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Petrous apex pneumatisation in children: a radiological study

Published online by Cambridge University Press:  24 August 2020

T Hardcastle*
Affiliation:
Department of ORL, Auckland City Hospital, New Zealand
I McKay-Davies
Affiliation:
ENT Department, Maidstone and Tunbridge Wells NHS Trust, UK
M Neeff
Affiliation:
Department of ORL, Auckland City Hospital, New Zealand
*
Author for correspondence: Dr Tim Hardcastle, Department of Otorhinolaryngology, Head and Neck Surgery, Auckland City Hospital, 2 Park Road, Auckland1023, New Zealand E-mail: thar956@aucklanduni.ac.nz Fax: +64 9 377 9656

Abstract

Objective

This study aimed to investigate petrous apex pneumatisation in children, as an understanding of petrous apex pneumatisation is useful in the diagnosis and surgical management of middle-ear disease.

Methods

Computed tomography head scans from 1700 patients aged 0–16 years were assessed. Petrous apex bone and air cell volumes were calculated to determine the degree of petrous apex pneumatisation. Scans were analysed for communicating tracts between the middle ear and petrous apex.

Results

Petrous apex pneumatisation was found in 21.0 per cent of patients. Positive relationships were found between age and petrous apex pneumatisation prevalence (rs = 0.990, p < 0.001), and between age and degree of petrous apex pneumatisation (rs = 0.319, p < 0.001). Petrous apex pneumatisation prevalence did not significantly differ by sex or ethnicity. Communicating tracts were identified in 84.3 per cent of patients with petrous apex pneumatisation, most commonly anterior to the otic capsule.

Conclusion

In children, the prevalence and degree of petrous apex pneumatisation increases with age, but prevalence is not affected by sex or ethnicity.

Type
Main Articles
Copyright
Copyright © The Author(s), 2020. Published by Cambridge University Press

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Footnotes

Dr T Hardcastle takes responsibility for the integrity of the content of the paper

References

Hill, CA, Richtsmeier, JT. A quantitative method for the evaluation of three-dimensional structure of temporal bone pneumatization. J Hum Evol 2008;55:682–90CrossRefGoogle ScholarPubMed
Lee, DH, Kim, MJ, Lee, S, Choi, H. Anatomical factors influencing pneumatization of the petrous apex. Clin Exp Otorhinolaryngol 2015;8:339–44CrossRefGoogle ScholarPubMed
Virapongse, C, Sarwar, M, Bhimani, S, Sasaki, C, Shapiro, R. Computed tomography of temporal bone pneumatization: 1. Normal pattern and morphology. AJR Am J Roentgenol 1985;145:473–81CrossRefGoogle ScholarPubMed
Kim, J, Song, SW, Cho, JH, Chang, KH, Jun, BC. Comparative study of the pneumatization of the mastoid air cells and paranasal sinuses using three-dimensional reconstruction of computed tomography scans. Surg Radiol Anat 2010;32:593–9CrossRefGoogle ScholarPubMed
Diamant, M. Pneumatization of the mastoid bone. J Laryngol Otol 1958;72:343–64CrossRefGoogle ScholarPubMed
Allam, AF. Pneumatization of the temporal bone. Ann Otol Rhinol Laryngol 1969;78:4964CrossRefGoogle ScholarPubMed
Rubensohn, G. Mastoid pneumatization in children at various ages. Acta Otolaryngol 1965;60:1114CrossRefGoogle ScholarPubMed
Shinnabe, A, Hara, M, Hasegawa, M, Matsuzawa, S, Kanazawa, H, Kanazawa, T et al. Differences in middle ear ventilation disorders between pars flaccida and pars tensa cholesteatoma in sonotubometry and patterns of tympanic and mastoid pneumatization. Otol Neurotol 2012;33:765–8CrossRefGoogle ScholarPubMed
Lindsay, JR. Petrous pyramid of temporal bone. Arch Otolaryngol 1940;31:231–55CrossRefGoogle Scholar
Radhakrishnan, R, Son, HJ, Koch, BL. Petrous apex lesions in the pediatric population. Pediatr Radiol 2014;44:325–39CrossRefGoogle ScholarPubMed
Curtin, HD, Som, PM. The petrous apex. Otolaryngol Clin North Am 1995;28:473–96CrossRefGoogle ScholarPubMed
Jen, A, Sanelli, PC, Banthia, V, Victor, JD, Selesnick, SH. Relationship of petrous temporal bone pneumatization to the eustachian tube lumen. Laryngoscope 2004;114:656–60CrossRefGoogle ScholarPubMed
Schmalfuss, IM. Petrous apex. Neuroimaging Clin N Am 2009;19:367–91CrossRefGoogle ScholarPubMed
Grant, IL, Welling, DB, Oehler, MC, Baujan, MA. Transcochlear repair of persistent cerebrospinal fluid leaks. Laryngoscope 1999;109:1392–6CrossRefGoogle ScholarPubMed
Hindi, K, Alazzawi, S, Raman, R, Prepageran, N, Rahmat, K. Pneumatization of mastoid air cells, temporal bone, ethmoid and sphenoid sinuses. Any correlation? Indian J Otolaryngol Head Neck Surg 2014;66:429–36CrossRefGoogle ScholarPubMed
Cinamon, U. The growth rate and size of the mastoid air cell system and mastoid bone: a review and reference. Eur Arch Otorhinolaryngol 2009;266:781–6CrossRefGoogle ScholarPubMed
Roland, PS, Meyerhoff, WL, Judge, LO, Mickey, BE. Asymmetric pneumatization of the petrous apex. Otolaryngol Head Neck Surg 1990;103:80–8CrossRefGoogle ScholarPubMed
Moore, KR, Harnsberger, HR, Shelton, C, Davidson, HC. ‘Leave me alone’ lesions of the petrous apex. AJNR Am J Neuroradiol 1998;19:733–8Google ScholarPubMed
Chapman, PR, Shah, R, Curé, JK, Bag, AK. Petrous apex lesions: pictorial review. AJR Am J Roentgenol 2011;196:2637CrossRefGoogle ScholarPubMed
Arriaga, MA. Petrous apex effusion: a clinical disorder. Laryngoscope 2006;116:1349–56CrossRefGoogle ScholarPubMed
Wanna, GB, Dharamsi, LM, Moss, JR, Bennett, ML, Thompson, RC, Haynes, DS. Contemporary management of intracranial complications of otitis media. Otol Neurotol 2010;31:111–17CrossRefGoogle ScholarPubMed
McKay-Davies, I, Selvarajah, K, Neeff, M, Sillars, H. The importance of petrous apex and peri-carotid pneumatisation in subtotal petrosectomy and blind sac closure: a radiological study. J Laryngol Otol 2018;132:698702CrossRefGoogle ScholarPubMed
Starship. CT - Head, Stealth and Anatomics XCARE. In: https://www.starship.org.nz/guidelines/ct-head-stealth-and-anatomics-xcare/ [20 July 2020]Google Scholar
Park, MS, Yoo, SH, Lee, DH. Measurement of surface area in human mastoid air cell system. J Laryngol Otol 2000;114:93–6CrossRefGoogle ScholarPubMed
Schindelin, J, Arganda-Carreras, I, Frise, E. Fiji: an open-source platform for biological-image analysis. Nat Methods 2012;9:676–82CrossRefGoogle ScholarPubMed
Swarts, JD, Doyle, BM, Doyle, WJ. Surface area-volume relationships for the mastoid air cell system in adult humans. J Laryngol Otol 2011;125:580–4CrossRefGoogle Scholar
Tan, AD, Ng, JH, Lim, SA, Low, DY, Yuen, HW. Classification of temporal bone pneumatization on high-resolution computed tomography: prevalence patterns and implications. Otolaryngol Head Neck Surg 2018;159:743–9Google Scholar
Goldstein, NA, Casselbrant, ML, Bluestone, CD, Kurs-Lasky, M. Intratemporal complications of acute otitis media in infants and children. Otolaryngol Head Neck Surg 1998;119:444–54CrossRefGoogle ScholarPubMed
Rossor, TE, Anderson, YC, Steventon, NB, Voss, LM. Conservative management of Gradenigo's syndrome in a child. BMJ Case Rep 2011;2011:bcr0320113978CrossRefGoogle ScholarPubMed
Johnston, J, McLaren, H, Mahadevan, M, Douglas, RG. Surgical treatment of otitis media with effusion in Maori children. ANZ J Surg 2018;88:1141–4CrossRefGoogle ScholarPubMed
McCallum, J, Craig, L, Whittaker, I, Baxter, J. Ethnic differences in acute hospitalisations for otitis media and elective hospitalisations for ventilation tubes in New Zealand children aged 0–14 years. N Z Med J 2015;128:1020Google ScholarPubMed
Holmquist, J. Middle ear ventilation in chronic otitis media. Arch Otolaryngol 1970;92:617–23CrossRefGoogle ScholarPubMed