醫學期刊發表
Journal Publication
Tinnitus Associated with Mild Osteomyelitis of the Temporal Bone Reversed after Conservative Antibiotic Treatment: A Case Series
Ping-Tao Tseng , Tien-Yu Chen , Chun-Chung Lui , Yen-Wen Chen , Jiann-Jy Chen
Abstract
The symptomatology and diagnostic tools for osteomyelitis of the temporal bone have not been well documented. Diagnosis of early stage (i.e., mild form) osteomyelitis of the temporal bone may be delayed due to the limitations of traditional computed tomography’s (CT) imaging resolution. With the advancement of high-resolution CT (HRCT) images, clinicians can now observe images that could not be observed with traditional CT imaging. In this neuro-image report, we present three patients with refractory/untreatable tinnitus. In their HRCT images, mild osteomyelitis of the temporal bone was revealed by mucosa thickening with bony sequestration of air cells, mild opacification of the air cells, and soft tissue density in the middle ear cavity, mild opacification, and bony sequestration attributed to mucosa thickening of the mastoid air cells (along with the cortical bone). All of the clinical presentations and findings in the pure tone audiometry of the reported patients improved after adequate antibiotic treatment. The current report highlights the potential benefit of HRCT to diagnose this in such patients. In addition, immediate and conservative antibiotic treatment is recommended for managing these patients shortly after the detection of mild osteomyelitis of the temporal bone. This treatment could reduce the risk of progression to the severe form.
Keywords: HRCT; antibiotic; computed tomography; osteomyelitis; tinnitus.
Conflict of interest statement
The authors declared that there are no potential conflict of interest in this work.
Figures
See this image and copyright information in PMC
Figure 1 High-resolution computed tomography (HRCT) results. The white arrow indicates the following: mucosa thickening and bony sequestration of air cells in the coronal view of Mr. H’s HRCT examination (A), mild opacification of the air cells along with the cortical bone and bony sequestration in the axial view of Ms. R’s HRCT examination (B), and soft tissue density in the middle ear cavity, mild opacification and bony sequestration of the mastoid air cells along with the cortical bone in the coronal view of Mrs. C’s HRCT examination (C).
Figure 2 Depiction of the baseline (A–C) and follow-up (D–F) pure tone audiometry (PTA) results. In the PTA, the Right ear is present in Red color, while the Left ear is present in Blue color. In general, the PTA revealed mild improvements in the standard audiogram and high-frequency audiogram in the right ear and the standard audiogram of the left ear of Mr. H (A,D). In case of Ms. R it showed mild improvements in the standard audiogram and high-frequency audiogram of the left ear (B,E). It also revealed improvements in the standard audiogram and high-frequency audiogram of the left ear and the standard audiogram of the right ear in case of Ms. C (C,F). O: right ear unmasked air conduction; △: right ear masked air conduction; X: left ear unmasked air conduction; □: left ear unmasked air conduction; < >: right/left unmasked bone conduction; [ ]: right/left masked air conduction.
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