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Файл:Ординатура / Хирургия / Библиотека им академика М.И. Перельмана / Книга_4399_Библиотеки_им_академика_М_И_Перельмана
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Figure 9–22a
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Figure 9–22b
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Figure 9–23
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Figure 9–24a
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Figure 9–24b
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Figure 9–25
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Temporal Bone Histology and Radiology Atlas212
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correlate with any symptoms. These microfractures may
result from stresses within the otic capsule that develop
with growth.
FIGURE 9–24
The tympanic membrane, carotid artery, and basal turn
of the cochlea are in view. The basal turn of the cochlea
is progressively getting smaller. Anterior to the cochlea
is the petrous apex that contains bone marrow. Along
the posterior wall, the chorda tympani nerve, facial
recess, pyramidal process with stapedius muscle and
facial nerve, and sinus tympani are seen, from lateral
to medial. The corresponding CT image demonstrates,
from posterior to anterior, the pyramidal process, the
sinus tympani, the posterior semicircular canal, the
round window niche, the round window membrane,
the cochlear aqueduct, the basal turn of the cochlea, the
carotid artery, and the Eustachian tube.
FIGURE 9–25
This most inferior horizontal section of this temporal
bone shows an intact tympanic membrane, the hypotympanic portion of the middle ear cavity, cochlea, posterior semicircular canal, stapedius muscle, and descending facial nerve.
REFERENCE
1. Wolf JS, Boyev KP, Manokey BJ, Mattox DE. Success of the
modified Epley maneuver in treating benign paroxysmal
positional vertigo. Laryngoscope
. 1999 Jun;109(6):900–903.
CHAPTER 10
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Future of Temporal Bone Studies
Sebahattin Cureoglu and Michael M. Paparella
INTRODUCTION
Pathology, the gold standard for discerning diseases in
humans, is essential to every discipline in the medical field. Human ear structures are usually inaccessible
during life, except for surgical biopsies. But such biopsies include only miniscule specimens of ear tissue
and are often unrepresentative of the overall condition
of the ear. Organs of the body, other than the ear, are
routinely studied in hospital pathology laboratories.
However, because of the difficulties and expense of
ear tissue acquisition and preparation and intricacies
of anatomical evaluation, human otopathology has
evolved as a separate research discipline.
THE CURRENT STATUS OF HUMAN
TEMPORAL BONE LABORATORIES
Currently, only three human temporal bone laboratories are active in the United States. Dr. Michael McKenna from one of these, the Massachusetts Eye and Ear
Infirmary, indicated in the April 2016 issue of Ameri-
can Neurotology Society newsletter that “the specialty of
otolaryngology is on the verge of losing its ability to
examine the pathology of the ear. If this were to occur,
we would no longer be able to characterize the pathology of a host of problems that we see and treat on a
daily basis. It will stifle our ability to develop new and
effective treatments and to evaluate the results of our
clinical interventions. Without this fundamental disci-
pline, our specialty will justifiably lose all credibility
with our medical and surgical colleagues and our patients. The study of human otopathology has been and
continues to be the foundation for advancements in
patient care.”
laboratories from 25 to 3 resulted from a significant reduction in research funding for human otopathology
and departmental discretionary funds used to support
these labs.
The skills and know-how for future discoveries
and for understanding the causes of old and newly
identified ear diseases can only occur with creation of
temporal bone facilities in a university environment
and recruitment of patients with otological issues and
good clinical records to bequeath their temporal bones
to the National Human Temporal Bone Registry.
is very certain that if we do not take any immediate
action, we will end up with the extinction of the technical and pathological expertise in the field of human
otopathology. More important than ever, the remaining otopathology laboratories should collaborate and
function as a united national center for the auditory
and vestibular research community.
1
The abrupt decline in numbers of active
2,3
It
NEW TECHNIQUES OF
TEMPORAL BONE STUDY
Light microscopy of human temporal bones has profoundly influenced our knowledge of otologic disorders
such as persistent middle ear infections (Figure 10–1), otosclerosis (Figure 10–2A–E), and vestibular schwannoma
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Figure 10–1A. Patient with long-term history of ear pain, prolonged antibiotic treatment, and immunocompromised status
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due to chronic myeloid leukemia. Histopathologic exam shows intact but thickened tympanic membrane, due to otomycosis,
and bacterial communities such as biolm-like structures in the middle ear. Figures 10-1B and 10-1C show the TM otomycosis
and bacterial communities in the middle ear at higher magnication.
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Figure 10–1B
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