Online first
Original article
Published online: 2024-05-21
Middle ear morphology and mastoid pneumatization: a computed tomography study
1
, 1, 1, 2, 1, 2, 3, 1
, 1, 1, 2, 1, 2, 3, 1
DOI: 10.5603/fm.100190
Pubmed: 38842073
Abstract
Background: Mastoid pneumatization is subject to numerous influencing factors including race, sex, and surrounding structures of the middle ear. This study aims to determine the mastoid air cell system (MACS) volume and its relationship with middle ear structures, and the influence of sex.
Materials and methods: A cross-sectional study was performed analyzing computed tomography (CT) scans in which MACS volume and the Estachian tube length (ETL) were visible. MACS volume, ETL, and width and height of the aditus ad antrum were obtained.
Results: A total of 100 CT were included with a mean age of 38.5 ± 15.3 years, of which 56 were women and 44 were men. The mean right and left MACS volume were 5.43 ± 3.15 cm3 and 5.54 ± 3.43 cm3 respectively , with a ETL of 24.55 ± 3.07 mm in right side and 24.24 ± 2.60 mm on left side. A aditus ad antrum width of 2.98 ± 0.65 in right and 2.98 ± 0.58 on the left and height of 4.51 ± 1.05 and 4.32 ± 0.85, on right and left side respectively. There were statistical differences between sexes in left ETL, and in MACS volume bilaterally. A low positive correlation between aditus ad antrum height and MACS volume was identified.
Conclusions: Mastoid pneumatization was bigger in men than women. There was a low positive correlation between mastoid volume and ETL on both sides, and a significant correlation between right mastoid volume and aditus ad antrum height. This could lead us to believe that the length of ETL does not affect the pneumatization of MACS.
Keywords: mastoid air cell systemaditus ad antrumEustachian tubemiddle earanatomy
References
- Aladeyelu OS, Olaniyi KS, Olojede SO, et al. Temporal bone pneumatization: A scoping review on the growth and size of mastoid air cell system with age. PLoS One. 2022; 17(6): e0269360.
- Allam F, Allam M. Sex discrimination of mastoid process by anthropometric measurements using multidetector computed tomography in Egyptian adult population. Egypt J Forensic Sci. 2016; 6(4): 361–369.
- Bahgat M. Patency of the aditus ad antrum in tubotympanic chronic suppurative otitis media. Otolaryngol Head Neck Surg. 2015; 152(2): 331–335.
- Casale G, Shaffrey E, Kesser BW. Correlation between hearing loss and middle ear volume in patients with a tympanic membrane perforation. Laryngoscope. 2020; 130(4): E228–E232.
- 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(6): 781–786.
- Colhoun EN, O'Neill G, Francis KR, et al. A comparison between area and volume measurements of the mastoid air spaces in normal temporal bones. Clin Otolaryngol Allied Sci. 1988; 13(1): 59–63.
- Conticello S, Saita V, Ferlito S, et al. Computed tomography in the study of the eustachian tube. Arch Otorhinolaryngol. 1989; 246(5): 259–261.
- Cros O, Knutsson H, Andersson M, et al. Determination of the mastoid surface area and volume based on micro-CT scanning of human temporal bones. Geometrical parameters depend on scanning resolutions. Hear Res. 2016; 340: 127–134.
- Csakanyi Z, Katona G, Josvai E, et al. Volume and surface of the mastoid cell system in otitis media with effusion in children: a case-control study by three-dimensional reconstruction of computed tomographic images. Otol Neurotol. 2011; 32(1): 64–70.
- Cuschieri S. The STROBE guidelines. Saudi J Anaesth. 2019; 13(Suppl 1): S31–S34.
- Dinç AE, Damar M, Uğur MB, et al. Do the angle and length of the eustachian tube influence the development of chronic otitis media? Laryngoscope. 2015; 125(9): 2187–2192.
- El-Anwar MW, Eldib DB, Nofal AA, et al. Eustachian tube: computed tomography analysis. J Craniofac Surg. 2020; 31(6): 1763–1765.
- Epprecht L, Qingsong L, Stenz N, et al. Correlation between tympanometry volume and three-dimensional computed tomography mastoid volumetry in tympanoplasty candidates. J Laryngol Otol. 2021; 135(8): 718–722.
- Falkenberg-Jensen B, Hopp E, Jablonski GE, et al. The cartilaginous Eustachian tube: Reliable CT measurement and impact of the length. Am J Otolaryngol. 2018; 39(4): 436–440.
- Gaihede M, Dirckx JJJ, Jacobsen H, et al. Middle ear pressure regulation — complementary active actions of the mastoid and the Eustachian tube. Otol Neurotol. 2010; 31(4): 603–611.
- Hasebe S, Takahashi H, Honjo I, et al. Mastoid condition and clinical course of cholesteatoma. ORL J Otorhinolaryngol Relat Spec. 2001; 63(3): 160–164.
- Hernandez-Trejo AF, Cuellar-Calderon KP, Treviño-Gonzalez JL, et al. Prevalence of facial canal dehiscence and other bone defects by computed tomography. Eur Arch Otorhinolaryngol. 2020; 277(10): 2681–2686.
- Isono M, Murata K, Azuma H, et al. Computerized assessment of the mastoid air cell system. Auris Nasus Larynx. 1999; 26(2): 139–145.
- Jackler RK, Schindler RA. Role of the mastoid in tympanic membrane reconstruction. Laryngoscope. 1984; 94(4): 495–500.
- Janzen-Senn I, Schuon RA, Tavassol F, et al. Dimensions and position of the Eustachian tube in humans. PLoS One. 2020; 15(5): e0232655.
- Jun BC, Song SW, Cho JE, et al. Three-dimensional reconstruction based on images from spiral high-resolution computed tomography of the temporal bone: anatomy and clinical application. J Laryngol Otol. 2005; 119(9): 693–698.
- Kawase T, Hori Y, Kikuchi T, et al. The effects of mastoid aeration on autophony in patients with patulous eustachian tube. Eur Arch Otorhinolaryngol. 2008; 265(8): 893–897.
- Kaymakçı M, Yanık B, Erel F, et al. Association between atopy, mastoid pneumatization and tympanometric findings. Eur Arch Otorhinolaryngol. 2015; 272(1): 15–21.
- Kim J, Song SW, Cho JH, et al. 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(6): 593–599.
- Koç A, Kaya S. Prevalence of foramen Huschke: evaluation of the association between mastoid pneumatization volume and the existence of foramen Huschke using cone beam computed tomography. Eur Arch Otorhinolaryngol. 2021; 278(3): 791–796.
- Lee DH, Jun BC, Kim DG, et al. Volume variation of mastoid pneumatization in different age groups: a study by three-dimensional reconstruction based on computed tomography images. Surg Radiol Anat. 2005; 27(1): 37–42.
- Lee DH, Jung MK, Yoo YH, et al. Analysis of unilateral sclerotic temporal bone: how does the sclerosis change the mastoid pneumatization morphologically in the temporal bone? Surg Radiol Anat. 2008; 30(3): 221–227.
- Lima MA, Farage L, Cury MC, et al. Mastoid surface area-to-volume ratios in adult Brazilian individuals. Braz J Otorhinolaryngol. 2013; 79(4): 446–453.
- Long X, Feng X, Zhu J. Normal anatomy of aditus of antrum and antrum on high-resolution CT and three-dimensional reconstruction. Lin Chuang Er Bi Yan Hou Tou Jing Wai Ke Za Zhi. 2012; 26(16): 747–750.
- Luntz M, Malatskey S, Tan M, et al. Volume of mastoid pneumatization: three-dimensional reconstruction with ultrahigh-resolution computed tomography. Ann Otol Rhinol Laryngol. 2001; 110(5 Pt 1): 486–490.
- Magro I, Pastel D, Hilton J, et al. Developmental anatomy of the eustachian tube: implications for balloon dilation. Otolaryngol Head Neck Surg. 2021; 165(6): 862–867.
- Miura M, Takahashi H, Honjo I, et al. Influence of the gas exchange function through the middle ear mucosa on the development of sniff-induced middle ear diseases. Laryngoscope. 1998; 108(5): 683–686.
- Park MS, Yoo SH, Lee DH. Measurement of surface area in human mastoid air cell system. J Laryngol Otol. 2000; 114(2): 93–96.
- Ratag Y, Asriyani S, Murtala B, et al. Anatomical measurement of normal Eustachian tube on the temporal bone computed tomography imaging. Jurnal Kesehatan Andalas. 2020; 9(3): 276.
- Shewel Y, Bassiouny M, Ebrahim M. Endoscopic assessment of the isthmus tympanicum and tensor tympani fold and their relationship with mastoid pneumatization in chronic otitis media. J Int Adv Otol. 2020; 16(2): 227–233.
- Sirikci A, Bayazit YA, Bayram M, et al. Significance of the auditory tube angle and mastoid size in chronic ear disease. Surg Radiol Anat. 2001; 23(2): 91–95.
- Smith ME, Weir AE, Prior DCC, et al. The mechanism of balloon Eustachian tuboplasty: a biomechanical study. Med Biol Eng Comput. 2020; 58(4): 689–699.
- Søndergaard N, Nyengaard JR, Bloch SL. Stereologic investigation of mastoid air cell geometry: volume, surface area, and anisotropy. Otol Neurotol. 2020; 41(5): e630–e637.
- Takahashi H, Sato H, Nakamura H, et al. Correlation between middle-ear pressure-regulation functions and outcome of type-I tympanoplasty. Auris Nasus Larynx. 2007; 34(2): 173–176.
- Takahashi M, Yamamoto Y, Koizumi H, et al. A quantitative study of the suppression of the development of the mastoid air cells by the presence of congenital cholesteatoma. Acta Otolaryngol. 2019; 139(7): 557–560.
- Takasaki K, Takahashi H, Miyamoto I, et al. Measurement of angle and length of the eustachian tube on computed tomography using the multiplanar reconstruction technique. Laryngoscope. 2007; 117(7): 1251–1254.
- Tanabe M, Takahashi H, Honjo I, et al. Factors affecting recovery of mastoid aeration after ear surgery. Eur Arch Otorhinolaryngol. 1999; 256(5): 220–223.
- Tapia-Nañez M, Quiroga-Garza A, Guerrero-Mendivil F, et al. A review of the importance of research in Anatomy, an evidence-based science. Eur J Anat. 2022; 26(4): 477–486.
- Thomassin JM, Dessi P, Danvin JB, et al. Anatomía del oído medio. EMC - Otorrinolaringología. 2008; 37(3): 1–20.
- Yegin Y, Çelik M, Şimşek BM, et al. Correlation between the degree of the mastoid pneumatization and the angle and the length of the Eustachian tube. J Craniofac Surg. 2016; 27(8): 2088–2091.
- Yegin Y, Çelik M, Şimşek BM, et al. Impact of the degree of the mastoid pneumatization on cartilage type 1 tympanoplasty success. J Craniofac Surg. 2016; 27(7): e695–e698.
