Radiographic anatomy of the petrous apex: A study related to the middle fossa approach

Otolaryngology– Head and Neck Surgery Volume 131 Number 2

P027 Rapid Diagnosis of Mycobacterial Cervical Adenitis Using Auramine O Stain Alan G-L Cheng, MD FRACS (presenter); Anthony Chang, MD; D Gregory Farwell, MD; S Nicholas Agoff, MD Seattle WA; Seattle WA; Seattle WA; Seattle WA

Objectives: Mycobacterial infection is one of the most prevalent infectious diseases worldwide and commonly presents as cervical adenitis. Current methods in diagnosing mycobacterial cervical adenitis (MCA) employ Ziehl-Neelsen stain followed by cultures. The former is a sensitive but time-consuming method, while the latter requires weeks before results become available. Independent studies have found the Auramine O (AO) stain effective in diagnosing mycobacterial infection in respiratory specimens. As clinicians are challenged to identify causes of neck masses in a cost-effective manner, we hypothesize that AO staining of fine needle aspirates is a sensitive and rapid tool for detecting mycobacteria. Methods: Nineteen patients with the presumed clinical diagnosis of MCA received fine needle aspiration of their neck masses. These cytologic smears were processed with the AO stain and examined under fluorescence microscopy. Corresponding cultures were submitted. Patients’ presenting symptoms, use of anti-mycobacterial medications, AO staining results, and culture results were analyzed. Results: Sixteen of the 19 patients presented with no systemic symptoms. Mycobacteria were identified in 16 of 19 AO-stained fine needle aspirates, with results available within four hours. Corresponding cultures confirmed the AO-positive diagnosis in 12 patients, 8 tuberculous and 4 nontuberculous, and grew mycobacterium tuberculosis from the 3 AO-negative specimens. The 4 patients with negative cultures had previously taken antimycobacterial medications. Conclusion: The AO stain with fluorescence microscopy, in comparison to the conventional Ziehl-Neelsen stain, is a more sensitive and rapid method for identifying tuberculous and nontuberculous mycobacteria. It is a valuable tool for the otolaryngologists and pathologists in the diagnosis of MCA. P028 Effect of Triamcinolone Acetonide on the Regrowth of Nasal Polyps after Surgical Treatment Maija Hytonen, MD PhD (presenter); Karin Blomgren, MD; Henrik Malmberg, MD Helsinki Finland; Helsinki Finland; Helsinki Finland

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Objectives: Nasal corticosteroids are widely used in the treatment the polypoid patients and to prevent the recurrence of polyps. The aim of this research was to study the effect of nasal steroid triamcinolone acetonide on the prevention of the regrowth of nasal polyps after surgical polypectomy. The study design was randomized, double-blind, placebo-controlled, and prospective. Methods: There were 60 patients, 23 women and 37 men. The polypectomy was either uni- or bilateral (re-) polypectomy. The patients were followed-up 2 weeks, and 3, 6, 9, and 12 months postoperatively. Results: During the follow-up period the polyps grew significantly slower in the treatment group than in the placebo group. In acoustic rhinometry, the difference between treatment groups was in favor of the active treatment. However, in rhinomanometry no statistically significant differences between the 2 groups were seen. Mean monthly rescue medication consumption was significantly lower in the treatment group than in the placebo group. In the treatment group the smell test results improved significantly. Conclusion: After surgical polypectomy regrowth of the polyps was slower in the treatment group as compared to the placebo group, but the treatment did not completely prevent the regrowth. In the active treatment group the smaller amount of rescue medication used, and the significantly better results in acoustic rhinometry and olfactometry showed that nasal triamcinolone acetonide spray can slow down the regrowth and reduce the symptoms caused by nasal polyps.

P029 Radiographic Anatomy of the Petrous Apex: A Study Related to the Middle Fossa Approach Aaron Gabriel Benson, MD (presenter); Hamid R Djalilian, MD Oak Park IL; Chicago IL

Objectives: The goal of our study is to use high resolution CT scanning to create standard measurements and ranges of commonly used anatomic landmarks for the middle cranial fossa approach. These measurements are then used to discuss the strengths and limitations of the systems currently used for IAC localization divised by House, Fisch, Garcia-Ibanez, Catalano, and others. Methods: High resolution CT images of the temporal bone 1.25 mm apart were obtained using the GE Lightspeed Ultra CT scanner. Identical head position was insured using the fixed landmarks of the hard palate (coronal plane) and anterior cranial fossa(axial plane). Scans were repeated if all images were not parallel to the anterior cranial fossa or perpendicular to the hard palate. All patients were 18 years of age or older; 108 temporal bones are included in the study. Films were read by a neurotologist and a neuroradiologist for evidence of abnormalities. Measurements were made using

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moved from fistulae of the oval window area, the promontory, multiple fistulae and large fistulae of the lateral semicircular canal if the matrix has already penetrated into the labyrinth. After removal of the matrix over fistulae of the lateral semicircular canal, a temporalis fascia graft should be used for cover.

Scientific Posters

Scientific Posters

the standard PACS (picture archiving and communication system) measurement software. Results: Ten temporal bones had evidence of chronic otitis media and were thus excluded from the study. Pneumatization over the superior semicircular canal and IAC are recorded. In 78 temporal bones the superior semicircular canal was not the arcuate eminence. This mean distance was recoded. Likewise, angles and distances used by other studies are measured and discussed. Conclusion: Our study of 98 temporal bones provides the operator with ranges where important anatomic structures lie. These measurements allow the surgeon to safely and more rapidly locate the IAC when perfoming a middle fossa approach.

P030 Tinnitus in Normal Hearing Patients: An Uncommon Group Italo Medeiros,

MD

(presenter); Tanit Ganz Sanchez,

MD PhD;

Cristiane P D Levy, MD; Hilda Santos, MD; Jeanne R O Ramalho, MD

Sao Paulo Brazil; Sao Paulo Brazil; Sao Paulo Brazil; Sao Paolo Brazil; Sao Paulo Brazil

Objectives: Tinnitus usually appears in patients with some degree of hearing loss. Just a few papers studied tinnitus in normal hearing patients, usually involving less than 20 cases. The objective of this study is to describe the main characteristics of a significant sample of tinnitus patients with normal pure tone audiometry. Methods: The files of 744 tinnitus patients following the same medical audiological protocol were reviewed, excluding those with hearing thresholds above 25dBHL in at least one frequency. Thus, 66 (8.8%) files belonging to patients with tinnitus and normal audiometry were enrolled in this study, analyzing their main characteristics (sex, gender, laterality, severity, laboratories alterations). Results: There was a high prevalence of female patients in 71.2% of the cases. The mean age was 42 ⫾ 13 years (minimum 7, maximum 72). Tinnitus was a single tone in 71.2%. There were 11 patients with pulsatile tinnitus. Bilateral in 51.5% and constant in 66.7%. According to the visual analogue scale, the tinnitus severity was mild in 6 cases, moderate in 27 and severe in 32. Caffeine abuse was detected in 45.4%, sweet compulsion in 45.4%, and lipid disturbances in 36.3%. Blood glucose and thyroid hormones levels were altered in 27.3% and 13.6%, respectively. Conclusion: Tinnitus in normal hearing patients may also evoke an important annoyance and showed an association with metabolic disorders. Trying to find the main characteristics of these patients and other possible etiologies can be fundamental for therapeutic approach.

P031 Helicobacter Pylori in the Adenoid of Children with and without Otitis Media with Effusion Hsin-Ching Lin, MD (presenter); Chih-Ying Su, MD Feng Shan City Taiwan (Republic of China); Kaohsiung Taiwan (Republic of China)

Objectives: Helicobacter pylori (HP) has been found in tonsil, adenoid, and sinonasal tissues. The adenoid plays a key role in the pathogenesis of otitis media with effusion (OME). In this study, we further investigate the difference in colonization by HP in the adenoid of children with and without OME. Methods: Thirty-five consecutive children who underwent grommet insertion for chronic OME (OME group, 19 patients) or adenotonsillectomy for obstructive sleep apnea syndrome (OSAS group, 16 patients) were prospectively enrolled. The patients who had taken antibiotics, bismuth compounds or H2-receptor blockers, or had a history of adenotonsillitis or sinusitis for 3 weeks prior to surgery were excluded. A 2–3 mm diameter specimen was obtained from the adenoid via nasoendoscope, and placed in Pronto Dry kits (Medical Instruments Corp., Solothurn, Switzerland) to detect the presence of HP. A pink-magenta color change in the external ring of the prepared kits indicated a positive reaction for HP. Results: There were 13 girls and 22 boys. The Pronto Dry test results were positive in 4 patients (11.4%) and negative in 31 patients (88.6%). The HP positive rate in the OME and OSAS groups were 21.1% (4/19) and 0% (0/16), respectively (Fisher exact test, P ⫽ 0.11). Conclusion: HP does in fact colonize human adenoid tissue (11.4%). Although the presence of HP in the adenoid of children with OME seemed to have a higher positive rate than in the adenoid of children without OME, it showed no statistical significance. Due to our small patient group, a more extended study is needed.

P032 The Possibility of Patient Suffocation during a CPAP Power Failure Edmund A Pribitkin, MD (presenter); Sunny Park, BS; William M Keane, MD Philadelphia PA; Washington DC; Philadelphia PA

Objectives: We wish to notify other sleep medicine practitioners that a patient using a full face CPAP mask has apparently died of suffocation during a power outage. This death raises serious concerns regarding patient education in the use of CPAP devices, especially in the case of a power outage. Methods: Case presentation, industry survey. Results: In our telephone survey of the companies listed on the www.sleepapnea.org website, we discovered no machines with an inherent backup power supply. The primary

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Otolaryngology– Head and Neck Surgery August 2004