Temporomandibular joint herniation through the foramen of Huschke with clicking tinnitus

Lim, Kang Hyeon; Jung, Jaebong; Rhee, Jiyoung; Choi, June

doi:10.1016/j.anorl.2018.05.014

Cited by 15 publications

(12 citation statements)

References 9 publications

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“…Conservative or surgical approaches are possible. First, conservative treatment such as medications and behavioral modifications for reducing masticatory force can be used for patients with mild symptoms [10,11]. With a surgical approach, the bone defect in EAC can be closed with certain material.…”

Section: Discussionmentioning

confidence: 99%

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Symptomatic Temporomandibular Joint Herniation through the Foramen of Huschke: A Case Report

et al. 2021

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The foramen of Huschke (FH) or foramen tympanicum is a persistent bony defect connecting the external auditory canal (EAC) to the temporomandibular joint (TMJ). It arises from an incomplete ossification of the tympanic part of the temporal bone that persists after the age of 5. If a herniation exists in the TMJ, otological symptoms may occur. An 80-year-old female patient complained of noise in her left TMJ and otorrhea in her left ear. On her cone beam computed tomography images, there were only degenerative joint disease signs on her left mandibular condyle. However, her computed tomography images revealed that the soft tissue of the TMJ herniate into the EAC. Additional examination was planned for the further evaluation. But the patient no longer visited the hospital due to her systemic health status, and symptoms disappeared spontaneously without any treatments. Usually this type of herniation is very rare, but years of mechanical stress from mastication may result in weakening and widening of the foramen with age. Therefore, although FH is usually congenital, sometimes it may be acquired in the elderly. The treatment plan should be determined in consideration of the patient's symptom level and the patient's general health status. If the clinical symptoms are not severe, no treatment is required.

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Section: Discussionmentioning

confidence: 99%

“…Tragal cartilage graft and polyethylene, polypropylene, or titanium miniplate can be used to close the defect. But short-term symptom relief has been reported in only several studies, and studies on the long-term prognosis are still insufficient [11].…”

Section: Discussionmentioning

confidence: 99%

Symptomatic Temporomandibular Joint Herniation through the Foramen of Huschke: A Case Report

et al. 2021

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“…Although persistent FT is usually asymptomatic, necessitating no further treatment, surgical closure of bony defect may be required in symptomatic cases [3,7,8,15]. Spontaneous TMJ herniation as a complication of persistent FT has been reported only about 30 cases in the English literature [2], [3], [4], [5],[7], [8], [9], [10], [11], [12], [13], [14], [15], and the “herniation” occurred into the EAC in all of the cases.…”

Section: Discussionmentioning

confidence: 99%

“…Foramen tympanicum (FT), or foramen of Huschke results from a defect in normal ossification of the tympanic portion of the temporal bone, and serves as a communication route between the external auditory canal (EAC) and infratemporal fossa. Although closure of FT normally occurs during the first 5 years after birth, rarely persistent FT may lead to herniation of the temporomandibular joint (TMJ) tissue into the EAC, causing symptoms including tinnitus, conductive hearing loss and otalgia [1], [2], [3], [4], [5], [6], [7], [8], [9], [10], [11], [12], [13].…”

Section: Introductionmentioning

confidence: 99%

Temporomandibular joint herniation into the middle ear: A rare cause of mastication-induced tinnitus

Choi

Nahm

Shin

et al. 2020

Radiology Case Reports

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A 75-year-old patient complained of mastication-induced clicking tinnitus on the left side, and otoendoscopic examination revealed that the left tympanic membraneTM was outwardly bulged by clenching her teeth. Temporal bone computed tomography demonstrated that the posteromedial bony wall of the glenoid was partially dehiscent, allowing herniation of soft tissue contents of temporomandibular joint into the middle ear. Increased middle ear pressure due to soft tissue herniation can induce left tympanic membrane bulging and accompanying clicking tinnitus. Herniation of temporomandibular joint soft tissue into the middle ear should be considered as a differential diagnosis when clicking tinnitus is evoked by mastication.

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“…Although incidental persistent FH is diagnosed in 11.5%-20% of individuals undergoing temporal bone imaging, few studies have described the clinical nature of this pathology. [2][3][4] Available literature reports on single cases [5][6][7][8][9][10][11][12][13][14] or small case series 15,16 that highlight the presentation and management variability associated with this pathology. Understanding of this pathology from the lone review examining temporomandibular joint herniation into the EAC is limited given the wide variance in literature and the presentation of all EAC fistula patients, including spontaneous and non-spontaneous fistulae, as a single group in this study; therefore, conclusions are restricted when looking specifically at persistent FH.…”

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confidence: 99%

Persistent foramen of Huschke: Presentation, evaluation, and management

Macielak

Nassiri

Fillmore

et al. 2022

Laryngoscope Investig Oto

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Objective: Describe the presentation and management strategy for patients with symptomatic foramen of Huschke (FH).Patients: Adults with persistent FH confirmed on imaging.Interventions: Diagnosis and management of symptomatic persistent FH.Main outcome measure: Resolution of otologic symptoms.Results: A total of four patients with symptomatic, radiographically-confirmed persistent FH were included. The majority of patients endorsed otalgia (n = 4) and otorrhea (n = 3), and only one patient was noted to have a conductive hearing loss. All patients were noted to have dynamic movement of an external auditory canal mass with mandible manipulation on examination, and all patients had an identifiable fistula on imaging. Patients underwent surgical intervention, including both preauricular (n = 2) and transcanal (n = 2) approaches, and all endorsed symptomatic resolution after convalescence.Conclusions: Persistent FH remains an uncommon and potentially underrecognized cause of otologic symptoms. Diagnosis requires a high index of suspicion, and one must rely on both key examination findings and imaging to confirm this diagnosis. In appropriately selected patients, surgical intervention can provide durable symptomatic resolution.

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Temporomandibular joint herniation through the foramen of Huschke with clicking tinnitus

Cited by 15 publications

References 9 publications

Symptomatic Temporomandibular Joint Herniation through the Foramen of Huschke: A Case Report

Symptomatic Temporomandibular Joint Herniation through the Foramen of Huschke: A Case Report

Temporomandibular joint herniation into the middle ear: A rare cause of mastication-induced tinnitus

Persistent foramen of Huschke: Presentation, evaluation, and management

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