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<strong>Color</strong> <strong>Atlas</strong> <strong>of</strong> <strong>the</strong> <strong>Anatomy</strong> <strong>and</strong><br />

<strong>Pathology</strong> <strong>of</strong> <strong>the</strong> Epitympanum<br />

Please send:<br />

copy/ies: Palva, T.; Ramsay, H.; Northrop, C.<br />

<strong>Color</strong> <strong>Atlas</strong> <strong>of</strong> <strong>the</strong> <strong>Anatomy</strong> <strong>and</strong> <strong>Pathology</strong><br />

<strong>of</strong> <strong>the</strong> Epitympanum<br />

CHF 257.– / EUR 170.77 / USD 223.50<br />

ISBN 3–8055–7227–1<br />

� information on <strong>Karger</strong> Titles in ORL<br />

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www.karger.com/orl<br />

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Fax +41 61 306 12 34, E-Mail karger@karger.ch<br />

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Farmington, CT 06085 Toll free: 1-800-828-5479<br />

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Bunkyo-ku, Tokyo 113-0034<br />

Australia: DA Information Services, 648 Whitehorse Road, P.O. Box,<br />

163, Mitcham, Vic. 3132<br />

To be ordered through:<br />

<strong>of</strong> related interest<br />

<strong>Karger</strong> Journals in<br />

Oto-Rhino-<br />

Laryngology<br />

S. <strong>Karger</strong><br />

Medical <strong>and</strong> Scientific<br />

Publishers<br />

Basel � Freiburg<br />

Paris � London<br />

New York � New Delhi<br />

Bangkok � Singapore<br />

Tokyo � Sydney<br />

Basic Research <strong>and</strong><br />

Clinical Applications<br />

Europäische Zeitschrift für Praxis,<br />

Klinik und Forschung<br />

63 t 3 t 01<br />

May–June 2001<br />

Journal for Oto-Rhino-Laryngology<br />

<strong>and</strong> Its Related Specialties<br />

Journal européen pour la pratique, European Journal for <strong>the</strong> Practitioner,<br />

la clinique et la recherche<br />

Clinician <strong>and</strong> Researcher<br />

Original Papers • Travaux originaux Originalarbeiten<br />

183 External Auditory Canal Measurements: Localization <strong>of</strong> <strong>the</strong> Isthmus<br />

Bestimmung des Isthmus des äusseren Gehörganges anh<strong>and</strong> von Messungen<br />

Mesures du conduit auditif externe: localisation de l’isthme<br />

Ahmad, I.; Lee, W.C.; Binnington, J.D. (Dudley)<br />

187 Akute Mastoiditis im Kindesalter. Retrospektivstudie 1979–1998<br />

Acute Mastoiditis in Children: Retrospective Study 1979–1998<br />

Mastoïdite aiguë de l’enfant: étude rétrospective 1979–1998<br />

Mross, C.; Klemm, E. (Dresden)<br />

194 TEOAE-Messungen zur Verlaufsbeurteilung akuter kochleovestibulärer<br />

Störungen: methodische Aspekte<br />

TEOAE Measurements in <strong>the</strong> Assessment <strong>of</strong> <strong>the</strong> Course <strong>of</strong> Acute<br />

Cochleovestivular Disturbances: Methodological Aspects<br />

Mesure des TEOAE pour la prédiction de l’évolution de troubles<br />

cochléovestibulaires aigus: aspects méthodologiques<br />

Nölle, C.; Wunder, M.; Ernst, A. (Berlin)<br />

204 Large Vestibular Aqueduct Syndrome Presenting with Mixed Hearing Loss <strong>and</strong><br />

an Intact Mobile Ossicular Chain<br />

Das Syndrom des grossen vestibulären Aquädukts mit kombinierter<br />

Schallleitungs- und Schallempfindungsschwerhörigkeit<br />

Déficit auditif mixte et chaîne ossiculaire intacte comme manifestation d’un<br />

aqueduc vestibulaire large<br />

Mam}kogElu, B. (Evanston, Ill.); Bentz, B. (Chicago, Ill.); Wiet, R.J. (Evanston, Ill.)<br />

207 Der Einfluss von druckinduzierten Trommelfellbewegungen auf vestibulospinale<br />

und vestibulookuläre Reaktionen bei Patienten mit Morbus Ménière<br />

The Influence <strong>of</strong> Pressure-Induced Ear Drum Movements on Vestibular Reactions<br />

in Patients Suffering from Ménière’s Disease<br />

Influence des mouvements du tympan liés aux variations de pression sur les<br />

réactions vestibulo-spinales et vestibulo-oculaires de patients souffrant de la<br />

maladie de Ménière<br />

Petzold, T.; Hüttenbrink, K.-B.; Dörr, C. (Dresden)<br />

www.karger.com/orl<br />

‘Audiology <strong>and</strong> Neuro-<br />

Otology’ provides a forum<br />

for <strong>the</strong> presentation <strong>of</strong><br />

outst<strong>and</strong>ing papers on <strong>the</strong><br />

auditory <strong>and</strong> vestibular<br />

systems. It aspires to promote<br />

an active <strong>and</strong> stimulating<br />

exchange <strong>of</strong> ideas<br />

between basic <strong>and</strong> clinical<br />

disciplines.<br />

Covering both basic <strong>and</strong><br />

clinical research on <strong>the</strong><br />

anatomy, pathology, pathophysiology,<br />

immunology<br />

<strong>and</strong> tumor biology <strong>of</strong><br />

<strong>the</strong> auditory <strong>and</strong> vestibular<br />

system <strong>and</strong> <strong>of</strong> <strong>the</strong> upper<br />

respiratory <strong>and</strong> digestive<br />

tract.<br />

Promoting an exchange<br />

<strong>of</strong> scientific information<br />

between <strong>the</strong> different<br />

linguistic communities<br />

<strong>of</strong> Europe <strong>and</strong> encouraging<br />

mutual underst<strong>and</strong>ing on<br />

a wide range <strong>of</strong> important<br />

issues.<br />

KP 01115 (16.07.01) Printed in Switzerl<strong>and</strong> (1.24, 1.02)<br />

A guide through middle ear compartments<br />

<strong>Color</strong> <strong>Atlas</strong><br />

<strong>of</strong> <strong>the</strong> <strong>Anatomy</strong> <strong>and</strong><br />

<strong>Pathology</strong> <strong>of</strong> <strong>the</strong><br />

Epitympanum<br />

T. Palva<br />

In collaboration with<br />

H. Ramsay<br />

C.Northrop


<strong>Color</strong> <strong>Atlas</strong><br />

<strong>of</strong> <strong>the</strong> <strong>Anatomy</strong> <strong>and</strong><br />

<strong>Pathology</strong> <strong>of</strong> <strong>the</strong><br />

Epitympanum<br />

<strong>Color</strong> <strong>Atlas</strong><br />

<strong>of</strong> <strong>the</strong> <strong>Anatomy</strong> <strong>and</strong><br />

<strong>Pathology</strong> <strong>of</strong> <strong>the</strong><br />

Epitympanum<br />

T. Palva<br />

In collaboration with<br />

H. Ramsay<br />

C.Northrop<br />

Palva, T. (Helsinki); Ramsay, H. (Helsinki);<br />

Northrop, C. (Boston, Mass.)<br />

<strong>Color</strong> <strong>Atlas</strong> <strong>of</strong> <strong>the</strong> <strong>Anatomy</strong> <strong>and</strong><br />

<strong>Pathology</strong> <strong>of</strong> <strong>the</strong> Epitympanum<br />

X + 104 p., 171 fig., 166 in color,<br />

hard cover, 2001<br />

CHF 257.– / EUR 170.77 / USD 223.50<br />

ISBN 3–8055–7227–1<br />

Prices subject to change<br />

EUR price for Germany,<br />

USD price for USA only<br />

This <strong>Atlas</strong> gives a detailed documentation<br />

<strong>of</strong> <strong>the</strong> superior compartments<br />

<strong>of</strong> <strong>the</strong> middle ear. New microdissection<br />

approaches have been developed, most importantly<br />

anterior microdissection. In addition to <strong>the</strong> tympanic<br />

cavity, this approach allows a direct view into <strong>the</strong><br />

anterior membrane <strong>of</strong> Prussak’s space, <strong>the</strong> anterior surface <strong>of</strong><br />

<strong>the</strong> tensor fold, <strong>and</strong> <strong>the</strong> supratubal recess, areas not explored<br />

earlier. The regular <strong>and</strong> hi<strong>the</strong>rto unknown auxiliary aeration<br />

<strong>and</strong> drainage pathways are shown in detail. Aeration <strong>of</strong> Prussak’s<br />

space is documented using both microdissection <strong>and</strong> serial sections;<br />

<strong>the</strong>se pathways from <strong>the</strong> mesotympanum or from <strong>the</strong> lower<br />

lateral attic are independent <strong>of</strong> <strong>the</strong> tympanic isthmus. The pathology<br />

caused by chronic inflammation on <strong>the</strong> aeration <strong>and</strong> drainage<br />

routes is also documented, <strong>and</strong> new surgical microdissection methods<br />

for removal <strong>of</strong> <strong>the</strong> tensor fold are described.<br />

This <strong>Atlas</strong> is invaluable in <strong>the</strong> temporal bone laboratory for all<br />

residents learning anatomy <strong>and</strong> pathology <strong>of</strong> <strong>the</strong> middle ear compartments,<br />

<strong>and</strong> for <strong>the</strong> experienced otologist <strong>the</strong> photographic documentation<br />

gives reliable evidence <strong>of</strong> <strong>the</strong> variable structures in <strong>the</strong><br />

epitympanic compartments.<br />

Fields <strong>of</strong> Interest: Otorhinolaryngology,<br />

Audiology, Histology,<br />

<strong>Pathology</strong>, Pediatrics<br />

Contents<br />

Preface<br />

Part 1: <strong>Anatomy</strong> <strong>and</strong> <strong>Pathology</strong> <strong>of</strong> <strong>the</strong><br />

Epitympanum<br />

Introduction <strong>and</strong> General Review<br />

� Development <strong>of</strong> <strong>the</strong> concept <strong>of</strong> epitympanum<br />

� Early data <strong>of</strong> <strong>the</strong> s<strong>of</strong>t tissues in <strong>the</strong> epitympanum<br />

� Fetal development <strong>of</strong> epitympanic folds <strong>and</strong><br />

compartments<br />

Tensor Fold � Lateral Incudomalleal Fold �<br />

Chordal Fold � O<strong>the</strong>r Duplicate Folds �<br />

Tympanic Isthmus � Development <strong>of</strong> Prussak’s<br />

Space<br />

� Contemporary Concepts <strong>of</strong> <strong>the</strong> <strong>Anatomy</strong> <strong>of</strong> <strong>the</strong><br />

Epitympanum<br />

Material <strong>and</strong> Methods<br />

<strong>Anatomy</strong> <strong>and</strong> <strong>Pathology</strong> <strong>of</strong> <strong>the</strong> Epitympanum <strong>and</strong><br />

Supratubal Recess<br />

� Epitympanic Diaphragm<br />

� Normal <strong>Anatomy</strong> <strong>of</strong> Prussak’s Space (with <strong>the</strong><br />

Lateral Malleal Space)<br />

Microdissection � Serial Sections<br />

� <strong>Pathology</strong> <strong>of</strong> Prussak’s Space <strong>and</strong> <strong>the</strong> Lateral<br />

Malleal Space<br />

Microdissection � Serial Sections<br />

� Cholesteatoma in Prussak’s Space<br />

� Large Epitympanic Compartments<br />

Posterior Epitympanum � Anterior Epitympanum<br />

� Supratubal Recess (Space)<br />

References<br />

Part 2: <strong>Pathology</strong> Related to Amniotic Fluid<br />

Cellular Content <strong>and</strong> Superimposed Infection<br />

Introduction <strong>and</strong> Short Review <strong>of</strong> <strong>the</strong> Literature on<br />

Amniotic Fluid Cellular Content<br />

Short Review <strong>of</strong> Mastoid Pneumatization<br />

Amniotic Fluid Cellular Content-Related Middle<br />

Ear <strong>Pathology</strong> as a Function <strong>of</strong> Age in Serial<br />

Sections<br />

� Temporal Bones from Neonates<br />

Superior <strong>and</strong> Anterior Epitympanum <strong>and</strong><br />

Antrum � Tensor Fold <strong>and</strong> Supratubal<br />

Recess � Lateral Incudomalleal Fold <strong>and</strong><br />

Lateral Attics � Lateral Malleal Space <strong>and</strong><br />

Prussak’s Space � Medial Attic <strong>and</strong> Tympanic<br />

Isthmus � Tympanic Cavity � Eustachian Tube �<br />

Mastoid Pneumatization � Comment<br />

� Temporal Bones from 2- to 4-Month-Old Infants<br />

Compartments above <strong>the</strong> Epitympanic<br />

Diaphragm <strong>and</strong> <strong>the</strong> Mastoid Antrum � Tensor<br />

Fold <strong>and</strong> Supratubal Recess � Lateral Malleal<br />

Space <strong>and</strong> Lateral Attics � Prussak’s Space <strong>and</strong><br />

Its Aeration Pathways � Tympanic Isthmus <strong>and</strong><br />

Posterior Tympanum � Tympanic Sinus <strong>and</strong><br />

Round Window Niche � Eustachian Tube �<br />

Elements Specific to Amniotic Fluid Cellular<br />

Content � Mastoid Pneumatization � Comment<br />

� Temporal Bones from 5- to 23-Month-Old Infants<br />

Case 1 � Case 2 � Case 3 � Case 4 � Case 5 �<br />

Elements Specific to Amniotic Fluid Cellular<br />

Content � Mastoid Pneumatization � Comment<br />

General Comments<br />

� Histological Considerations regarding Amniotic<br />

Fluid Cellular Content- Associated <strong>Pathology</strong><br />

� Mastoid Pneumatization<br />

� Clinical Considerations<br />

References<br />

Part 3: Microsurgical Approaches to<br />

Inflammatory Ear Disease<br />

Introduction<br />

Early Attempts to Improve Epitympanic Aeration<br />

Microsurgical Methods in Surgery for Retraction<br />

Pockets<br />

� Surgery for Incipient Retraction Pocket<br />

� Surgery for Established Retraction Pockets<br />

Frontolateral Atticotomy<br />

� Extensive Attic <strong>and</strong> Mesotympanic Disease in<br />

Chronic Otitis media<br />

Spread <strong>of</strong> Cholesteatoma from Prussak’s Space<br />

� Posterior Route<br />

� Inferior Central Route<br />

� Superior Route<br />

� Anterior Route<br />

Final Remarks<br />

References<br />

Subject Index

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