Aneurysmal bone cyst of mastoid bone is seldom, here one case was reported. The mastoid bone of the patient presented with a baloon-like swelling full of non-coagulated blood and serous-hemorrhagic fluid. CT scan demonstrated a large expansile destructive mass located in left mastoid bone region with the thin or absent cortical bone. The MRI demonstrated T2-weighted images and clear boudary from surrounding tissue. Pathologic reported that the mastoid bone was repalcement with lacunar divided by fibro-tissue, containing numerous hemosiderin, giant cells and inflammatory cells. A surgery was performed and the patient was cured.
Bone Cysts, Aneurysmal ; diagnosis ; pathology ; surgery ; Humans ; Magnetic Resonance Imaging ; Mastoid ; pathology ; Tomography, X-Ray Computed

OBJECTIVE: To investigate the reconstruction method of lateral attic wall with tragal cartilage and temporalis fascia graft. And analyze the postoperative result of its clinical application. METHOD: From Jan 2005 to Jul 2014, 45 patients whose middle ear disease were limited to attic received this surgery in our department. Among 31 cases of cholesteatoma otitis media and 14 cases of external auditory canal cholesteatoma were included. In order to expose the attic fully, we operated epitympanotomy through retroauricular incision and then removed the scutum and lateral attic bone wall. After eliminating the lesions, we reconstructed the lateral attic bone wall with tragal cartilage, covered the cartilage with temporalis fascia and then repaired the tympanic membrane and external ear canal skin. After surgery, all patients were followed up at 10 days, 1 month, 2 months, 6 months and 1 year. RESULT: Two months after surgery, 45 patients' achieved one-stage wound healing. Six months later, all of the patients' operation area had epithelized completely. After 1 year, 37 patients had recovered the normal shapes and stable audition; 7 cases patients have different level tympanic membrane retraction; 1 patient suffered from tympanic membrane retraction and recurrent cholesteatoma. CONCLUSION With regard to the lesion limited to the attic, we can remove it by operating epitympanotomy through retroauricular incision, and then reconstruct the lateral attic wall with tragal cartilage and temporalis fascia. By the support of the cartilage, we can keep the epitympanic aeration, reduce the retraction of pars flaccida membrana tympani, and maintain the fundamental shape of lateral attic wall.
Cartilage ; transplantation ; Cholesteatoma ; surgery ; Ear Auricle ; Ear Canal ; Ear Diseases ; surgery ; Ear, Middle ; pathology ; Fascia ; transplantation ; Humans ; Mastoid ; Otitis Media ; surgery ; Tympanic Membrane ; surgery ; Tympanic Membrane Perforation ; surgery

Heterotopic brain tissue usually involves extracranial midline structures of the head and neck such as nose, nasopharynx, and oral cavity. Its occurrence in the non-midline structures, including middle ear, is rare. We described a 50-yr-old-man with heterotopic glial tissue in the middle ear and mastoid bone. The patient presented with progressive hearing loss for 8 yr. There was no history of congenital anomalies, trauma, or ear surgery. Computed tomography revealed a mass-like lesion with soft tissue density occupying the middle ear cavity and mastoid antrum. At the operation, a graywhite fibrotic mass was detected in the epitympanic area. Mesotympanum and ossicles were intact. The patient underwent left simple mastoidectomy with type I tympanoplasty. During operation, definite cranial bone defect or cerebrospinal fluid leakage was not found. Histologically, the lesion was composed of exclusively mature, disorganized glial tissue with fibrovascular elements in a rather loose fibrillary background. Glial tissue showed diffuse positive reaction for glial fibrillar acidic protein and S100 protein on immunohistochemical study.
Audiometry ; Brain/pathology ; Brain Diseases/*pathology ; Choristoma/*diagnosis ; Ear, Middle/*pathology ; Human ; Immunohistochemistry ; Male ; Mastoid/*pathology/surgery ; Middle Aged ; Neuroglia/*pathology ; Tomography, X-Ray Computed

OBJECTIVETo investigate the efficacy of operations of acquired middle ear cholesteatoma.

METHODSRetrospectively analyzed clinical data of 102 patients whom received tympanoplasty with CWU or CWD with mastoid obliteration in our hospital between January 2014 and December 2014. Patients were divided into different groups according to types of the cholesteatoma as well as the different surgical procedures. Patients were followed up for 12-24 months, the pre and post-operative PTA was performed and evaluated. The post-operative hearing was assessed in terms of average ABG.

RESULTSThe average dry ear time was (5.4±1.7)weeks. The dry ear time of patients of attic cholesteatoma was shorter than those of tensa cholesteatoma[(4.9±1.7)weeks vs(6.1±1.5)weeks, t=-3.52, P=0.001]; the dry ear time of patients underwent CWU was shorter than those underwent CWD with mastoid obliteration[(2.3±0.5)weeks vs(5.8±1.4)weeks, t=-8.43, P=0.000]. Mean pre and post-operative air bone gaps in 93 ears underwent ossiculoplasty were (34.2±11.8)dB and (19.0±5.5)dB respectively and these differences were statistically significant. Both the pre and post-operative air bone gaps of ears of attic cholesteatoma were smaller than those ears of tensa cholesteatoma(P<0.05). In the patients who underwent ossiculoplasty with CWD with mastoid obliteration, the post-operative air bone gaps of attic cholesteatoma were smaller than those of tensa cholesteatoma(P<0.05). Both the pre and post-operative air bone gaps of ears underwent CWU were smaller than those underwent CWD with mastoid obliteration(P<0.05). The post-operative air bone gaps of ears underwent PORP with CWD with mastoid obliteration were smaller than those underwent TORP with CWD with mastoid obliteration(P<0.05).

CONCLUSIONSBoth the hearing loss and the outcome of tensa cholesteatoma are worser than attic cholesteatoma. The outcome of PORP is better than TORP. The patients who will accept CWU should be selected more carefully and be followed up regularly.

Cholesteatoma, Middle Ear ; classification ; surgery ; Ear, Middle ; pathology ; Hearing ; Hearing Loss ; Humans ; Mastoid ; surgery ; Postoperative Period ; Retrospective Studies ; Treatment Outcome ; Tympanoplasty

OBJECTIVETo analyze factors relevant to revisional tympanomastoid surgery for chronic otitis media(COM).

METHODSThe clinical data of 159 patients (159 ears), who exhibited either wet ear or relapsed after the initial operation, and were subjected to revisional tympanomastoid surgery, were retrospectively analyzed in this study. Of those 159 consecutive patients, 85 were males and 74 were females, aged 11-64 years, with a median age of 36 years old. The situations in terms of intra-operative findings, surgical procedures, change dressing post-operation, dry ear time, and the improvement of aural ability during the second operation, were recorded and analyzed.

RESULTSThe second surgery found that, of those 159 patients underwent the re-operation, 67 presented with cholesteatoma and 92 had no cholesteatoma. In addition, the inadequate skeletonization and insufficient opening for mastoid cavity accounted for 70.4% (112/159) of all previous operations, the external auditory canal stenosis for 98.7% (157/159), the high facial ridge leading to insufficient drainage for 61.0% (97/159), the lesion in tympanic ostium of Eustachian tube for 34.6% (55/159), the insufficient drainage due to inappropriate post-operating dressing for 5.0% (8/159), the postauricular incision for 30.8% (49/159), and the endaural incision for 69.2% (110/159). As for the re-operation of the canal wall down mastoidectomy, tympanoplasty plus plastic repairing of cavity of concha were performed in 94 cases, the modified Bondy plus plastic repairing of cavity of concha in four cases, the radical mastoidectomy plus plastic repairing of cavity of concha in 59 cases, and the simple cleaning for mastoid cavity in two cases. Since one to two weeks after the revisional operations, the post-operating dressing was performed with aid of microscopy once a week on average. The average dry ear time ranged from 2 to 6 weeks (median=3 weeks). During a period of 6-93 months for the follow-up, all patients presented with dry ears. The epithelialization of the operating cavity was well and the tympanic membranes were integrity. Neither granulation tissue nor cholesteatoma was found to reoccur. Both pure tone hearing thresholds and air-bone gap decreased in 87 cases after the revisional operation, with statistically significant different in comparison to those two parameters before the operation (P<0.05).

CONCLUSIONThe primary causes responsible for the wet ear or reoccurrent cholesteatoma after tympanomastoid surgery may be related to the improper operation procedures and selection of incision, the non-standard operation, inexhaustive removal of pathological tissues, as well as the irregular postoperation change dressing, and other factors.

Adolescent ; Adult ; Child ; Cholesteatoma, Middle Ear ; surgery ; Chronic Disease ; Ear Auricle ; surgery ; Eustachian Tube ; pathology ; Female ; Humans ; Male ; Mastoid ; surgery ; Middle Aged ; Otitis Media ; surgery ; Postoperative Period ; Reconstructive Surgical Procedures ; Reoperation ; Retrospective Studies ; Treatment Outcome ; Tympanic Membrane ; pathology ; surgery ; Tympanoplasty ; Young Adult