The possible associations of septal deviation on mastoid pneumatization and chronic otitis

The Age-Related Growth of Mastoid Air Cells in Infancy: A Retrospective Cross-Sectional Study

OBJECTIVES

To investigate the normal growth and development of mastoid pneumatization volume from 5 to 12 months for pediatric otosurgeons.

STUDY DESIGN

Retrospective chart review.

SETTING

A tertiary referral center.

PATIENTS

This study evaluated age-dependent changes in mastoid air cell volume in 94 (188 ears) patients aged 5 to 12 months without a history of middle ear disease.

MAIN OUTCOME MEASURES

Volume reconstruction was based on high-resolution computed tomography images using a three-dimensional reconstruction that is considered normal by radiologists. One-way analysis of variance and linear regression were used to determine the relationship between the volume and age in male and female subjects.

RESULTS

Forty-eight scans were from male and 46 from female patients. In the age group from 5 to 12 months, the mastoid pneumatization was independent of age ( p > 0.05). There were no significant volume differences found between the age groups. Neither male/female nor right/left significant differences were observed in relation to the algebraic data of the mastoid air cells volume ( p > 0.05).

CONCLUSIONS

Based on this analytic study, we are the first to use three-dimensional volume quantification based on high-resolution computed tomography in such large samples of early infancy. Because of its potential role as a susceptibility factor for otitis media and other otologic problems, it is important to describe the growth and development of mastoid pneumatization. More extensive clinical studies are needed to give a comprehensive insight into the air cell volume across age groups in different populations.

The Relationship Between Temporal Bone Pneumatization Pattern and Sinus Mucosal Thickness Grading on Computed Tomography Scans of Paranasal Sinuses

The relationship between temporal bone pneumatization (TBP) pattern and sinus mucous thickness grading on computed tomography scans of paranasal sinuses was investigated. In this cross-sectional study, a total of 200 temporal bones and paranasal sinuses were evaluated in CT scans of 100 patients with chronic sinusitis (CRS). The mucosal thickness of paranasal sinuses was classified into two groups (0-6 and 7-12) according to the Lund-Mackay (LM) staging system. Also, pneumatization patterns of petrous apex and perilabyrinthine regions were classified according to Jadvah et al. method. Data were analyzed using Chi-square and Fisher's exact tests. The most common pneumatization pattern in the petrous apex was pattern A (49.5%) and in the perilabyrinthine region was pattern B (50%). In the petrous apex, the highest frequencies of pattern A (51.7%) and pattern C (24.6%), among other pneumatization patterns, were found in score range of 7-12 and 0-6, respectively, which was statistically significant (P = 0.017). Although in the perilabyrinthine region, the highest frequencies of pattern A (24.1%) and pattern C (32.7%) were in LM score ranges of 7-12 and 0-6, respectively, no significant difference was found (P = 0.589). The petrous apex pneumatization decreases with an increase in the severity of CRS, which can be in response to the eustachian tube dysfunction and common pathogens with CRS. A similar relationship was also found in the perilabyrinthine region, although it was not statistically significant. No significant relationship between TBP and severity of CRS was found in the age and sex groups.

The prognostic value of subjective nasal symptoms and SNOT-22 score in middle ear surgery

BACKGROUND

The relationship between nasal functions and middle ear surgery is still under debate. Nasal obstruction is considered as a negative prognostic factor in middle ear surgery. This is based on the theory that it may cause Eustachian tube dysfunction (ETD) by leading to reduced ventilation of the middle ear, as found in several patients with nasal septal deviation, chronic rhinitis and nasal polyps.

OBJECTIVES

To assess how the subjective feeling of nasal function, evaluated by a preoperative questionnaire, may be predictive of surgical outcome and/or risk of failure in middle ear surgery.

METHODS

We prospectively evaluated data of patients undergoing middle ear surgery for chronic otitis media with and without cholesteatoma. All patients completed the SNOT-22 and ETDQ-7 questionnaires. They underwent surgery for their pathology, as appropriate.

RESULTS

The SNOT-22 score was higher in patients with retraction pocket and in patients whose retraction pockets recurred after surgery (p < 0.05). Patients with higher score at SNOT-22 questionnaire, were more likely to show recurrence of atelectasis aftersurgery.

CONCLUSIONS

The SNOT-22 questionnaire, administrered before surgical procedure, can help in the identification of patients who are at risk of failure in the post-operative period, as well as ETDQ-7.

Linking Chronic Otitis Media and Nasal Obstruction: A CFD Approach

OBJECTIVES

To investigate a possible relationship between altered nasal flow and chronic otitis media (COM) using computational fluid dynamics (CFD).

STUDY DESIGN

Retrospective case series.

METHODS

Retrospective cohort sample of CT scans from patients with COM and controls without COM to compare the results of various nasal airflow parameters determined by CFD between a group of patients with COM (N = 60) and a control group of subjects without any evidence of ear disease (N = 81). The CT were subjected to various procedures to carry out CFD studies, determining the resistance to nasal flow, the proportion of flow through the right and left nasal cavity, and two nondimensional estimators. The results of CFD studies between patients with COM and controls were compared.

RESULTS

Whereas only 12.3% of the controls had CFD alteration (10 out of 81), 43.3% of the patients suffering COM displayed alterations of our nondimensional parameters R - ϕ (26 out of 60).

CONCLUSIONS

According to our results, the incidence of alterations in nasal airflow by studying with CFD is significantly higher in patients with COM than in controls. To our knowledge, this is the first article linking nasal cavity and COM using a CFD approach. Our results support the hypothesis that nasal flow alterations could be implicated in the etiopathogenesis of the COM.

LEVEL OF EVIDENCE

Level 4 Laryngoscope, 2021.

Impact of the Angles of the Septal Deviation on the Degree of the Mastoid Pneumatization

Introduction:

The aim was to explore the developmental relationships between the angles of septal deviations and the degree of the mastoid pneumatization.

Materials and Methods:

In total, 143 patients with a diagnosis of septal deviation who underwent septoplasty were included. The patients were divided into three groups in terms of the angles of the septal deviation. The angle of the septal deviations was defined as mild (<9 degrees), moderate (between 9 and 15 degrees) and severe (15 degrees and above). The degree of the mastoid pneumatization of each groups were compared.

Results:

In right-sided septal deviation subjects, the right mastoid air cell volumes of group mild, moderate and severe were 6,31±2,33 cm3, 5,20± 1,51 cm3, and 5,31±1,57 cm3, respectively. The mean right mastoid volumes of each groups did not differ in right-sided deviations subjects (P>0.05). The mean left mastoid volumes of each groups did not differ in right-sided deviations subjects (P>0.05). In right-sided septal deviation subjects, the mean volume of the right and left-sided mastoid air cells of each groups did not differ (P>0.05). In left-sided septal deviation subjects, the mean volume of the right and left-sided mastoid air cells of each groups did not differ (P>0.05).

Conclusions:

No developmental relationships between the angles of septal deviations and the degree of the mastoid pneumatization was observed in the study.

The Effect of Nasal Septal Deviation on the Postoperative Hearing Results of Patients With Tympanosclerosis

OBJECTIVE

The main aim is to discuss the effect of nasal septal deviation on the postoperative hearing results of patients with tympanosclerosis.

MATERIAL AND METHODS

We analyzed the hearing results of patients with tympanosclerosis who were operated on in a tertiary center. Pure tone audiometric results were compared according to the existence of nasal septal deviation.

RESULTS

This study included 48 patients with unilateral tympanosclerosis disease. Moderate or severe septal deviation had no significant effect on postoperative hearing results.

CONCLUSION

The nasal septal deviation as the only pathologic factor in patients with tympanosclerosis did not have a deteriorating effect after surgery.

The Possible Associations of Nasal Septal Deviation with Mastoid Pneumatization and Chronic Otitis

BACKGROUND:

The nasal septum deviation is the most common deformity of the nasal, and that can be congenital or acquired. Despite many studies exist about the impact of nasal septum deviation on chronic sinusitis and also association between chronic otitis and mastoid pneumatization; few studies exist about the impact of nasal septum deviation on chronic otitis and mastoid pneumatization.

AIM:

The aim of this study was to evaluate the associations of nasal septum deviation and mastoid pneumatization and chronic otitis.

METHODS:

In this study review, all CT scans of PNS and Mastoid View in the imaging section from Imam Ali hospital in 2016-2017 years and cases of nasal septum deviation were enrolled. The nasal septum deviation was recorded, and the degree of nasal septum deviation in the coronal plane that showed the maximum deviation of the nasal septum was recorded. The volume of the mastoid cells automatically and directly was calculated using three diameter measurements (2 coronal diameters and 1 axial diameter) by the program. The software of SPSS 22 was used for statistical analysis.

RESULTS:

There was no relationship between nasal septum deviation severity and incidence of mastoid pneumatization in patients with nasal septum deviation (P > 0.05). There was relationship between nasal septum deviation severity and chronic otitis in patients with nasal septum deviation (P < 0.05). In patients with moderate and severe intensity of nasal septum deviation, the volume of mastoid air cells in deviation side was lower than the front side (P < 0.05).

CONCLUSION:

Based on the results of the CT scan, in patients with moderate and severe nasal septum deviation intensity, the volume of mastoid air cells in deviation side was lower than the front side. Also, there was a relationship between nasal septum deviation severity and chronic otitis.

Panel 2: Anatomy (Eustachian Tube, Middle Ear, and Mastoid-Anatomy, Physiology, Pathophysiology, and Pathogenesis)

Objective In this report, we review the recent literature (ie, past 4 years) to identify advances in our understanding of the middle ear-mastoid-eustachian tube system. We use this review to determine whether the short-term goals elaborated in the last report were achieved, and we propose updated goals to guide future otitis media research. Data Sources PubMed, Web of Science, Medline. Review Methods The panel topic was subdivided, and each contributor performed a literature search within the given time frame. The keywords searched included middle ear, eustachian tube, and mastoid for their intersection with anatomy, physiology, pathophysiology, and pathology. Preliminary reports from each panel member were consolidated and discussed when the panel met on June 11, 2015. At that meeting, the progress was evaluated and new short-term goals proposed. Conclusions Progress was made on 13 of the 20 short-term goals proposed in 2011. Significant advances were made in the characterization of middle ear gas exchange pathways, modeling eustachian tube function, and preliminary testing of treatments for eustachian tube dysfunction. Implications for Practice In the future, imaging technologies should be developed to noninvasively assess middle ear/eustachian tube structure and physiology with respect to their role in otitis media pathogenesis. The new data derived from these structure/function experiments should be integrated into computational models that can then be used to develop specific hypotheses concerning otitis media pathogenesis and persistence. Finally, rigorous studies on medical or surgical treatments for eustachian tube dysfunction should be undertaken.

Pneumatization Patterns of the Petrous Apex and Lateral Sphenoid Recess

Introduction  The petrous apex poses a challenge for surgical intervention due to poor access. As intraoperative image guidance and surgical instrumentation improve, newer endoscopic approaches are increasingly favored. This study aims to provide normative data on the anatomy of the lateral sphenoid sinus recess and petrous apex. These normative data could assist in determining the efficacy of a transnasal transsphenoidal approach to lesions of the anteroinferior petrous apex. Methods  This is a retrospective study investigating normative data on all maxillofacial computed tomography (CT) scans performed at a level I trauma center over a 6-month period. All appropriate images had the pneumatization pattern of the petrous apex and lateral recess of the sphenoid sinus reviewed by a single otologist and graded bilaterally. These were then analyzed in SPSS; Pearson correlation analyses and χ ² test were used. Results  A total of 481 patients were identified, yielding a total of 962 temporal bones and sphenoid sinuses for analysis. Eighty-eight percent of sides analyzed had a nonpneumatized lateral recess. The petrous apex was nonpneumatized in 54% of sides analyzed. There was a correlation noted between the degree of pneumatization of the petrous apex and pneumatization of the lateral recess of the sphenoid. Conclusion  This study is the first to provide normative data comparing pneumatization of the petrous apex and sphenoid sinus. These data may support future work evaluating the utility of an endonasal approach to the petrous apex.

Temporal bone thickness and texture are major determinants of the high rate of insonation failures of transcranial Doppler in Amerindians (the Atahualpa Project)

PURPOSE

To assess the role of temporal bone characteristics in transcranial Doppler (TCD) insonation failures in Amerindians living in rural Ecuador.

METHODS

We evaluated thickness and texture of temporal bones in community-dwelling Amerindians ≥65 years old undergoing TCD. Using receiver operator characteristics curve analysis and generalized estimating equations, we investigated factors associated with insonation failures.

RESULTS

Of 65 participants (mean age 74.7 ± 6.7 years, 60% women), 32 (49%) had uni- or bilateral insonation failure through temporal windows. Considering temporal bones independently, 57 of 130 (44%) had poor insonation. Mean thickness was higher (4.7 ± 1.2 versus 2.7 ± 0.9, p < 0.0001), and texture more often heterogeneous (93% versus 22%, p < 0.0001) in bones with poor acoustic windows. Thickness, better predicting poor insonation, was ≥3.6 mm if used alone, and ≥2.7 mm if used together with heterogeneous texture. For every millimeter of increase in thickness, subjects were 2.9 times more likely to have insonation failures. Per se, heterogeneous texture increased by 3.2 times the odds for poor insonation. In all models, being woman increased the odds for poor insonation by six to nine times.

CONCLUSIONS

Temporal bone thickness and texture are independent predictors of TCD insonation failure in Amerindians.

Assessment of nasal airway resistances and nasal mucociliary activities of patients with unilateral chronic otitis media by acoustic rhinometry and saccharin test

CONCLUSIONS

A significant increase was determined in nasal airway resistance of the pathological side of the patients with unilateral chronic otitis media (COM) compared with the non-pathological side and the patients with normal ears. Based upon this result, nasal pathologies should also be considered during the diagnosis and treatment stages of patients with COM.

OBJECTIVES

We aimed to investigate whether there was a causal relationship between nasal pathologies causing eustachian tube dysfunction and COM.

METHODS

Thirty patients were randomly selected from among patients who presented due to hearing loss and ear discharge, and 30 healthy volunteers were randomly selected as the control group. Acoustic rhinometry and saccharin tests were performed in all of the subjects. Test results were recorded for both the groups and statistical analysis was performed.

RESULTS

A statistically significant correlation was found between the pathological results and COM side in acoustic rhinometry (p < 0.01). The prevalence of pathology in the right side of the nasal cavity was found to be higher in the group with perforation in the right ear (73.7%) and in the left side of the nasal cavity was also found to be higher in the group with perforation in the left ear (54.5%).

Analysis of Nasal Septal Deviation in Cleft Palate and/or Alveolus Patients Using Cone-Beam Computed Tomography

OBJECTIVE

This study was performed to analyze features of nasal septal deviation of patients with different cleft types and noncleft controls.

STUDY DESIGN

Case-control study.

SETTING

West China Hospital of Stomatology, Chengdu, China.

SUBJECTS AND METHODS

Sixty-six patients with palatal and/or alveolar cleft and 42 noncleft controls were recruited in the study. All the subjects have undergone cone-beam computed tomography scan. The range, angle, vertical location, and convex direction of nasal septal deviation were carefully studied for each subject. The data were compared between the cleft group and noncleft controls. The differences of deviation among various cleft types were also carefully evaluated to demonstrate whether the differences in cleft types affect the features of nasal septal deviation.

RESULTS

The mean range 7.71 mm and angle 10.37° of nasal septal deviation in cleft group were significantly greater than that in control group of 1.96 mm and 2.34°. The maximum point of nasal septal deviation in cleft group vertically occurred more often at inferior turbinate level (27/66) followed by lower inter-turbinate level (16/66) and middle turbinate level (11/66). Patients with complete cleft palate presented greater deviation than incomplete cleft palate or simple cleft alveolus patients. The convex direction of deviation was to the cleft side for all patients with complete cleft palate or simple alveolar cleft.

CONCLUSION

Patients with cleft palate and/or alveolus presented greater deviation of nasal septum than noncleft controls. Patients of different cleft types showed various severity and features of nasal septal deviation.