Cholesteatomatous Exposure of the Sigmoid Sinus Through the Posterior Osseous Canal Wall

Abstract

This case report is interesting since a survey of the literature did not reveal any record of a similar pathologic finding. E. H., a white woman aged 26, sought examination July 26, 1941, because of a purulent odorous discharge from the right ear, as well as poor hearing and occasional bleeding since early childhood. Alternating periods of exacerbation and improvement followed rhinopharyngeal and sinal infections. Examination of the right ear revealed the following : The auricle and cartilaginous canal were normal. Some tenderness was present over the mastoid process. The posterior osseous canal wall showed a large defect through which a large vascular grayish blue bulge (anterior vertical part of the sigmoid sinus) projected into the lumen of the canal. Brownish red pigmentation with slight superficial ulceration, from which some bleeding occurred on mild manipulation, was also noted over this vascularity.The cholesteatomatous process had destroyed part of the posterior canal wall, the sinus plate, the ossicles and the drum membrane, fusing the mastoid antrum, the middle ear and the external auditory canal into one cavity. Fibrosis had taken place over part of the drum membrane. More deeply toward the labyrinthine wall of the middle ear, a glistening small mass, possibly part of the cholesteatoma, appeared.Drs. Wells P. Eagleton and Lester M. Hubby communicated their findings as follows :Dr. Eagleton's comment: "Coming from the posterior wall forward, just this side of the middle, there is a mass which appears to be a blood vessel because when I touch it there is a hemorrhage into the wall. It is, however, too firm to be simply a blood vessel coming from the floor. Beyond this I can see the remains of the middle ear ; it is a glistening mass, like a cholesteatoma, and yet I do not think it is."Dr. Hubby's comment : "There appears to be a cholesteatomatous cavity in the right temporal bone, in which the bone over the anterior half of the vertical portion of the sigmoid sinus, the annulus and the ossicles have disappeared. "The exposed portion of the sigmoid sinus is blue and thin. There is a thin scar-tissue-like membrane over the anterior half of the tympanum. The rest of the tympanum and attic appear to be bony and covered with a thin layer of epithelium."Roentgenograms revealed sclerosis with obliteration of the right mastoid cells. Dr. Eagleton also found an area of increased radiability in the upper portion of the right mastoid process, possibly due to a cholesteatoma.Treatment consisted of gentle cleansing and insufflation of sulfanilamide powder during the period of discharge. Extreme caution against trauma and manipulation was advised. 888 Grand Concourse.