Pediatric neurotology

Tympanomastoid cholesterol Granulomas presenting as a Blue Eardrum in children

OBJECTIVE(S)

This clinical study was performed to analyze the characteristics of cholesterol granuloma (CG) and evaluate our results in children.

METHODS

The clinical records of children diagnosed with CG were retrospectively reviewed.

RESULTS

The total of 17 children (20 ears) with CGs were included in this study. Endoscopy revealed pars flaccida retractions and lipoid tissue deposition behind the intact blue tympanic membrane (TM). CT scan revealed bony erosion and extensive soft tissue in the middle ear and mastoid. No ossicular chain destruction was found. All 20 ears underwent canal wall-up mastoidectomy and ventilation tube (VT) insertion, 3 sets of VT were performed in 5 ear and 2 sets in one. The residual perforation was seen in 2 ears following VT. The CT revealed well-pneumatized antra and tympanic cavities at postoperative 12-24 months.

CONCLUSION(S)

The CG should be suspected for the patients with yellow lipoid deposition behind the blue TM. CT of CG usually revealed bony erosion and extensive soft tissue in the middle ear and mastoid. Mastoidectomy combined with VT insertion and etiological treatment have a favorable prognosis for CG in children.

Salvaging the Exposed Cochlear Implant

Cochlear implant exposure is an uncommon occurrence that may imperil the fate of the implant. Insertion of this costly device is a delicate procedure, and reimplantation with another implant after removal is expensive and emotionally stressful for patients. Salvage of the original implant can be quite successful with a fully vascularized scalp-nape of the neck rotation flap. The authors review the literature and report their experience in salvaging exposed implants in 2 patients, who had risk factors that compromised healing.

Differenzialdiagnose von Raumforderungen im Kleinhirnbr�ckenwinkel

Most of the space demands in the cerebellopontine angle lie extra-axially. Important structures run within the cisterns of the cerebellopontine angle, such as the trigeminal, facial and vestibulocochlear nerves as well as the anterior inferior and posterior inferior cerebellar arteries and the veins which lead to the petrosal sinus. The most common space demands are caused by acoustic neuromas, meningeomas, vascular ectasia and aneurysms. Less common are epidermoid and other schwannomas as well as metastases, paragangliomas and arachnoidal cysts. Intra-axial tumours in the area of the cerebellopontine angle include the medulloblastoma, astrocytoma and the ependymoma, which occurs predominantly in children, in addition to the uncommon choroid plexus papilloma. Nearby, there are also space demands around the petrous bone, such as cholesterol granuloma, malignant otitis media, paraganglioma and metastases. For differential diagnosis, an understanding of the space requirements of the tumours in the cerebellopontine angle is needed in addition to knowledge of the anatomical structures.