Otitis media CT or MRI: Difference between revisions
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==Overview== | ==Overview== | ||
Imaging in otitis media patients will reveal opacification of the [[middle ear]], for acute, chronic, and otitis media with effusion. [[High Resolution CT]] scans of the [[temporal bone]] in acute otitis media patients may reveal complications, including otomastoiditis. [[MRI]] is used for patients with suspected intracranial complications, such as brain [[abscess]]. sinus [[thrombosis]], and [[meningitis]]. For otitis media with effusion patients, contrast-enhanced MRI or CT scan imaging may reveal complete and homogenous [[middle ear]] and [[mastoid]] cavity opacification. Primary imaging findings for chronic otitis media include complications associated with and without [[cholesteatoma]]. | |||
==Key CT or MRI Findings in Otitis Media== | ==Key CT or MRI Findings in Otitis Media== | ||
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===Acute otitis media=== | ===Acute otitis media=== | ||
*[[High Resolution CT]] scans of the [[temporal bone]] in acute otitis media patients may reveal complications, such as the following:<ref name="pmid22695997">{{cite journal |vauthors=Trojanowska A, Drop A, Trojanowski P, Rosińska-Bogusiewicz K, Klatka J, Bobek-Billewicz B |title=External and middle ear diseases: radiological diagnosis based on clinical signs and symptoms |journal=Insights Imaging |volume=3 |issue=1 |pages=33–48 |year=2012 |pmid=22695997 |pmc=3292638 |doi=10.1007/s13244-011-0126-z |url=}}</ref> | *[[High Resolution CT]] scans of the [[temporal bone]] in acute otitis media patients may reveal complications, such as the following:<ref name="pmid22695997">{{cite journal |vauthors=Trojanowska A, Drop A, Trojanowski P, Rosińska-Bogusiewicz K, Klatka J, Bobek-Billewicz B |title=External and middle ear diseases: radiological diagnosis based on clinical signs and symptoms |journal=Insights Imaging |volume=3 |issue=1 |pages=33–48 |year=2012 |pmid=22695997 |pmc=3292638 |doi=10.1007/s13244-011-0126-z |url=}}</ref> | ||
**Acute coalescent | **Acute coalescent otomastoiditis: Findings include [[mastoid]] [[septation]] and [[cortex]] erosion. | ||
*[[MRI]] is used for patients with suspected intracranial complications, such as the following: | *[[MRI]] is used for patients with suspected intracranial complications, such as the following: | ||
**Brain [[abscess]] | **Brain [[abscess]] | ||
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===Otitis media with effusion=== | ===Otitis media with effusion=== | ||
*For otitis media with effusion patients, contrast-enhanced MRI or CT scan imaging may reveal complete and homogenous [[middle ear]] and [[mastoid]] cavity opacification.ref name="pmid22695997">{{cite journal |vauthors=Trojanowska A, Drop A, Trojanowski P, Rosińska-Bogusiewicz K, Klatka J, Bobek-Billewicz B |title=External and middle ear diseases: radiological diagnosis based on clinical signs and symptoms |journal=Insights Imaging |volume=3 |issue=1 |pages=33–48 |year=2012 |pmid=22695997 |pmc=3292638 |doi=10.1007/s13244-011-0126-z |url=}}</ref> | *For otitis media with effusion patients, contrast-enhanced MRI or CT scan imaging may reveal complete and homogenous [[middle ear]] and [[mastoid]] cavity opacification.<ref name="pmid22695997">{{cite journal |vauthors=Trojanowska A, Drop A, Trojanowski P, Rosińska-Bogusiewicz K, Klatka J, Bobek-Billewicz B |title=External and middle ear diseases: radiological diagnosis based on clinical signs and symptoms |journal=Insights Imaging |volume=3 |issue=1 |pages=33–48 |year=2012 |pmid=22695997 |pmc=3292638 |doi=10.1007/s13244-011-0126-z |url=}}</ref> | ||
**A [[tumor]] in the [[nasopharynx]] may also be revealed as a cause for effusion. | **A [[tumor]] in the [[nasopharynx]] may also be revealed as a cause for effusion. | ||
===Chronic [[suppurative]] otitis media=== | ===Chronic [[suppurative]] otitis media=== | ||
*Primary imaging findings for chronic otitis media include the following:<ref name="pmid22695997">{{cite journal |vauthors=Trojanowska A, Drop A, Trojanowski P, Rosińska-Bogusiewicz K, Klatka J, Bobek-Billewicz B |title=External and middle ear diseases: radiological diagnosis based on clinical signs and symptoms |journal=Insights Imaging |volume=3 |issue=1 |pages=33–48 |year=2012 |pmid=22695997 |pmc=3292638 |doi=10.1007/s13244-011-0126-z |url=}}</ref> | |||
**Markers for [[inflammation]]. | |||
**[[Ossicle]] erosion or other possible causes for [[hearing loss]]. | |||
**Determination of [[cholesteatoma]]. | |||
**Intratemporal complications: [[petrositis]], [[labyrinthitis]], [[subperiosteal]] [[abscess]], labyrinthine [[fistula]] | |||
**Intracranial complications: [[brain abscess]], [[meningitis]] | |||
*Without a presence of [[cholesteatoma]], [[MRI]] or [[HRCT]] images may reveal the following indications of chronic otitis media: | |||
**Presence of [[fibrous]] [[tissue]]. | |||
**Tympanosclerosis. | |||
**Formation of new bone matter. | |||
*With presence of [[cholesteatoma]], [[MRI]] or [[HRCT]] images may reveal the following indications of chronic otitis media: | |||
**[[Ossicles|Ossicle]] erosion and displacement. | |||
**Extension of [[cholesteatoma]] to [[sinuses]]. | |||
==CT or MRI Examples of Otitis Media== | |||
<gallery> | |||
Image: Chronic-otitis-media.JPEG| Selected CT images showing soft tissue density material occupying partially the right [[middle ear]] cavity without [[ossicular]] chain destruction. [[Mastoid]] air cells are obliterated on this side. Case provided by Dr. Bruno Di Muzio. <SMALL><SMALL>''[http://radiopaedia.org/articles/middle-ear From Radiopaedia Image Library.] ''<ref name="urlMiddle ear | Radiology Reference Article | Radiopaedia.org">{{cite web |url=http://radiopaedia.org/articles/middle-ear |title=Middle ear | Radiology Reference Article | Radiopaedia.org |format= |work= |accessdate=}}</ref></SMALL></SMALL> | |||
Image: Acute-otitis-media-bulging-tympanic-membrane-1.jpg| Fluid in the [[middle ear]] cleft on the right as well as the [[mastoid]] [[antrum]] and [[mastoid]] air cells. No overlying soft tissue swelling nor bone erosion to indicate [[osteomyelitis]]/gross [[mastoiditis]]. Note bulging of the upper [[tympanic membrane]] ([[pars flaccida]]) due to raised pressure in the tympanic cavity with pulling in at the umbo ie the [[malleolal]] attachment. Note the inferior [[pars tensa]] portion of the membrane does not bulge as dramatically as the upper [[flaccida]]. Case provided by Dr. Chris O'Donnell.<SMALL><SMALL>''[http://radiopaedia.org/articles/middle-ear From Radiopaedia Image Library.] ''<ref name="urlMiddle ear | Radiology Reference Article | Radiopaedia.org">{{cite web |url=http://radiopaedia.org/articles/middle-ear |title=Middle ear | Radiology Reference Article | Radiopaedia.org |format= |work= |accessdate=}}</ref></SMALL></SMALL> | |||
Image: Adhesive-chronic-otitis-media.jpg| The left [[middle ear]] is filled by soft tissue completely encasing the auditory [[ossicles]]. There is some residual ventilation near the tympanic [[ostium]] of the [[Eustachian tube]]. In this region, a linear calcification can also be seen. In the right middle ear, there are also some strands with soft tissue attenuation neighbouring the tympanic membrane, which is retracted on both sides. The right ossicles are not affected. Bilateral mastoid [[sclerosis]] is also present. There are no bony destructions hinting at a [[cholesteatoma]]. Case presented by Dr. Roberto Schubert.<SMALL><SMALL>''[http://radiopaedia.org/articles/middle-ear From Radiopaedia Image Library.] ''<ref name="urlMiddle ear | Radiology Reference Article | Radiopaedia.org">{{cite web |url=http://radiopaedia.org/articles/middle-ear |title=Middle ear | Radiology Reference Article | Radiopaedia.org |format= |work= |accessdate=}}</ref></SMALL></SMALL> | |||
Image: Acute-otomastoiditis.jpg| CT of the brain demonstrates right middle ear effusion with some minute gas [[locules]] likely percolating through effusion via [[pharyngotympanic]] tube. The opacification extends to the [[mastoid]] air cells with no evidence of bony destruction. Case presented by Dr. Steve Lau. <SMALL><SMALL>''[http://radiopaedia.org/articles/middle-ear From Radiopaedia Image Library.] ''<ref name="urlMiddle ear | Radiology Reference Article | Radiopaedia.org">{{cite web |url=http://radiopaedia.org/articles/middle-ear |title=Middle ear | Radiology Reference Article | Radiopaedia.org |format= |work= |accessdate=}}</ref></SMALL></SMALL> | |||
</gallery> | |||
==References== | ==References== | ||
{{reflist|2}} | {{reflist|2}} | ||
{{WH}} | |||
{{WS}} | |||
[[Category:Disease]] | [[Category:Disease]] | ||
[[Category:Inflammations]] | [[Category:Inflammations]] | ||
[[Category:Otolaryngology]] | [[Category:Otolaryngology]] | ||
[[Category:Otology]] | [[Category:Otology]] | ||
[[Category:Pediatrics]] | [[Category:Pediatrics]] | ||
Latest revision as of 23:30, 29 July 2020
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Luke Rusowicz-Orazem, B.S.
Overview
Imaging in otitis media patients will reveal opacification of the middle ear, for acute, chronic, and otitis media with effusion. High Resolution CT scans of the temporal bone in acute otitis media patients may reveal complications, including otomastoiditis. MRI is used for patients with suspected intracranial complications, such as brain abscess. sinus thrombosis, and meningitis. For otitis media with effusion patients, contrast-enhanced MRI or CT scan imaging may reveal complete and homogenous middle ear and mastoid cavity opacification. Primary imaging findings for chronic otitis media include complications associated with and without cholesteatoma.
Key CT or MRI Findings in Otitis Media
Imaging in otitis media patients will reveal opacification of the middle ear[1]
Acute otitis media
- High Resolution CT scans of the temporal bone in acute otitis media patients may reveal complications, such as the following:[1]
- MRI is used for patients with suspected intracranial complications, such as the following:
- Brain abscess
- Sinus thrombosis
- Meningitis
Otitis media with effusion
- For otitis media with effusion patients, contrast-enhanced MRI or CT scan imaging may reveal complete and homogenous middle ear and mastoid cavity opacification.[1]
- A tumor in the nasopharynx may also be revealed as a cause for effusion.
Chronic suppurative otitis media
- Primary imaging findings for chronic otitis media include the following:[1]
- Markers for inflammation.
- Ossicle erosion or other possible causes for hearing loss.
- Determination of cholesteatoma.
- Intratemporal complications: petrositis, labyrinthitis, subperiosteal abscess, labyrinthine fistula
- Intracranial complications: brain abscess, meningitis
- Without a presence of cholesteatoma, MRI or HRCT images may reveal the following indications of chronic otitis media:
- With presence of cholesteatoma, MRI or HRCT images may reveal the following indications of chronic otitis media:
- Ossicle erosion and displacement.
- Extension of cholesteatoma to sinuses.
CT or MRI Examples of Otitis Media
-
![Selected CT images showing soft tissue density material occupying partially the right middle ear cavity without ossicular chain destruction. Mastoid air cells are obliterated on this side. Case provided by Dr. Bruno Di Muzio. From Radiopaedia Image Library. [2]](/images/b/ba/Chronic-otitis-media.JPEG)
Selected CT images showing soft tissue density material occupying partially the right middle ear cavity without ossicular chain destruction. Mastoid air cells are obliterated on this side. Case provided by Dr. Bruno Di Muzio. From Radiopaedia Image Library. [2]
-
![Fluid in the middle ear cleft on the right as well as the mastoid antrum and mastoid air cells. No overlying soft tissue swelling nor bone erosion to indicate osteomyelitis/gross mastoiditis. Note bulging of the upper tympanic membrane (pars flaccida) due to raised pressure in the tympanic cavity with pulling in at the umbo ie the malleolal attachment. Note the inferior pars tensa portion of the membrane does not bulge as dramatically as the upper flaccida. Case provided by Dr. Chris O'Donnell.From Radiopaedia Image Library. [2]](/images/a/ac/Acute-otitis-media-bulging-tympanic-membrane-1.jpg)
Fluid in the middle ear cleft on the right as well as the mastoid antrum and mastoid air cells. No overlying soft tissue swelling nor bone erosion to indicate osteomyelitis/gross mastoiditis. Note bulging of the upper tympanic membrane (pars flaccida) due to raised pressure in the tympanic cavity with pulling in at the umbo ie the malleolal attachment. Note the inferior pars tensa portion of the membrane does not bulge as dramatically as the upper flaccida. Case provided by Dr. Chris O'Donnell.From Radiopaedia Image Library. [2]
-
![The left middle ear is filled by soft tissue completely encasing the auditory ossicles. There is some residual ventilation near the tympanic ostium of the Eustachian tube. In this region, a linear calcification can also be seen. In the right middle ear, there are also some strands with soft tissue attenuation neighbouring the tympanic membrane, which is retracted on both sides. The right ossicles are not affected. Bilateral mastoid sclerosis is also present. There are no bony destructions hinting at a cholesteatoma. Case presented by Dr. Roberto Schubert.From Radiopaedia Image Library. [2]](/images/6/64/Adhesive-chronic-otitis-media.jpg)
The left middle ear is filled by soft tissue completely encasing the auditory ossicles. There is some residual ventilation near the tympanic ostium of the Eustachian tube. In this region, a linear calcification can also be seen. In the right middle ear, there are also some strands with soft tissue attenuation neighbouring the tympanic membrane, which is retracted on both sides. The right ossicles are not affected. Bilateral mastoid sclerosis is also present. There are no bony destructions hinting at a cholesteatoma. Case presented by Dr. Roberto Schubert.From Radiopaedia Image Library. [2]
-
![CT of the brain demonstrates right middle ear effusion with some minute gas locules likely percolating through effusion via pharyngotympanic tube. The opacification extends to the mastoid air cells with no evidence of bony destruction. Case presented by Dr. Steve Lau. From Radiopaedia Image Library. [2]](/images/f/fa/Acute-otomastoiditis.jpg)
CT of the brain demonstrates right middle ear effusion with some minute gas locules likely percolating through effusion via pharyngotympanic tube. The opacification extends to the mastoid air cells with no evidence of bony destruction. Case presented by Dr. Steve Lau. From Radiopaedia Image Library. [2]
![Selected CT images showing soft tissue density material occupying partially the right middle ear cavity without ossicular chain destruction. Mastoid air cells are obliterated on this side. Case provided by Dr. Bruno Di Muzio. From Radiopaedia Image Library. [2]](/index.php/File:Chronic-otitis-media.JPEG)
![Fluid in the middle ear cleft on the right as well as the mastoid antrum and mastoid air cells. No overlying soft tissue swelling nor bone erosion to indicate osteomyelitis/gross mastoiditis. Note bulging of the upper tympanic membrane (pars flaccida) due to raised pressure in the tympanic cavity with pulling in at the umbo ie the malleolal attachment. Note the inferior pars tensa portion of the membrane does not bulge as dramatically as the upper flaccida. Case provided by Dr. Chris O'Donnell.From Radiopaedia Image Library. [2]](/index.php/File:Acute-otitis-media-bulging-tympanic-membrane-1.jpg)
![The left middle ear is filled by soft tissue completely encasing the auditory ossicles. There is some residual ventilation near the tympanic ostium of the Eustachian tube. In this region, a linear calcification can also be seen. In the right middle ear, there are also some strands with soft tissue attenuation neighbouring the tympanic membrane, which is retracted on both sides. The right ossicles are not affected. Bilateral mastoid sclerosis is also present. There are no bony destructions hinting at a cholesteatoma. Case presented by Dr. Roberto Schubert.From Radiopaedia Image Library. [2]](/index.php/File:Adhesive-chronic-otitis-media.jpg)
![CT of the brain demonstrates right middle ear effusion with some minute gas locules likely percolating through effusion via pharyngotympanic tube. The opacification extends to the mastoid air cells with no evidence of bony destruction. Case presented by Dr. Steve Lau. From Radiopaedia Image Library. [2]](/index.php/File:Acute-otomastoiditis.jpg)
References
- ↑ 1.0 1.1 1.2 1.3 Trojanowska A, Drop A, Trojanowski P, Rosińska-Bogusiewicz K, Klatka J, Bobek-Billewicz B (2012). "External and middle ear diseases: radiological diagnosis based on clinical signs and symptoms". Insights Imaging. 3 (1): 33–48. doi:10.1007/s13244-011-0126-z. PMC 3292638. PMID 22695997.
- ↑ 2.0 2.1 2.2 2.3 "Middle ear | Radiology Reference Article | Radiopaedia.org".