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Research ArticleHead and Neck Imaging

A Persistent Foramen of Huschke: A Small Road to Misery in Necrotizing External Otitis

W.L. van der Meer, M. van Tilburg, C. Mitea and A.A. Postma
American Journal of Neuroradiology September 2019, 40 (9) 1552-1556; DOI: https://doi.org/10.3174/ajnr.A6161
W.L. van der Meer
aFrom the Departments of Radiology and Nuclear Medicine (W.L.v.d.M., C.M., A.A.P.)
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M. van Tilburg
bOtorhinolaryngology and Head and Neck Surgery (M.v.T.), Maastricht University Medical Center, Maastricht, the Netherlands
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C. Mitea
aFrom the Departments of Radiology and Nuclear Medicine (W.L.v.d.M., C.M., A.A.P.)
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A.A. Postma
aFrom the Departments of Radiology and Nuclear Medicine (W.L.v.d.M., C.M., A.A.P.)
cSchool for Mental Health and Neuroscience (A.A.P.), Maastricht University, Maastricht, the Netherlands.
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    Fig 1.

    A 79-year-old man with type II diabetes presented with a painful right ear and pain during mastication. CT shows an increased distance of the TMJ (A, white arrow) and infiltration of the retrocondylar fat pad and surrounding fat planes (B, curved arrow). The contrast-enhanced T1-weighted MR imaging shows enhancement of the retrocondylar fat pad (C, broad arrow), with increased FDG accumulation on PET/MR imaging (D, arrowhead). The biopsy of the external ear canal was positive for P Aeruginosa.

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    Fig 2.

    A 76-year-old man without a medical history presented with a painful ear and otorrhea. CT shows an increased distance of the TMJ (A, white arrow), obliteration of subtemporal fat lines, and a retrocondylar fat pad sign (B. arrowhead), as well as osseous destruction of the mastoid (C, white curved arrow). Contrast-enhanced T1-weighted image 2 weeks after diagnosis demonstrates progression of NEO with an anterior, medial, and intracranial spreading pattern complicated by a thrombus in the left jugular vein (D, black arrow) with increased FDG accumulation on PET/MR imaging (E, asterisk). History revealed noncompliance with antibiotic treatment. Biopsy of the external ear canal was positive for P Aeruginosa.

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    Fig 3.

    Coronal illustration of the location of the fissures of Santorini and the foramen of Huschke. The fissures of Santorini extend through the osteocartilaginous or cartilaginous junctions of the EAC (arrows). The foramen of Huschke (arrowhead) is located anterior-inferior to the EAC and posterior-medial to the temporomandibular joint.

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    Fig 4.

    Temporal bone axial and sagittal views of patients with NEO with a persistent foramen of Huschke. The views show a subtle (1A and 1B), mild (2A and 2B), moderate (3A and 3B), and extensive dehiscence (4A and 4B) as indicated by the white arrows.

Tables

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    Table 1:

    Demographics for patients with NEO and controlsa

    Age range (Mean) (yr)NEO (n = 39)Controls (n = 39)
    Women (n = 11)Men (n = 28)Women (n = 11)Men (n = 28)
    50–591 (51)2 (50)1 (59)2 (56)
    60–692 (63)9 (66)2 (63)9 (65)
    70–793 (78)6 (78)3 (74)6 (74)
    80 or older5 (87)11 (86)5 (84)11 (84)
    • ↵a Data are number of patients per age range.

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    Table 2:

    Prevalence of the foramen of Huschke in patients with NEO and controls

    Foramen of HuschkeNEO (n = 39)Controls (n = 39)P < .05
    No.PercentageNo.Percentage
    Absent1846%3282%.002a
    Present2154%718%.002a
        Unilateral1641%513%–
        Bilateral513%25%–
    Total39100%39100%
    • Note:— – indicates data is not available.

    • ↵a Significant.

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    Table 3:

    Location of the foramen of Huschke in patients with NEO and controls

    LocationForamen of Huschke
    PresentAbsent
    No.PercentageNo.Percentage
    NEO
        Left ear1641%2359%
        Right ear1026%2974%
    Controls
        Left ear38%3692%
        Right ear615%3385%
    • View popup
    Table 4:

    Size of the persistent foramen of Huschke specified in controls and patients with NEO

    Foramen SizeNEOTotal Control Ears (n = 78)
    Nonaffected Side/Ears (n = 38)Affected NEO Ears (n = 40)NEO Total Ears (n = 78)
    Subtle (<0.5 mm)4266
    Mild (0.5–1.0 mm)0221
    Moderate (1.0–1.5 mm)1670
    Extensive (>1.5 mm)110112
    Total620269
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American Journal of Neuroradiology: 40 (9)
American Journal of Neuroradiology
Vol. 40, Issue 9
1 Sep 2019
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Cite this article
W.L. van der Meer, M. van Tilburg, C. Mitea, A.A. Postma
A Persistent Foramen of Huschke: A Small Road to Misery in Necrotizing External Otitis
American Journal of Neuroradiology Sep 2019, 40 (9) 1552-1556; DOI: 10.3174/ajnr.A6161

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A Persistent Foramen of Huschke: A Small Road to Misery in Necrotizing External Otitis
W.L. van der Meer, M. van Tilburg, C. Mitea, A.A. Postma
American Journal of Neuroradiology Sep 2019, 40 (9) 1552-1556; DOI: 10.3174/ajnr.A6161
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