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The relationship between traumatic tympanic membrane perforations and pneumatization of the mastoid
1Department of Otorhinolaryngology, Turgut Ozal Medical Center, Inönü University School of Medicine, Malatya, Turkey. daktas@usa.net
Abstract:
We evaluated the possible relationship between tympanic membrane perforations resulting from blast trauma or slap and pneumatization of the mastoid cells. A total of 25 male patients with tympanic membrane perforations resulting from blast injury (n = 7), slap (n = 17), and football hit (n = 1) and 20 healthy male volunteers without any ear problem had temporal bone computed tomographic scans in the axial plane, parallel to the infraorbitomeatal line, with 2 mm slice thickness and 2-mm intervals using bone algorithm with a ProSpeed Spiral tomography machine. The area of air cells in each slice was measured using trace and area measurement functions of the tomography machine, and by multiplying the resulting area by slice thickness, the volume of each slice was calculated. For each ear, the total of volumes of air cells was calculated by adding the volumes of each slice containing air cells. The calculated volumes of mastoid cells were evaluated by comparing microscopic findings. Both patient and control groups consisted of males, and their ages ranged from 17 to 32 (mean 24.5) years. Microscopic examinations revealed that perforations were frequently located in the lower quadrants and that most of them were less than 3 mm. There were no pars flaccida and marginal perforations. Ossicular chain destruction was noted neither in temporal bone tomographic nor during intraoperative examinations. The mean (+/- SD) volumes of right and left ear mastoid air cells in patient and control groups were 6.92 +/- 2.45 vs. 7.00 +/- 2.59 cm(3) and 9.04 +/- 4.55 vs. 8.95 +/- 4.53 cm(3), respectively, and the differences were not statistically significant. It was found that the level of mastoid pneumatization has no statistically significant effect on tympanic membrane pathologies due to blast or other injuries.
Insights
Mastoid pneumatization, the air cell development in the mastoid bone, does not significantly impact tympanic membrane perforations from blast or slap injuries. This study found no correlation between mastoid air cell volume and injury outcomes.
Area of Science:
- Otolaryngology
- Radiology
- Anatomy
Background:
- Tympanic membrane perforations can result from various traumas, including blast and slap injuries.
- Mastoid pneumatization, the development of air cells within the mastoid bone, is a key anatomical feature of the temporal bone.
Purpose of the Study:
- To investigate the potential relationship between tympanic membrane perforations and the degree of mastoid pneumatization.
- To determine if mastoid air cell volume influences the occurrence or characteristics of tympanic membrane perforations from trauma.
Main Methods:
- Computed tomographic (CT) scans of temporal bones were performed on 25 male patients with tympanic membrane perforations and 20 healthy male controls.
- Mastoid air cell volume was calculated by measuring air cell areas in CT slices and summing their volumes.
- Microscopic examination of perforations and comparison of CT findings with intraoperative observations were conducted.
Main Results:
- Perforations were predominantly in the lower quadrants and measured less than 3 mm, with no pars flaccida or marginal types observed.
- No statistically significant differences in mean mastoid air cell volumes were found between the patient and control groups for either the right or left ear.
- Ossicular chain destruction was not identified in either CT scans or during intraoperative examinations.
Conclusions:
- The extent of mastoid pneumatization does not appear to have a statistically significant effect on the development of tympanic membrane pathologies resulting from blast or other traumatic injuries.
- These findings suggest that factors other than mastoid air cell volume are more critical in the context of traumatic tympanic membrane perforations.