcome Measures The treatment outcome and recurrence were evaluated with regard to sex, age, duration of symptoms, etiologic factors, migraines, osteoporosis, vascular risk factors, endocrine diseases, localization of otoconia, and simultaneous involvement of multiple canals. Results The results indicate that treatment was negatively affected by patients’ age, osteoporosis, and head trauma, without them causing recurrent symptoms. The highest number of uncured patients was observed in the 73- to 88-year-old age group (14.8%). The application of more than one maneuver was necessary in 27.5% of cases with primary BPPV and 88.9% with secondary BPPV. The highest treatment success was achieved in the group with BPPV of the posterior semicircular canal (F = 3.668, p = 0.026). The recurrence rate was 15.5%. Conclusion Potential risk factors associated to the treatment failure were as follows: the age older than 50, secondary BPPV, head trauma, the occurrence of osteoporosis, and localization of otoconia in the anterior semicircular canal. The analyzed factors did not have impact on the recurrence.

Anatomical Variations and Relations of the Bony Portion of the Eustachian Tube

The bony portion of the Eustachian tube was examined, using anatomical and histological methods, on 200 temporal bones of adults. This part of the tube averages 11.38 mm in length, its tympanic opening has an average diameter of 5.20 X 3.95 mm, and its lumen can be of an irregular (45%), rectangular (35%) or triangular (20%) shape. The dimensions of the bony portion of the tube diminish gradually toward the isthmus, so that in the middle the average diameter is 4.02 X 3 mm and at the level of the isthmus, 2.5 X 1.5 mm. The outer wall forms the tympanic plate of the tympanic bone, which in 65% of the cases is compact and in 35% finely pneumatized. On this wall bony trabeculae often appear, which more or less block the lumen of the tube. The medial part of the upper wall forms the bony septum toward the m. tensor tympani and the lateral represents the tegmen. The average distance from the lumen of the tube to the dura at the level of the tegmen is 3.62 mm. The tegmen above the tube may be pneumatized (45%) or compact (55%). The lower wall in 20% of the cases is represented by a shallow groove, and if formed is usually convex into the tubes lumen, but is less often concave. The jutting out of the lower wall is usually caused by its pneumatization.

Randomized prospective trial of hyperbaric oxygen therapy and intratympanic steroid injection as salvage treatment of sudden sensorineural hearing loss.

Objective To compare the effects of hyperbaric oxygen (HBO) and intratympanic (IT) steroid injection on hearing after the failure of primary treatment in patients with idiopathic sudden sensorineural hearing loss (ISSHL). Study Design A prospective randomized trial. Setting Tertiary referral center. Patients Fifty patients with failure of primary therapy for ISSHL. Intervention(s) After primary treatment with systemic steroids and failure of therapy, defined as less than 10-dB hearing gain, 50 patients were enrolled in the study and received either hyperbaric oxygen or intratympanic steroid treatment. The patients were not matched and not similar. Main Outcome Measure(s) Hearing gain at 0.25, 0.5, 1, 2, and 4 kHz after treatment. Results There were significant differences between hearing thresholds at all frequencies before and after the HBO treatment. Similarly, there were significant differences between hearing thresholds at most frequencies (except 2 kHz) before and after the treatment in the IT group. The subgroups of patients with pure tone average less than 81 dB and were younger than 60 years had better response to HBO treatment than those with profound deafness and in the elderly. Conclusion HBO and IT steroid therapy could be successfully used as salvage therapies in patients with sudden deafness. Further study is needed to demonstrate superiority of one of the treatments.

Surgical anatomy of the hypotympanum

Anatomical characteristics of the hypotympanum were tested on 50 temporal bones. The hypotympanum has the shape of an irregular bony groove which is surrounded by five walls. The outer wall is formed by the tympanic part of the temporal bone. In 65 per cent of the cases the inner wall is formed by part of the petrous bone which extends under the promontory; in 25 per cent it is formed only by the lower part of the promontory; and in 10 per cent it corresponds to the juncture of the promontory and the petrous bone. The lower wall is clearly defined in 48.2 per cent of cases and corresponds to the juncture of its inner and outer walls. In 65 per cent of cases a recess of the inferior hypotympanic sinus is found on the floor of the hypotympanum. In 25.3 per cent of cases the jugular bulb protrudes into the tympanic cavity. In 73.4 per cent of cases the front wall is formed by part of the petrous bone which extends from its floor towards the tympanic opening of the protympanum, and in 26 per cent of the cases it is formed by the wall of the internal carotid artery. On the front wall, in 22.4 per cent of cases, a recess of the anterior hypotympanic sinus is found. The back wall is formed by elements of the styloid complex and in five per cent of the cases a recess or posterior hypotympanic sinus is found on it.

Fibrous dysplasia of the temporal bone and maxillofacial region associated with cholesteatoma of the middle ear

Fibrous dysplasia of the temporal bone is a rare disease which may lead to progressive stenosis of the external auditory canal and the development of cholesteatoma. We present a case in which minimal symptoms were present despite a massive temporal bone fibrous dysplasia. Cholesteatoma resulted most probably secondary to external auditory canal stenosis. Retroauricular fistula developed as a result of destructive effect of cholesteatoma, that influenced previous diagnosis and treatment of this clinically silent disease.

The relations of the mastoid segment of the facial canal to surrounding structures in congenital middle ear malformations

The authors investigated the relations between the mastoid segment of the facial canal and the temporomandibular joint, the posterior wall of the cavum tympani and the external wall of the mastoid process in 19 cases with congenital ear malformations and 10 cases with normal ears. A significantly reduced distance was found between the facial canal and the temporomandibular joint as well as between the facial canal and the posterior wall of the cavum tympani in the groups with malformed ears as compared to the control group with normal ears.

Hensen's Cell Cyst of the Organ of Corti

The temporal bone collection at the Massachusetts Eye and Ear Infirmary contains the bones of two subjects with bilaterally symmetrical cyst formations in the Hensens cell areas of the organs of Corti. In both subjects the cysts are located in the 8-14-mm regions of the cochlear ducts. Both cochleas of one subject show pressure atrophy of the outer hair cells, demonstrating that the cysts may have the potential for producing high-tone hearing loss. While the genesis and contents of the cysts are unknown, it is postulated that they may represent the coalescence of lipid droplets extruded from Hensens cells.

Anatomical variations and relations of the medical and lateral portions of the attic and their surgical significance

The medial and lateral attics were examined in 150 specimens of temporal bones of adults using anatomical and histological methods. The medial attic varies in shape and size, depending upon the position of the auditory ossicles, the degree of prominence of the lateral semicircular canal and the direction in which the tympanic segment of the facial canal extends. The latero-medical diameter of this attic at the level of the body of the incus averages 1.7 mm., but is somewhat smaller at the level of the head of the malleus. The medial attic always communicates with the mesotympanum through an opening between the prominence of the tympanic part of the facial canal and the superstructures of the auditory ossicles. The lateral attic is always of smaller dimensions than the medial attic and its latero-medial diameter averages less than 1 mm. This attic very seldom communicates with the mesotympanum.

Endotemporal Branching of the Facial Nerve

Out of 400 specimens of temporal bone the authors found two cases of branching of the facial nerve in the mastoid course, i.e., 0.5%. Knowledge of this anomaly has a certain practical value in surgical intervention of the middle ear.