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==Overview==
==Overview==
[[High Resolution CT]] scans of the [[temporal bone]] in mastoiditis patients is a very good diagnostic tool and may reveal mastoiditis and its complications. CT findings in acute mastoiditis are partial-to-complete opacification of mastoid air cells, erosion of mastoid air cell bony septum, mastoid cortex destruction and irregularity, periosteal thickening, periosteal disruption and subperiosteal abscess. CT findings in subacute and chronic mastoiditis are: markers for [[inflammation]], sclerosis or opacification of mastoid process, tympanic membrane changes such as thickening, retraction, tympanic membrane perforation or calcification; ossicle erosion or other possible causes for [[hearing loss]], determination of [[cholesteatoma]], intratemporal complications such as petrositis, [[labyrinthitis]], [[subperiosteal]] [[abscess]], labyrinthine [[Fistula|fistula;]] Intracranial complications such as [[brain abscess]], [[meningitis]]; presence of [[fibrous]] [[tissue]], tympanosclerosis, formation of new bone matter[[Ossicles|, ossicle]] erosion and displacement and extension of [[cholesteatoma]] to [[sinuses]].
[[High Resolution CT]] scans of the [[temporal bone]] in mastoiditis patients is a very good diagnostic tool and may reveal mastoiditis and its complications. CT findings in acute mastoiditis are partial-to-complete opacification of [[mastoid air cells]], erosion of [[Mastoid air cells|mastoid air cell]] bony septum, mastoid cortex destruction and irregularity, periosteal thickening, periosteal disruption and subperiosteal abscess. CT findings in subacute and chronic mastoiditis are: markers for [[inflammation]], sclerosis or opacification of mastoid process, [[tympanic membrane]] changes such as thickening, retraction, [[tympanic membrane]] perforation or calcification; [[Ossicles|ossicle]] erosion or other possible causes for [[hearing loss]], determination of [[cholesteatoma]], intratemporal complications such as petrositis, [[labyrinthitis]], [[subperiosteal]] [[abscess]], labyrinthine [[Fistula|fistula;]] Intracranial complications such as [[brain abscess]], [[meningitis]]; presence of [[fibrous]] [[tissue]], tympanosclerosis, formation of new bone matter[[Ossicles|, ossicle]] erosion and displacement and extension of [[cholesteatoma]] to [[sinuses]].


==CT==
==CT==
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[[High Resolution CT]] scans of the [[temporal bone]] in mastoiditis patients is a very good diagnostic tool and may reveal complications, such as the following: <ref name="pmid19734439">{{cite journal |vauthors=Lin HW, Shargorodsky J, Gopen Q |title=Clinical strategies for the management of acute mastoiditis in the pediatric population |journal=Clin Pediatr (Phila) |volume=49 |issue=2 |pages=110–5 |year=2010 |pmid=19734439 |doi=10.1177/0009922809344349 |url=}}</ref><ref name="pmid17668240">{{cite journal |vauthors=Stähelin-Massik J, Podvinec M, Jakscha J, Rüst ON, Greisser J, Moschopulos M, Gnehm HE |title=Mastoiditis in children: a prospective, observational study comparing clinical presentation, microbiology, computed tomography, surgical findings and histology |journal=Eur. J. Pediatr. |volume=167 |issue=5 |pages=541–8 |year=2008 |pmid=17668240 |doi=10.1007/s00431-007-0549-1 |url=}}</ref><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><ref name="pmid21982482">{{cite journal |vauthors=Pellegrini S, Gonzalez Macchi ME, Sommerfleck PA, Bernáldez PC |title=Intratemporal complications from acute otitis media in children: 17 cases in two years |journal=Acta Otorrinolaringol Esp |volume=63 |issue=1 |pages=21–5 |year=2012 |pmid=21982482 |doi=10.1016/j.otorri.2011.06.007 |url=}}</ref><ref name="pmid18617870">{{cite journal |vauthors=van den Aardweg MT, Rovers MM, de Ru JA, Albers FW, Schilder AG |title=A systematic review of diagnostic criteria for acute mastoiditis in children |journal=Otol. Neurotol. |volume=29 |issue=6 |pages=751–7 |year=2008 |pmid=18617870 |doi=10.1097/MAO.0b013e31817f736b |url=}}</ref>
[[High Resolution CT]] scans of the [[temporal bone]] in mastoiditis patients is a very good diagnostic tool and may reveal complications, such as the following: <ref name="pmid19734439">{{cite journal |vauthors=Lin HW, Shargorodsky J, Gopen Q |title=Clinical strategies for the management of acute mastoiditis in the pediatric population |journal=Clin Pediatr (Phila) |volume=49 |issue=2 |pages=110–5 |year=2010 |pmid=19734439 |doi=10.1177/0009922809344349 |url=}}</ref><ref name="pmid17668240">{{cite journal |vauthors=Stähelin-Massik J, Podvinec M, Jakscha J, Rüst ON, Greisser J, Moschopulos M, Gnehm HE |title=Mastoiditis in children: a prospective, observational study comparing clinical presentation, microbiology, computed tomography, surgical findings and histology |journal=Eur. J. Pediatr. |volume=167 |issue=5 |pages=541–8 |year=2008 |pmid=17668240 |doi=10.1007/s00431-007-0549-1 |url=}}</ref><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><ref name="pmid21982482">{{cite journal |vauthors=Pellegrini S, Gonzalez Macchi ME, Sommerfleck PA, Bernáldez PC |title=Intratemporal complications from acute otitis media in children: 17 cases in two years |journal=Acta Otorrinolaringol Esp |volume=63 |issue=1 |pages=21–5 |year=2012 |pmid=21982482 |doi=10.1016/j.otorri.2011.06.007 |url=}}</ref><ref name="pmid18617870">{{cite journal |vauthors=van den Aardweg MT, Rovers MM, de Ru JA, Albers FW, Schilder AG |title=A systematic review of diagnostic criteria for acute mastoiditis in children |journal=Otol. Neurotol. |volume=29 |issue=6 |pages=751–7 |year=2008 |pmid=18617870 |doi=10.1097/MAO.0b013e31817f736b |url=}}</ref>
=== Acute mastoiditis ===
=== Acute mastoiditis ===
*Partial-to-complete opacification of mastoid air cells due to fluid accumulation and thickening of the mucosa that lines the middle ear.  
*Partial-to-complete opacification of [[mastoid air cells]] due to fluid accumulation and thickening of the [[mucosa]] that lines the [[middle ear]].  
*Erosion of mastoid air cell bony septum
*Erosion of [[Mastoid air cells|mastoid air cell]] bony septum
*Mastoid cortex destruction and irregularity
*Mastoid cortex destruction and irregularity
*Periosteal thickening, periosteal disruption,  
*Periosteal thickening, periosteal disruption,  
*subperiosteal abscess.
*Subperiosteal [[abscess]].


=== Sub acute and chronic mastoiditis ===
=== Sub acute and chronic mastoiditis ===
Primary imaging findings for chronic mastoiditis include the following:
Primary imaging findings for chronic mastoiditis include the following:
* Markers for [[inflammation]].
* Markers for [[inflammation]].
* Sclerosis or opacification of mastoid process
* Sclerosis or opacification of [[mastoid process]]
* Tympanic membrane changes: thickening, retraction, tympanic membrane perforation or calcification
* [[Tympanic membrane]] changes: thickening, retraction, tympanic membrane perforation or [[calcification]]
* Ossicle erosion or other possible causes for [[hearing loss]].
* [[Ossicles|Ossicle]] erosion or other possible causes for [[hearing loss]].
* Determination of [[cholesteatoma]].
* Determination of [[cholesteatoma]].
* Intratemporal complications: petrositis, [[labyrinthitis]], [[subperiosteal]] [[abscess]], labyrinthine [[fistula]]
* Intratemporal complications: petrositis, [[labyrinthitis]], [[subperiosteal]] [[abscess]], labyrinthine [[fistula]]

Revision as of 15:44, 5 July 2017

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Mehrian Jafarizade, M.D [2]

Overview

High Resolution CT scans of the temporal bone in mastoiditis patients is a very good diagnostic tool and may reveal mastoiditis and its complications. CT findings in acute mastoiditis are partial-to-complete opacification of mastoid air cells, erosion of mastoid air cell bony septum, mastoid cortex destruction and irregularity, periosteal thickening, periosteal disruption and subperiosteal abscess. CT findings in subacute and chronic mastoiditis are: markers for inflammation, sclerosis or opacification of mastoid process, tympanic membrane changes such as thickening, retraction, tympanic membrane perforation or calcification; ossicle erosion or other possible causes for hearing loss, determination of cholesteatoma, intratemporal complications such as petrositis, labyrinthitis, subperiosteal abscess, labyrinthine fistula; Intracranial complications such as brain abscess, meningitis; presence of fibrous tissue, tympanosclerosis, formation of new bone matter, ossicle erosion and displacement and extension of cholesteatoma to sinuses.

CT

High Resolution CT scans of the temporal bone in mastoiditis patients is a very good diagnostic tool and may reveal complications, such as the following: [1][2][3][4][5]

Acute mastoiditis

  • Partial-to-complete opacification of mastoid air cells due to fluid accumulation and thickening of the mucosa that lines the middle ear.
  • Erosion of mastoid air cell bony septum
  • Mastoid cortex destruction and irregularity
  • Periosteal thickening, periosteal disruption,
  • Subperiosteal abscess.

Sub acute and chronic mastoiditis

Primary imaging findings for chronic mastoiditis include the following:

Although, high resolution CT scanning(HRCT) is the best tool to evaluate ossicular chain and tympanic cavity walls and mastoid itself, however, HRCT is unable to differentiate between different types of effusions in the tympanic cavity, also evaluation of cholesteatoma can be challenging.

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. [6]
    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. [6]
  • 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. [6]
    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. [6]
  • 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. [6]
    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. [6]

References

  1. ↑ Lin HW, Shargorodsky J, Gopen Q (2010). "Clinical strategies for the management of acute mastoiditis in the pediatric population". Clin Pediatr (Phila). 49 (2): 110–5. doi:10.1177/0009922809344349. PMID 19734439.
  2. ↑ Stähelin-Massik J, Podvinec M, Jakscha J, Rüst ON, Greisser J, Moschopulos M, Gnehm HE (2008). "Mastoiditis in children: a prospective, observational study comparing clinical presentation, microbiology, computed tomography, surgical findings and histology". Eur. J. Pediatr. 167 (5): 541–8. doi:10.1007/s00431-007-0549-1. PMID 17668240.
  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.
  4. ↑ Pellegrini S, Gonzalez Macchi ME, Sommerfleck PA, Bernáldez PC (2012). "Intratemporal complications from acute otitis media in children: 17 cases in two years". Acta Otorrinolaringol Esp. 63 (1): 21–5. doi:10.1016/j.otorri.2011.06.007. PMID 21982482.
  5. ↑ van den Aardweg MT, Rovers MM, de Ru JA, Albers FW, Schilder AG (2008). "A systematic review of diagnostic criteria for acute mastoiditis in children". Otol. Neurotol. 29 (6): 751–7. doi:10.1097/MAO.0b013e31817f736b. PMID 18617870.
  6. ↑ 6.0 6.1 6.2 "Middle ear | Radiology Reference Article | Radiopaedia.org".

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