CT Findings in Temporal Bone Osteoradionecrosis

Ahmed, Salmaan; Gupta, Nakul; Hamilton, Jackson; Garden, Adam S.; Gidley, Paul W.; Ginsberg, Lawrence E.

doi:10.1097/rct.0000000000000096

Cited by 16 publications

(15 citation statements)

References 13 publications

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“…The differential diagnosis for the radiological findings of bilateral otic capsule demineralisation includes osteogenesis imperfecta, otosclerosis, and Paget's disease [30]. Radiation related change is another increasingly recognised cause of temporal bone demineralisation [31].…”

Section: Discussionmentioning

confidence: 99%

“…The temporal bone is frequently included within the radiation field during the treatment of head and neck cancer. Clinical symptoms can present 3 months to 40 years from the date of the initial treatment [31]. The pathophysiology involves an oblierative endarteritis and periarteritis which causes avascular necrosis [39].…”

Section: Discussionmentioning

confidence: 99%

“…Histologically, there is death of osteocytes, increased osteolysis and fibrosis in the region of the dead bone with loss of marrow [40]. On CT, mild cases of osteoradionecrosis involve bony erosion around the external auditory canal and mastoid opacification [31].…”

Section: Discussionmentioning

confidence: 99%

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Pediatric otosyphilis—An unusual cause of conductive hearing loss

Arain

Abbas

Adams

2020

Radiology Case Reports

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We present the case of a 5 year old female with a unilateral conductive hearing loss which had a relapsing and remitting course over a 3 year period. An initial noncontrast CT temporal bone study was unremarkable and a diagnosis of otitis media was made in the first instance. However, a second CT temporal bone study performed 3 years later demonstrated bilateral demineralisation of the ossicles and abnormal lucency affecting both the otic capsules. A diagnosis of otosyphilis was proposed on the basis of the imaging features and a prior medical history of previously treated congenital syphilis. With the benefit of hindsight, early pericochlear lucency was identified on the initial CT temporal bone study. There has been a steady rise of syphilis cases since the millennium with resurgence in many high income countries. Otosyphilis has a highly variable clinical presentation and there is limited data to establish the pattern of hearing loss in pediatric patients with a background of congenital otosyphilis. Temporal bone and otic capsule demineralisation carries a broad differential diagnosis including osteogenesis imperfecta, otosclerosis, Paget's disease and radiation related changes. Otosyphilis is a rare but potentially treatable cause of deafness and a high index of suspicion is required to make the diagnosis. In conjunction with a positive syphilis serology, a noncontrast temporal bone CT can aid the diagnosis and expedite the treatment.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Pediatric otosyphilis—An unusual cause of conductive hearing loss

Arain

Abbas

Adams

2020

Radiology Case Reports

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“…The presence of an open wound is then secondarily exposed to skin flora leading to an osteomyelitis clinical scenario. Studies have shown the onset of osteoradionecrosis varied from 1 to 22 years with a mean of 8 years [44,45]. CT findings identified erosions of the external auditory canal and mastoid effusions in nearly all patients.…”

Section: Osteonecrosis/osteomyelitis Of Temporal Bonementioning

confidence: 99%

“…Other CT features included soft tissue enhancement mimicking tumor recurrence, and soft tissue air/abscess formation. The TMJ may also be involved with erosions of the condylar bone concurrently present with temporal bone osteoradionecrosis [45]. In cases where osteonecrosis is identified in the absence of prior radiation therapy, medication-related osteonecrosis may be a consideration but requires clinical correlation to identify a prior history of anti-resorptive type medications such as bisphosphonates and/or denosumab.…”

Section: Osteonecrosis/osteomyelitis Of Temporal Bonementioning

confidence: 99%

Ear and Temporal Bone: Cartilaginous and Osseous Pathologies

Sabharwal

Magliocca

Williams

2018

Head and Neck Pathol

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Although the majority of conditions involving the ear and temporal bone are inflammatory or epithelial based, cartilage and osseous entities will also be encountered. The pathologic examination of these underlying cartilaginous and osseous structures and their histologic findings and associated differential diagnoses will be discussed. Correlation with clinical and imaging findings are also critical for accurate determination of the pathologic entity.

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Temporal Bone Osteoradionecrosis: An 18‐year, Single‐Institution Experience

et al. 2021

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Objectives/Hypothesis: To report the largest single-institution review of temporal bone osteoradionecrosis (TBORN), and characterize the disease's natural history, prognostic factors, management, and outcomes.Study Design: Retrospective chart review. Methods: Retrospective review was conducted to identify patients with TBORN. Pertinent data were extracted. Descriptive statistics were used to summarize patient, tumor, and treatment characteristics. Multivariable analyses were conducted to explore associations between these characteristics and time to TBORN diagnosis and risk of developing diffuse disease.Results: TBORN was identified in 145 temporal bones from 128 patients. Mean age at diagnosis was 62 years, and mean time to diagnosis after radiotherapy was 10 years. Age greater than 50 years was associated with earlier diagnosis. According to the Ramsden criteria, 76% of TBs had localized and 24% had diffuse disease at initial diagnosis; 37% had diffuse disease at last follow-up. On multivariable analysis, diabetes, three-dimensional conformal radiotherapy (3D-CRT), and periauricular skin malignancy were significant risk factors for developing diffuse disease. Localized disease was successfully managed with conservative measures, whereas surgery was often necessary for diffuse disease. When TBORN spread outside the mastoid or infratemporal fossa, conservative measures were always unsuccessful.Conclusions: TBORN occurs earlier in older patients. While diffuse disease is less common than localized disease, it occurs more frequently in patients with diabetes, history of 3D-CRT, and periauricular skin malignancies. Conservative management is appropriate for localized disease, while surgery is often necessary for diffuse disease. The prognostic factors identified helped propose a TBORN staging system and treatment guidelines which may improve patient risk stratification and disease management.

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CT Findings in Temporal Bone Osteoradionecrosis

Cited by 16 publications

References 13 publications

Pediatric otosyphilis—An unusual cause of conductive hearing loss

Pediatric otosyphilis—An unusual cause of conductive hearing loss

Ear and Temporal Bone: Cartilaginous and Osseous Pathologies

Temporal Bone Osteoradionecrosis: An 18‐year, Single‐Institution Experience

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