21. ACQUIRED CHOLESTEATOMA CASE STUDY (AIDAN1) ACQUIRED cholesteatoma http://tmsyn.wc.ask.com/r?t=an&s=hb&uid=24312681243126812&sid=343126

22. Www.nlm.nih.gov/cgi/mesh/2K/MB_cgi?term=Cholesteatoma cholesteatomacholesteatoma links dedicated to informing patients, students, and hearinghealthcare providers. Contains summary of each link to notify you what is present http://www.nlm.nih.gov/cgi/mesh/2K/MB_cgi?term=Cholesteatoma

23. Cholesteatoma And Chronic Mastoiditis in some cases to recurrent infections of the mastoid, or even cholesteatoma.cholesteatoma is an epithelial cyst (made from the tissue and cells that http://www.nycornell.org/ent/cholesteatoma.html

Cholesteatoma and Chronic Mastoiditis The middle ear and the mastoid are directly connected to each other and are normally filled with air. Air enters the middle ear via the eustachian tube which opens into the naspharynx (deep portion of the nasal chamber). Recurrent middle ear infections may be due to poor function of the eustachian tube. Although most middle ear infections resolve, some recur or persist. Those chronic infections may lead to damage of the tympanic membrane (ear drum) that can result in a perforation or, in some cases to recurrent infections of the mastoid, or even cholesteatoma. Cholesteatoma is an epithelial cyst (made from the tissue and cells that make skin). Technically, it is not a tumor, but it grows independently. Cholesteatomas grow slowly, yet are able to erode and destroy bone in their path. Most commonly bone destruction is manifest as erosion of the ossicles (the vibrating bones of hearing), but cholesteatoma can erode into the inner ear, leading to nerve deafness and vertigo, or can erode into the intracranial cavity leading to infection around or inside the brain. Cholesteatoma can erode the bone surrounding and protecting the facial nerve, and can lead to facial weakness, or in severe cases paralysis. Cholesteatoma is treated by microsurgery. Several different types and degrees of tymanomastoidectomy surgery exist for cholesteatoma. The appropriate surgery is selected on the basis of the size and location of the cholesteatoma. Reconstruction of damaged ossicles is also possible, but may require additional surgery depending on the findings at the initial surgery. Cholesteatoma surgery can be lengthy, since it requires meticulous microdissection, but success rates for control of cholesteatoma are high and risks of surgery are low.

24. Grand Rounds Archives The term cholesteatoma is actually a misnomer coined by Johannes Muller in Based on these findings Glasscock concluded that pediatric cholesteatoma is http://www.bcm.edu/oto/grand/10793.html

Grand Rounds Archives The information contained within the Grand Rounds Archive is intended for use by doctors and other health care professionals. These documents were prepared by resident physicians for presentation and discussion at a conference held at The Baylor College of Medicine in Houston, Texas. No guarantees are made with respect to accuracy or timeliness of this material. This material should not be used as a basis for treatment decisions, and is not a substitute for professional consultation and/or peer-reviewed medical literature. PEDIATRIC CHOLESTEATOMA A. Paul Vastola, MD October 7, 1993 The term cholesteatoma is actually a misnomer coined by Johannes Muller in 1838. He described "a layered pearly tumor of fat which was distinguished from other fat tumors by the presence of biliary fat or cholestrin that is interspersed among sheets of polyhedral cells." Aural cholesteatomas are best thought of as skin growing in the middle ear space. Cholesteatomas actually do not contain fat but are composed of an outer matrix which surrounds layers of desquamated epithelium. The matrix is comprised of fully differentiated keratinizing squamous epithelium resting on a collagenous perimatrix. Various theories have been advanced to account for the destructive bone resorption seen commonly with these lesions. These include activation of osteoclastic bone destruction, mechanical pressure necrosis and bone degradation by enzymes such as collagenases and lysozymes.

25. Chronic Otitis Media And Cholesteatoma Chronic otitis media can also lead to a cholesteatoma. A cholesteatoma is a skingrowth that occurs behind the eardrum. It is usually caused by repeated ear http://www.bcm.edu/oto/jsolab/tm_me_mastoid/chron_OM_cholesteatoma.htm

Tympanic Membrane, Middle Ear and Mastoid Disease Bobby R. Alford Department of Otorhinolaryngology and Communicative Sciences Baylor College of Medicine Chronic Otitis Media and Cholesteatoma Etiology and Diagnosis A patient with a perforated tympanic membrane can develop chronic otitis media. This is defined as a chronic ear infection with drainage out the ear canal (otorrhea). The long-standing infection slowly erodes the middle ear ossicles, causing ossicular chain discontinuity. Occasionally, the infection can spread to the inner ear causing permanent sensorineural hearing loss, to the facial nerve causing facial nerve paralysis, or to the brain causing meningitis or a brain abscess. Chronic otitis media can also lead to a cholesteatoma. A cholesteatoma is a skin growth that occurs behind the eardrum. It is usually caused by repeated ear infections associated with poor Eustachian tube function. Over time, the cholesteatoma increases in size and destroys the delicate middle ear bones. Eventually, it may erode into the inner ear and cause permanent hearing loss or dizziness. It may grow to involve the facial nerve causing facial paralysis. In some instances, cholesteatomas can expand up into the brain. Chronic otitis median and/or cholesteatoma are a serious conditions that requires prompt treatment. Initially, this involves careful cleaning of the ear, antibiotics, and eardrops. Often, computed tomography (CT scan) is helpful to define the extent of the disease. This also can act as a road map for surgery.

26. InteliHealth: Cholesteatoma InteliHealth Featuring Harvard Medical School s consumer health information.For more than 550 diseases and conditions, learn What Is It?, Symptoms, http://www.intelihealth.com/IH/ihtIH/WSIHW000/9339/9710.html

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27. MURAL CHOLESTEATOMA IN 13 YEAR FEMALE PATIENT A VO picture of the mural cholesteatoma was taken in December 1997. Mural cholesteatoma12/97. Her surgery was delayed but was rescheduled for May 1998. http://www.rcsullivan.com/www/ponsmur.htm

CASE STUDY (PONS1): MURAL CHOLESTEATOMA IN 13 YEAR FEMALE PATIENT Case contributed by: Kevin C. Pons, M.A., FAAA ENT Department, Yankton Medical Clinic; Yankton, SD The patient is a 13 year old female who was being seen by the ENT Department for follow up care since undergoing a canal up [intact wall] mastoidectomy and tympanoplasty at age 11.5 yrs. During her initial surgery a massive amount of cholesteatomatous material and granulation tissue was removed from the middle ear. The long process of the incus had been eroded by the cholesteatoma but was used to reossicularize the chain following its reshaping and repositioning between the neck of the malleus and the capitulum of the stapes. The defect in the TM was grafted and a collar tube was inserted. At her second 6 month check-up it was noted that a small mural cholesteatoma had developed anterior to the handle of the malleus and posterior to the tube. A VO picture of the mural cholesteatoma was taken in December 1997. Mural Cholesteatoma 12/97 Her surgery was delayed but was rescheduled for May 1998.

28. PRIMARY CHOLESTEATOMA; 16 Month M. CASE STUDY (PONS1) PRIMARY cholesteatoma IN 16 MONTH MALE INFANT The chordatympani nerve remained intact and no other cholesteatoma or other http://www.rcsullivan.com/www/pons1.htm

CASE STUDY (PONS1): PRIMARY CHOLESTEATOMA IN 16 MONTH MALE INFANT Case contributed by: Kevin C. Pons, M.A., FAAA ENT Department, Yankton Medical Clinic; Yankton, SD The cholesteatoma was removed in toto . The middle ear could be visualized and the ossicles were intact and not damaged by the tumor. A tympanotomy was then performed in preparation to repair the defect. At this time all the ossicles were confirmed to be normal. The chorda tympani nerve remained intact and no other cholesteatoma or other abnormalities were noted. Figures below present two views of the dissected cholesteatoma The pathology report demonstrated a cystic structure with indistinct lining but whose features were consistent with a cholesteatoma. The specimen was 1.5 mm at its pedunculated base, 2.5 mm wide and 3 mm in length. Video Otoscopy of Primary Cholesteatoma, AD in situ Dissected choleteatoma, superior view Dissected cholesteatoma, lateral view RETURN TO MAIN MENU

29. Cholesteatoma, Chronic Ear Problems, Hearing Loss, Ear Drum Perforations, Ear Dr Western Florida practice exclusively dedicated to the care of congenital oracquired ear, nose and throat disorders in children and adosescents. http://www.pediatric-ent.com/learning/problems/cholesteatoma.htm

Cholesteatoma and other Chronic Ear Problems What Causes Hearing Loss in a Normal Ear? The ear is commonly divided into three segments: the external ear which includes the ear lobe and ear canal, the middle ear which includes the ear drum and the ear bones, and the inner ear which houses the hearing organ and the nerve that travels from the ear to the brain. the middle and inner ear represent delicate structures that, when exposed to long term infection and disease, can lead to hearing loss. This hearing loss can either be temporary or permanent. Many times, your doctor will be unable to guarantee the return of your child's hearing loss. However, many times a good estimate of hearing "reserve" can be made from the initial hearing test. What are Ear Drum Perforations and Ear Drainage? The ear drum may develop a hole, (or perforation), due to trauma or infection. In most instances, ear drum perforations caused by infection will close after the infection resolves. However, some perforations are too large to close spontaneously and will become infected causing drainage from the ear. When this occurs, your doctor's first priority is to treat the infection and provide your child with a "safe" ear. This will prevent further hearing loss and damage to the ear due to infection.

30. About Ears A cholesteatoma is a skin growth that occurs in an abnormal location, the middle ear Over time, the cholesteatoma can increase in size and destroy the http://www.midwestear.com/educatb.htm

Cholesteatoma: A Serious Condition What is cholesteatoma? A cholesteatoma is a skin growth that occurs in an abnormal location, the middle ear behind the eardrum. It is usually due to repeated infection which causes an ingrowth of the skin of the eardrum. cholesteatomas often take the form of a cyst or pouch which sheds layers of old skin that builds up inside the ear. Over time, the cholesteatoma can increase in size and destroy the surrounding delicate bones of the middle ear. Hearing loss, dizziness, and facial muscle paralysis are rare but can result from continued cholesteatoma growth. How does it occur? A cholesteatoma usually occurs because of poor eustachian tube function was well as infection in the middle ear. The eustachian tube conveys air from the back of the nose into the middle ear to equalize ear pressure ("clear the ears"). When the eustachian tubes work poorly, perhaps due to allergy, a cold or sinusitis, the air in the middle ear is absorbed by the body, and a partial vacuum results in the ear. The vacuum pressure sucks in a pouch or sac by stretching the eardrum, especially areas weakened by previous infections. This sac often becomes a cholesteatoma. A rare congenital form of cholesteatoma (one present at birth) can occur in the middle ear and elsewhere, such as in the nearby skull bones. However, the type of cholesteatoma associated with ear infections is most common. What are the symptoms?

31. Introduction: Cholesteatoma - WrongDiagnosis.com Introduction to cholesteatoma as a medical condition including symptoms, diagnosis,misdiagnosis, treatment, prevention, and prognosis. http://www.wrongdiagnosis.com/c/cholesteatoma/intro.htm

Home Symptoms Diseases Risks ... Diseases Search our medical database Subscribe to our free Newsletter sample Send this page to a friend Condition Lists By Organ By Symptom By Class By Prevalence ... List A-Z Current chapter: Cholesteatoma Next sections Basic Summary for Cholesteatoma Causes of Cholesteatoma Symptoms of Cholesteatoma Complications of Cholesteatoma ... Misdiagnosis of Underlying Causes of Cholesteatoma Next chapters: Ear wax Glue ear Labrynthitis Ménière's disease ... Feedback Introduction: Cholesteatoma Cholesteatoma: Uncommon middle ear condition Researching symptoms of Cholesteatoma: Further information about the symptoms of Cholesteatoma is available including a list of symptoms of Cholesteatoma , or alternatively return to research other symptoms in the symptom center Treatments for Cholesteatoma: Various information is available about treatments available for Cholesteatoma , or research treatments for other diseases. Causes of Cholesteatoma: Research more detailed information about the causes of Cholesteatoma , other possibly hidden causes of Cholesteatoma , or other general information about Cholesteatoma Contents for Cholesteatoma: Basic Summary for Cholesteatoma Causes of Cholesteatoma Symptoms of Cholesteatoma Complications of Cholesteatoma ... Glossary for Cholesteatoma Last revision: May 26, 2003

32. Treatments For Cholesteatoma - WrongDiagnosis.com Treatments for cholesteatoma including drugs, prescription medications, alternativetreatments, surgery, and lifestyle changes. http://www.wrongdiagnosis.com/c/cholesteatoma/treatments.htm

Home Symptoms Diseases Risks ... Cholesteatoma Search our medical database Subscribe to our free Newsletter sample Send this page to a friend Condition Lists By Organ By Symptom By Class By Prevalence ... List A-Z Current chapter: Cholesteatoma Next sections Doctors and Medical Specialists for Cholesteatoma Glossary for Cholesteatoma Next chapters: Ear wax Glue ear Labrynthitis Ménière's disease ... Feedback Treatments for Cholesteatoma Treatment list for Cholesteatoma: The list of treatments mentioned in various sources for Cholesteatoma includes the following list. Always seek professional medical advice about any treatment or change in treatment plans. Ear surgery Surgical reconstruction of middle ear Hearing aid Last revision: May 26, 2003 Diseases Cholesteatoma Did we miss something? Please provide feedback or suggestions By using this site you agree to our . Information provided on this site is for informational purposes only; it is not intended as a substitute for advice from your own medical team. The information on this site is not to be used for diagnosing or treating any health concerns you may have - please contact your physician or health care professional for all your medical needs. Please see our IMPORTANT! Use of this site is subject to our

33. Cholesteatoma Of The Middle-Ear & Hearing Loss My son had surgery for cholesteatoma and now he is now deaf in his left ear.Is there any way to restore his hearing? http://health.ivillage.com/ent/ear/0,,6c88,00.html

var iv_cimsUid = "172148"; var iv_cimsCid = "131351"; var iv_createDate = "12/13/1999"; var iv_lastModDate = "06/25/2001"; // Tacoda category stamp var dartCatStamp = "health_ent_ear_earhear"; Tacoda_AMS_DDC_addPair("dartCatStamp", dartCatStamp); var iv_secondarytopicID = 131347; @import "/shared/css/global/0,,,00.css"; @import "/shared/css/layout/0,,layout_article,00.css"; @import "/shared/css/content/0,,qa,00.css"; @import "/shared/css/channel/0,,16,00.css"; Skip to Main Content iVillage Entertainment Magazines iVillage web Ear Hearing Energy Happiness ... Message Boards: Live Support and Advice Eat Right, Get Active iVillage Health Women's Well-Being more newsletters by Douglas Hoffman, MD, PhD (see more from this expert) Email this page Print Early Signs of ... Sensitive to Noise Please tell me about a disease called cholesteatoma and deafness. My son had surgery for cholesteatoma. The doctor "botched" it and my son is now totally deaf in his left ear. Is there any way to restore his hearing? He is only 12 years old. C.N.

34. Cholesteatoma All I can say after doing the research for this article, is that I hope I neverget one of THESE things in my ear. cholesteatomas not only cause hearing http://deafness.about.com/b/a/141132.htm

zJs=10 zJs=11 zJs=12 zJs=13 zc(5,'jsc',zJs,9999999,'') zfs=0;zCMt='a55' About Deafness / Hard of Hearing Deafness Essentials ... Help zau(256,140,140,'el','http://z.about.com/0/ip/417/C.htm','');w(xb+xb+' ');zau(256,140,140,'von','http://z.about.com/0/ip/496/6.htm','');w(xb+xb); FREE Newsletter Sign Up Now for the Deafness / Hard of Hearing newsletter! See Online Courses Search Deafness / Hard of Hearing Cholesteatoma Deafness/Hard of Hearing Blog Main From Jamie Berke Your Guide to Deafness / Hard of Hearing FREE Newsletter. Sign Up Now! January 22, 2005 Cholesteatoma All I can say after doing the research for this article, is that I hope I never get one of THESE things in my ear. Cholesteatomas not only cause hearing loss but can be dangerous. Email to a Friend Display Latest Headlines Read Archives powered by Movable Type Advertisement Most Popular Sign Language Dictionaries I Love You Handshape Sign Word Reference Guide Learn Sign Language What's Hot Thomas H. Gallaudet Rush's Hearing Loss Laurent Clerc Ten Years of King Jordan ... Interpreter Issues in School adunitCM(150,100,'x55') Topic Index Email to a Friend Our Story Be a Guide ... Patent Info.

35. Cholesteatoma AllRefer Health cholesteatomacholesteatoma information center covers causes, prevention, symptoms, diagnosis,treatment, incidence, risk factors, signs, tests, support groups, http://deafness.about.com/od/diseasesandsyndromes/a/cholesteatoma.htm

var zLb=7; var zIoa2 = new Array('Suggested Reading','Hearing Loss Causes','http://deafness.about.com/c/ec/83.htm','Acoustic Neurinoma','http://deafness.about.com/cs/etiology/a/acousticneur.htm','Autoimmune Inner Ear Disease','http://deafness.about.com/cs/etiology/a/aied.htm'); var zIoa3 = new Array('Other','Comments? Questions?','http://deafness.about.com/library/blmail.htm','Current Features on Deafness and Hearing Loss','http://deafness.about.com/library/weekly/mpreviss.htm','Articles by Topic','http://deafness.about.com/library/weekly/topicmenu.htm'); zJs=10 zJs=11 zJs=12 zJs=13 zc(5,'jsc',zJs,9999999,'') zfs=0;zCMt='a55' About Deafness / Hard of Hearing Hearing Loss Basics Medical Causes ... Diseases and Syndromes Cholesteatoma Deafness Essentials Sign Language Word Reference Guide Famous or Historic Deaf People ... Help zau(256,140,140,'el','http://z.about.com/0/ip/417/C.htm','');w(xb+xb+' ');zau(256,140,140,'von','http://z.about.com/0/ip/496/6.htm','');w(xb+xb); FREE Newsletter Sign Up Now for the Deafness / Hard of Hearing newsletter! See Online Courses Search Deafness / Hard of Hearing Stay up to date!

36. AllRefer Health - Cholesteatoma Prognosis (Expectations) cholesteatoma information center covers Prognosis (Expectations). http://health.allrefer.com/health/cholesteatoma-prognosis.html

AllRefer Channels :: Yellow Pages Reference Health Home ... Contact Us Quick Jump ADD/ADHD Allergies Alzheimer's Disease Arthritis Asthma Back Pain Breast Cancer Cancer Colon Cancer Depression Diabetes Gallbladder Disease Heart Attack Hepatitis High Cholesterol HIV/AIDS Hypertension Lung Cancer Menopause Migraines/Headaches Osteoporosis Pneumonia Prostate Cancer SARS Stroke Urinary Tract Infection 1600+ More Conditions Alternative Medicine Health News Symptoms Guide Special Topics ... Medical Encyclopedia Web health.allrefer.com You are here : AllRefer.com Health Cholesteatoma : Prognosis of Cholesteatoma Cholesteatoma Definition Prevention Treatment Expectations or Prognosis Complications Calling Your Health Care Provider Go To Main Page Cholesteatoma Prognosis (Expectations) Cholesteatomas usually continue to grow if not removed. Surgical treatment is effective, but there may be a need for periodic cleaning or repeat surgery if the cholesteatoma recurs. Previous Top Next Jump to another section Definition Cholesteatoma Prevention Cholesteatoma Treatment Cholesteatoma Prognosis Cholesteatoma Complications Calling Your Health Care Provider Topics that might be of interest to you Brain Abscess Labyrinthitis Meningitis Otitis Media - Chronic ... Electronystagmography Other Topics Chronic Cysts Dizziness Ear Discharges or Bleeding ... Numbness and Tingling Review Date : 9/5/2002 Reviewed By : Jason Newman, M.D., Department of Otolaryngology, Kaiser Permanente Medical Group, Washington, DC. Review provided by VeriMed Healthcare Network.

37. Cholesteatoma:  A Serious Ear Condition However, the type of cholesteatoma associated with ear infections is most cholesteatoma is a serious but treatable ear condition which can only be http://www.entassociates.com/cholesteatoma.htm

of corpus christi What is a cholesteatoma? Why did it occur in the ear? How does it occur? How is it dangerous? When should something be done about it? If nothing is done, what can happen? Will I always have this problem? Can it be removed or cured? What is a cholesteatoma? A cholesteatoma is a skin growth that occurs in an abnormal location, the middle ear behind the eardrum. It is usually due to repeated infection, which causes an ingrowth of the skin of the eardrum. Cholesteatomas often take the form of a cyst or pouch which sheds layers of old skin that builds up inside the ear. Over time, the cholesteatoma can increase in size and destroy the surrounding delicate bones of the middle ear. Hearing loss, dizziness, and facial muscle paralysis are rare but can result from continued cholesteatoma growth. How does it occur? A cholesteatoma usually occurs because of poor eustachian tube function as well as infection in the middle ear. The eustachian tube conveys air from the back of the nose into the middle ear to equalize ear pressure ("clear the ears"). When the eustachian tubes work poorly perhaps due to allergy, a cold or sinusitis, the air in the middle ear is absorbed by the body, and a partial vacuum results in the ear. The vacuum pressure sucks in a pouch or sac by stretching the eardrum, especially areas weakened by previous infections. This sac often becomes a cholesteatoma. A rare congenital form of cholesteatoma (one present at birth) can occur in the middle ear and elsewhere, such as in the nearby skull bones. However, the type of cholesteatoma associated with ear infections is most common.

38. Ae 90% of cases with this constellation of findings will be cholesteatoma. acquired cholesteatoma -98% of middle ear cholesteatomas, pars flaccida http://www.med.uc.edu/neurorad/webpage/fma.html

Click on small image to see full size. Cholesteatoma Findings: An erosive soft tissue mass is present in the left middle ear involving Prussak's space, with erosion of the scutum and ossicles. Differential Diagnosis: 90% of cases with this constellation of findings will be cholesteatoma. Cholesterol granuloma, metastasis, rhabdomyosarcoma, and carcinomas such as squamous cell, adeno, and adenoid cystic could also be considered. This is the wrong location for glomus tympanicum (cochlear promontory), and the findings are not consistent with vascular lesions. Discussion: -acquired cholesteatoma -98% of middle ear cholesteatomas, pars flaccida -Prussak's space with medial ossicular displacement, +/- bone destruction -complications: -conductive hearing loss due to ossicular destruction -labyrinthine fistula, facial n., tegmen erosion -intracranial extension, sigmoid sinus erosion/thrombosis, automastoidectomy -intracranial abscess, meningitis -CSF rhinorrhea reference: Harnsberger, H. Handbook of Head and Neck Imaging 2nd Ed. 1995: Mosby Year Book. pp. 444-447.

39. Cholesteatoma This site contains information about cholesteatoma. http://www.mamashealth.com/ear/cho.asp

Mamashealth.com Home Ear Health Acute Middle Ear Infection Airplane Ear Cholesteatoma Cochlear Implant ... Waardenburg Links Email Mama What is Cholesteatoma? Cholesteatoma is a type of cyst located in the middle ear. What Causes Cholesteatoma? Cholesteatoma usually occurs as a complication of chronic ear infection. Long-term inflammation and malfunction of the eustachian tube (the tube that connects your middle ear to the back of your nose and throat) leads to chronic negative pressure in the middle ear. Chronic negative pressure in the middle ear causes a portion of the eardrum to pull inward, creating a sac or cyst that fills with old skin cells and other debris. The cyst becomes chronically infected. The cyst typically continues to fill with debris over time and may erode the mastoid bone and the bones of the middle ear. Cholesteatoma may also be caused by a congenital defect. Can Cholesteatoma be Prevented? Yes. Prompt and complete treatment of chronic ear infection may help to prevent some cases of cholesteatoma. Symptoms of Cholesteatoma?

40. Pictures Of Mastoidectomy And Cholesteatoma  *  OTOLARYNGOLOGY HOUSTON Surgical pictures of mastoidectomy (canal wall up) and cholesteatoma. Informedconsent postoperative information. http://www.ghorayeb.com/Mastoidectomy.html

Professional Information Office Information What is Otolaryngology? Post-Op Information ... Home Otolaryngolgy Houston WWW.GHORAYEB.COM Pictures of Mastoidectomy and Cholesteatoma This page was last updated on: March 25, 2005 Pictures Ear Pictures Tympanic Membrane Perforation Cholesteatoma ... Post-Op Information (Spanish) Home cholesteatomas This is a "canal wall up" For "canal wall down", click here. In this left canal wall up mastoidectomy, the tympanic membrane has been elevated forward and a cholesteatoma sac is visible in the attic. This patient has a recurrent cholesteatoma which has found its way to the surface of the post-auricular skin, forming a mastoid cutaneous fistula. This cholesteatoma sac has eroded the lateral surface of the mastoid bone and was found immediately under the post-auricular skin.

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