Volume 117 Number 6 ARDEN et al. S153 cases were asymptolaaatic, and the lesion was therefore not excised. 4,s Temporal bone osteomas in other locations may cause a variety of symptoms. Eustachian tube osteomas may cause chronic serous otitis media or otorrhea. Internal auditory canal osteomas may result in sensorineural hearing loss, tinnitus, and vertigo. 4'13 Mastoid cortex osteomas can cause a cosmetic defect. 14For middle ear osteomas causing heating loss, surgical excision with the appropriate otologic approach is curative. Ossicular reconstruction can be performed at the time of excision. Removal of osteomas that are fixed to important middle ear structures such as the facial nerve or promontory should be performed carefully with the drill, because a case of inadvertent cochleostomy with the use of a chisel has been reported. 3
SUMMARYOsteomas of the middle ear are uncommon entities that typically cause no symptoms. If a definitive diagnosis of such asymptomatic osteomas is made by inspection and CT scan, no intelwention is required. Those lesions that are radiolucent cannot be differentiated from other lesions such as a cholesteatoma or neoplasm and therefore should be excised for diagnosis. Finally, middle eat" osteomas that cause hearing loss or other symptoms may be excised, with care being taken not to injure important middle ear structures.