Dr. Mona Fawzi Berier

Dr. Mona Fawzi Berier Doctor (ORL, H&N Surgery)

One of the possible causes of patulous Eustachian tube dysfunction is the presence of a longitudinal concave defect invo...
15/02/2026

One of the possible causes of patulous Eustachian tube dysfunction is the presence of a longitudinal concave defect involving the valve within the cartilaginous portion of the Eustachian tube, most commonly affecting the membranous (anterolateral) wall. Less frequently, a deficiency may be present in the cartilaginous (posteromedial) wall.
Under normal conditions, the membranous wall of the Eustachian tube demonstrates a convex bulge, which can be readily observed during nasopharyngoscopic examination. Any structural deficiency within the valve region may prevent complete closure of the tube at rest, thereby compromising its normal function of preventing reflux of sound and nasopharyngeal secretions into the middle ear.
In the setting of a patulous Eustachian tube, this failure of closure creates an abnormal pathway that allows sound and nasopharyngeal secretions to reach the middle ear, and potentially the inner ear, resulting in symptoms such as autophony, audible breathing, and pulsatile tinnitus.
Endoscopic examination of the Eustachian tube illustrates this distinction clearly: a normal Eustachian tube appears closed with a convex configuration of the membranous wall, whereas in patulous Eustachian tube dysfunction, a characteristic hollowed-out concave deformity of the membranous wall at the level of the mucosal valve is observed (Arrow)

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08/02/2026

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Structure of cochlea
03/02/2026

Structure of cochlea

Eagle Syndrome*DefinitionEagle syndrome is a rare condition caused by:Elongation of the styloid processand/orCalcificati...
30/01/2026

Eagle Syndrome

*Definition

Eagle syndrome is a rare condition caused by:
Elongation of the styloid process
and/or

Calcification of the stylohyoid ligament
Normal styloid process length: 2–2.5 cm
Pathologic: usually > 3 cm

*Types (High-Yield)

1. Classic Eagle Syndrome
Often follows tonsillectomy
Due to irritation of cranial nerves (V, VII, IX, X)
Symptoms:
Throat pain
Foreign body sensation in the throat
Odynophagia
Referred otalgia
Pain worsens with swallowing or yawning

2. Stylo-carotid Syndrome
Elongated styloid compresses internal or external carotid artery

*Symptoms:

Neck or facial pain
Headache
Dizziness, syncope
Visual disturbances
TIA-like symptoms (rare but important)
Clinical Examination
Pain reproduced by palpation of the tonsillar fossa
Symptoms exacerbated by head rotation or extension

*Diagnosis

✅ CT neck with 3D reconstruction (Gold standard)
Measures styloid length
Demonstrates ligament calcification
Shows relationship to carotid vessels
❌ Plain X-ray is less reliable

*Differential Diagnosis

Glossopharyngeal neuralgia
Trigeminal neuralgia
Temporomandibular joint disorders
Cervical spine disease
Chronic tonsillitis
Temporal arteritis

*Management

Conservative

NSAIDs

Neuropathic pain medications (gabapentin, carbamazepine)

Local steroid or lidocaine injection

Surgical (Definitive)

Styloidectomy

Transoral or external approach

*High success rate in properly selected patients
Exam Pearls

Chronic throat pain + otalgia + normal brain imaging → think Eagle syndrome

Post-tonsillectomy throat pain → classic type

Neurologic or vascular symptoms → stylo-carotid type

CT 3D reconstruction is diagnostic

Keratin Debris – This is keratin debris, not fungal infection and not cerumenComposed of accumulated desquamated squamou...
15/01/2026

Keratin Debris – This is keratin debris, not fungal infection and not cerumen
Composed of accumulated desquamated squamous epithelium
Originates from external auditory canal or middle ear epithelium
Results from impaired epithelial migration
Indicates chronic ear pathology (cholesteatoma).

Headless Mermaid Sign on Coronal HRCT of the Temporal BoneWhen reviewing a coronal HRCT image of the temporal bone, the ...
01/01/2026

Headless Mermaid Sign on Coronal HRCT of the Temporal Bone

When reviewing a coronal HRCT image of the temporal bone, the medial wall of the middle ear may display a characteristic configuration that resembles a “headless mermaid”, sometimes appearing in a ballerina pose
This visual analogy is a helpful anatomical orientation sign, especially useful for trainees and during rapid image review.

Components of the Headless Mermaid:
Tail
▪️ Basal turn of the cochlea
▪️ Forms the cochlear promontory
Umbilicus
▪️ Oval window

Chest & Abdomen
▪️ Vestibule

Hands in ballerina pose
▪️ Superior semicircular canal (SCC)
▪️ Lateral semicircular canal (LCC)
Headless
▪️ The semicircular canals are not fully visualized in the same coronal section, giving a “headless” appearance
Why is this sign important?
*Confirms normal medial wall anatomy of the middle ear
*Facilitates quick recognition of inner ear structures
*Helps detect subtle distortions caused by pathology (congenital anomalies, otosclerosis, erosive or expansile lesions)

Clinical Pearl:
Any alteration in the Headless Mermaid appearance on coronal HRCT should prompt a careful search for underlying pathology affecting the bony labyrinth.

Named by professor Anagha (India)

How to Differentiate Axial and Coronal CT Views (Temporal Bone)The distinction between axial and coronal CT images depen...
25/12/2025

How to Differentiate Axial and Coronal CT Views (Temporal Bone)

The distinction between axial and coronal CT images depends on the orientation of the slice and the anatomical relationships seen.

View
Represents a horizontal slice, viewed from above downward
Emphasizes anterior–posterior relationships
Commonly shows:

*The cochlea in its characteristic spiral shape
*The internal auditory canal (IAC)
*Horizontal course of the facial nerve
*The external auditory canal usually appears round or oval

Key clue: dominance of cochlea and IAC → Axial view

View
Represents a vertical slice, viewed from front to back
Emphasizes superior–inferior relationships
Commonly shows:
*The tegmen tympani clearly superiorly
*Mastoid air cells extending inferiorly
*The external auditory canal seen along its length
*Ossicles appearing stacked vertically

Key clue: clear tegmen above and mastoid below → Coronal view

Practical Rule
Anterior–posterior orientation → Axial
Superior–inferior orientation → Coronal

a ,b axial
C,d coronal

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Rustaq

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