A 27-year-old man undergoes otolaryngologic evaluation for blunt head trauma suffered in a vehicular accident. With regards to the right ear, pertinent otologic findings include an ear canal laceration and a delayed-onset facial nerve paresis. Tuning fork testing reveals an abnormal Rinne test on the right (ACimaging study of the temporal bone indicated the presence of a longitudinal fracture of the right temporal bone with no disruption of the ossicular chain. (Figure 1) However, careful examination of the anatomy of the malleo-incudal complex in relation to the other structures in the epitympanum actually reveals findings indicative of a malleo-incudal complex dislocation. How can this discrepancy in the radiologic interpretation be accounted for? By what objective parameters can the presence of a malleoincudal complex dislocation be identified?
Temporal Bone ; Diagnostic Imaging ; Ear Ossicles

Bone Neoplasms/therapy* ; Humans ; Temporal Bone/diagnostic imaging*

Encephalocele ; Facial Bones ; Humans ; Meningocele ; Temporal Bone/diagnostic imaging*

Ear, Inner/diagnostic imaging* ; Temporal Bone/diagnostic imaging* ; Tomography, X-Ray Computed/methods*

During a discussion on temporal bone imaging, a group of resident trainees in otolaryngology were asked to corroborate the finding of a fracture in set of images that were supposed to be representative of a fracture involving the otic capsule.1(Figure 1) Their comments included the following statements: “The image still does not clearly identify the fracture. It would have been better if the images were set to the optimal bone window configuration...” “The windowing must be of concern as well. The exposure setting for the non-magnified view is different from the magnified ones. One must observe consistent windowing in order to assess the fractures more accurately.” “...the images which demonstrate a closer look on the otic capsule areas are not rendered in the temporal bone window which makes it difficult to assess.” “...aside from lack of standard windowing...”
Tomography, X-Ray Computed ; Temporal Bone Diagnostic ; Imaging Diagnostic Tests ; Routine ; Tomography, X-Ray Computed ;

UNLABELLEDOBJECTIVE To make the computer tomography data based rapid prototyping models of the temporal bone and discuss its prospect for clinical application.

METHODSThree-dimensional models of one normal temporal bone and five dry temporal bones were reconstructed using volume rendering software of Materialise Mimics 6. 3 based on horizontal slices of one normal temporal bone and five dry temporal bones scanned and reconstructed with spiral CT. This model was duplicated with Auro SLA stereolithographic rapid prototyping machine and operational practice was performed.

RESULTSThree-dimensional computer model of temporal bone were reconstructed and duplicated successfully with clear bony marks on its surface and clear display of interior delicate structures on different sections. It was proved by operational practice that this model could be used for simulation of clinical operation of temporal bone.

CONCLUSIONSRapid prototyping technique could duplicate real model of temporal bone which could be used for preoperational practice. It had broad prospect of application in lateral skull base surgery and had significance for designing operational approach and decreasing complications.

Computer Simulation ; Humans ; Imaging, Three-Dimensional ; Models, Anatomic ; Temporal Bone ; diagnostic imaging ; Tomography, Spiral Computed

OBJECTIVE: To explore the high resolution CT image of temporal bone in infants with hearing loss, and its value in evaluating the cause of hearing loss. METHOD: In 2005, 0.12 million newborns have been included in the hearing screening system in Shanghai, and 1077 infants have failed to pass the hearing screening. One hundred and eight four infants were diagnosed as congenital hearing loss from mild to profound. A temporal bone HRCT scanning was performed to these infants. RESULT: Among the 184 patients with congenital hearing loss, HRCT showed that 26 cases (14.1%) were associated with external ear malformation, and 21 cases (11.4%) were associated with middle ear malformation, 31 cases (16.8%) associated with inner ear malformation. The patients with inner ear malformation included 12 cases with Mondini malformation, 1 case with common cavity malformation, 6 cases with large vestibule malformation, 5 cases with internal auditory canal abnormalities, and 10 cases with vestibule, semicircular canals abnormalities. In addition, there were 20 cases (10.8%) with fluid in middle ear. CONCLUSION HRCT image play an important role in the differential diagnosis and treatment of infants with congenital hearing loss.
Hearing Loss ; diagnostic imaging ; Hearing Tests ; Humans ; Infant, Newborn ; Neonatal Screening ; Temporal Bone ; diagnostic imaging ; Tomography, X-Ray Computed

OBJECTIVE: To investigate the diagnostic value of high resolution CT for temporal bone traumatic facial nerve paralysis and the guidance significance for surgery. METHOD: Twenty-nine patients of traumatic facial nerve paralysis were investigated. The predictive diagnosis was made according to the clinical data and the image features of HRCT, then a comparative analysis of the preoperative image features and the surgical findings were carried out. RESULT: The trend of temporal bone fracture displayed on the CT scan was basically consisted with the surgical findings. The direct CT signs of facial nerve injury include the bone fracture line went through the tube, bone tube rupture or continuity interruption, while the indirect CT signs include local incrassation of the facial nerve, lower bone density of the tube, geniculate fossa expansion, oppressed facial nerve, et al. The predictive diagnostic accordance rates of all the image features were above 90% as to the surgical findings. CONCLUSION High resolution CT could localize the trend of temporal bone fracture,and is helpful to estimate the extent of facial nerve injury and other complications. High resolution CT could provide reliable basis for clinical diagnosis and treatment.
Adolescent ; Adult ; Facial Nerve ; diagnostic imaging ; Facial Nerve Injuries ; diagnostic imaging ; Facial Paralysis ; diagnostic imaging ; Female ; Fractures, Bone ; diagnostic imaging ; Humans ; Male ; Middle Aged ; Temporal Bone ; diagnostic imaging ; injuries ; Tomography, X-Ray Computed ; methods ; Young Adult

OBJECTIVETo appreciate clinically of masked mastoiditis to explored how to reduce the incidence and associated morbidity of otogenic complications.

METHODSBetween January 1998 and February 2005, 11 cases of masked mastoiditis were collected retrospectively. Their clinical presentation, results of investigations, and response to treatment were reviewed.

RESULTSOf 11 cases, there were 8 cases with hearing impairment, 5 cases with otalgia, 4 cases with facial nerve palsy, one patient with postauricular subperiosteal abscess, one case with meningitis, and one with thrombosis of the lateral sinus. Computed tomography (CT) scan revealed blurring (haziness) of the mastoid air-cells. After admission, intravenous antibiotics were prescribed and antro-mastoidectomy or mastoidectomy was performed for eradication of infection source. The predominant finding at mastoidectomy was granulation tissue filling the mastoid cavity and antrum. A varying amount of pus and osteitis was found in the 5 cases. The granulations into the antrum were severe, obstructing the drainage into the attic and the middle ear. The mastoid tip cells were filled with granulation tissue which spared the antrum. The patients recovered excellently postoperative, without facial palsy, vertigo or other complications.

CONCLUSIONSTo be a contemporary otologist, such severe complications of otologic diseases should not be overlooked. Appropriate intravenous antibiotics and adequate surgeries, as soon as possible, were recommended. Advanced CT scans of the temporal bone were necessary. Failure to identify associated concomitant pathology might result in treatment failure or persistent neurological deficit.

Adult ; Aged ; Female ; Humans ; Male ; Mastoiditis ; diagnostic imaging ; surgery ; Middle Aged ; Otitis Media ; diagnostic imaging ; surgery ; Retrospective Studies ; Temporal Bone ; diagnostic imaging ; Tomography, X-Ray Computed

OBJECTIVE: To investigate the clinical features in cochlear otosclerosis. METHOD: Three cases with cochlear otosclerosis in our hospital from March 2007 to October 2008 were reported and the relevant literatures were reviewed. All the cases were confirmed the diagnose by temporal bone high-resolution CT scan (HRCT). RESULT: The chief complaint when visited was recurrent episodic vertigo or equilibrium disturbance with progressing hearing loss in all cases. Two ears in 2 cases were simple sensorineural deafness and considered the pure cochlear otosclerosis. Others were mixed deafness with the descent of bone conduction in different extent. The characters in HRCT: the low density area could be seen in different areas of the otic capsule, the pericochlear lucency or double-ring effect were the typical signs. CONCLUSION The diagnosis of cochlear otosclerosis is considered in the insoluble sensorineural deafness and the mixed deafness with vestibular symptoms and chronic hearing loss history. Temporal bone HRCT plays an important role in the clinical diagnosis of cochlear otosclerosis.
Adult ; Aged, 80 and over ; Cochlea ; diagnostic imaging ; Female ; Humans ; Middle Aged ; Otosclerosis ; diagnosis ; diagnostic imaging ; Temporal Bone ; diagnostic imaging ; Tomography, X-Ray Computed