Otherwise 1 point is assigned.ĩ) External ear: A normal and fairly developed auricle is assigned 1 point, but when configuration is poorer (microtia) 0 points are assigned.Otitis externa is most commonly caused by infection (usually bacterial, although occasionally fungal), but it may also be associated with a variety of noninfectious systemic or local dermatologic processes. In case of joint discontinuity, rotation or fusion to adjacent bony structures, 0 points are assigned.Ĩ) Round window: If the round window diameter is < 1 mm in diameter, it is considered stenotic and assigned 0 points. Otherwise 1 point is assigned.ħ) Incudostapedial articulation: If the joint is well-defined, 1 point is assigned. Otherwise 1 point is assigned.ĥ) Incudomallear articulation: Unless severe deformity is present 1 point is assigned.Ħ) Mastoid pneumatization: A sclerotic, poorly or non-aerated mastoid receives 0 points. A measure ≥ 3 mm receives 1 point, whereas measures < 3 mm receive 0 points.Ĥ) Facial nerve: If the course of the facial nerve is unfavorable for surgical approach it receives 0 points. A diameter < 2 mm gives 0 points.ģ) Middle ear cavity: In the coronal plane, width of the middle ear cavity is measured from the promontory to the atretic bone. This is because patients with anomalies in the inner ear are not surgical candidates.ġ) Stapes: 2 points are assigned if the stapes is present, 0 if it is absent.Ģ) Oval window: The oval window diameter should be ≥ 2 mm where the oval window enters the vestibule (1 point). An important perquisite for using the grading scale is that cochlear function and inner ear structures must be normal.
AUDITORY MEATUS HOW TO
The 9 structures included in the Jahrsdoerfer grading scale are listed below together with a brief explanation on how to perform the grading. In general, patients with a Jahrsdoerfer score < 6 are not considered surgical candidates. The higher the Jahrsdoerfer score, the higher is the probability of a good postoperative hearing outcome. According to this scale the presence or absence of 9 anatomical structures yields a score from 0-10. Temporal bone HRCT findings are used to select patients that are candidates for surgery, as well as to plan the operation, and to predict the postoperative hearing outcome.Ī systematical approach in evaluating temporal bone HRCT in the EACA patient is to use the grading scale introduced by Jahrsdoerfer et al. HRCT is the method of choice for evaluating temporal bone anatomy in the EACA patient. Surgical reconstruction of EACA is feasible. Fourteen percent of patients have a positive family history, as was seen in the present case. In the present case however, the auricle, middle ear and mastoid were normal on both sides.ĮACA may be an isolated malformation or part of an underlying malformation syndrome. Inner ear anomalies are rarely seen, whereas auricle, middle ear and mastoid anomalies are common. Anomaly of the external ear and conductive hearing loss are the most common clinical findings of EACA. Bilateral involvement is present in only 1/3 of the cases. Based on the HRCT findings, the patient was found to be eligable for surgical reconstruction.ĮACA is rare with a reported incidence of 1:10.000. The auricles were not completely included in the field of view, but the included parts had normal configuration (Fig. Also the remaining parts of temporal bones and their relations were normal. Bilaterally, the middle and inner ear structures were normal (Fig. Laterally, the external auditory canals were closed by soft tissue. At the normal sites of the tympanic membranes, osseous segments (the atresia plates) were seen. HRCT showed bilateral complete atresia of the external auditory canals (Fig. To evaluate if reconstruction surgery was possible, high-resolution computed tomography (HRCT) of the temporal bones was performed. Clinical examination showed bilateral conductive hearing loss and EACA. However, hearing loss was progressive and there were difficulties with language courses in school. A bone conducting hearing aid had been used, and overall speech and perception skills were good.
0 kommentar(er)
