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Author: admin | 29.11.2014 | Category: Ringing In The Ears Causes

The aim of this presentation is to demonstrate imaging findings of common diseases of the temporal bone. There are several normal variants which may simulate disease or should be reported because they can endanger the surgical approach. A cochlear cleft is a narrow curved lucency extending from the cochlea towards the promontory. On the left an example of bilateral cochlear cleft in a one-year old boy with congenital hearing loss.
The petromastoid canal or subarcuate canal connects the mastoid antrum with the cranial cavity and houses the subarcuate artery and vein. The jugular bulb is often asymmetric, with the right jugular bulb usually being larger than the left. The vestibular aqueduct is a narrow bony canal (aqueduct) that connects the endolymphatic sac with the inner ear (vestibule). In external ear atresia the external auditory canal is not developed and sound cannot reach the tympanic membrane.
Malformations of the vestibule and semicircular canals vary from a common cavity to all these structures to a hypoplastic lateral semicircular canal.
On the left a 16-year old boy, examined preoperatively for a cholesteatoma of the right ear.
For the ENT-surgeon the differentiation between chronic otitis media and cholesteatoma is important. On the left a coronal reconstruction of the same patient.CT shows the tympanostomy tube (yellow arrow) and complete opacification of the tympanic cavity and mastoid air cells with soft tissue. Pars flaccida cholesteatoma The lesion starts anterosuperiorly in 'Prussaks space', the area just below the scutum, which is limited by the tympanic membrane, the malleus, and the lateral ligament of the malleus. Pars tensa cholesteatoma The cholesteatoma begins posterosuperiorly and extends posteriorly towards the facial recess and tympanic sinus, and medially towards the ossicular chain. On the left a large cholesteatoma in the right middle ear with destruction of the lateral wall of the tympanic cavity.
Erosion of the facial nerve canal is difficult to distinguish because the wall is often so thin that it is not visible at CT.
On the left images of a cholesteatoma, which has eroded the ossicular chain and the wall of the lateral semicircular canal (arrows). On the left images of a 50-year old man who presented with a left- sided retraction pocket and otorrhoea. Otosclerosis is a genetically mediated metabolic bone disease of unknown etiology.It is sometimes called otospongiosis because the disease begins with an otospongiotic phase, which is followed by an otosclerotic phase when osteoclasts are replaced by osteoblasts and dense sclerotic bone is deposited in areas of previous bone resorption.
On CT the detection of otosclerosis can be difficult to the inexperienced eye because the spread of the disease is often symmetrical. Wirral University Teaching Hospital Safeguarding Team provides support and advice to all colleagues in contact with patients to recognise report and prevent abuse of adults and   children.
Inform a member of staff such as Nurse, Doctor or PALS who will ensure you receive the appropriate support and guidance by contacting the hospital Safeguarding Team.
The following link will take you to the Local Authority Safeguarding information page which provides detail regarding reporting abuse and what to do.
Additionally, please click on the links below to access leaflets containing further information regarding Safeguarding Adults and Children and the Mental Capacity Act. Neurofibromatosis is a condition that affects bones, tissue, skin and the nervous system, causing multiple tumours to grow on (or under) the skin and bone deformities. There are two types of neurofibromatosis: neurofibromatosis type 1 (NF1) and neurofibromatosis type 2 (NF2).

NF2 is a rare chromosomal defect that leads to tumour growth on auditory nerves that affect hearing (acoustic neuroma) and balance.
DISCLAIMERThe information above is of a general nature and is designed to provide you with an overview of the topic with links to local and international resources which maybe of interest.
You should always, however, seek specific professional medical advice, treatment and care appropriate to you, and as such we strongly recommend you consult with your general practitioner first. 1- Superior orbital fissure 2- Inferior orbital foramen 3- Mental foramen 1 2 3 1 2 3 Fissures and foramen have nerves that show on lab practicals. FRACTURE EPIDURAL HEMATOMA Cause: Laceration of the meningeal artery adjacent to inner table. CT SINUS AXIAL SCAN normal Note the destroyed posterior wall of the left frontal sinus due to bacterial invasion.
SCAN LEVEL MAXILLARY SINUSES ZYGOMA SPHENOID SINUS LT Sections from the skull base extending inferiorly through the neck. CT is the imaging modality of choice for most of the pathologic conditions of the temporal bone, especially for those of the middle ear. The cochlear aqueduct is a narrow canal which runs towards the cochlea in almost the same direction as the inner auditory canal, but situated more caudally.It is a point where infected cerebrospinal fluid can enter the inner ear. It can be accidentally lacerated during a mastoidectomy and therefore should be mentioned in the radiological report when present.
Running through this bony canal is a tube called the endolymphatic duct.A large vestibular aqueduct is associated with progressive sensorineural hearing loss. A conductive hearing loss is the result.It is important to note whether the atretic plate is composed of soft tissue or bone. Early developmental arrest leads to an inner ear that consists of a small cyst, the so-called Michel deformity.
During embryogenesis the lateral semicircular canal is the last structure to form, thus in malformations of the semicircular canals the lateral canal is most commonly affected. As a coincidental finding, there is a plump lateral semicircular canal (yellow arrow) and an absence of the superior canal (blue arrow).
Both diseases often occur in poorly pneumatized mastoids.An important finding which can help differentiate the two conditions is bony erosion. There is calcification of the eardrum (white arrow) and calcific deposits on the stapes and the tendon of the stapedius muscle (black arrow).
It gradually enlarges over time due to exfoliation and encapsulation of the tissue.Most cholesteatomas are acquired, but some are congenital. Granulations on left ear drum.Soft tissue mass between ossicular chain and lateral tympanic wall, which is eroded.
A cholesteatoma will then extend laterally towards the ossicular chain and into the epitympanum.
A large cholesteatoma has resulted in a so called 'automastoidectomy', with severe erosion of the lateral tympanic cavity wall and destruction of the ossicular chain.
The right ear shows a soft tissue mass medial to the ossicular chain with lateral displacement of the incus with erosion of its lenticular process and of the stapes, compatible with a pars tensa cholesteatoma (arrow). The examination shows a mass with mixed intensity on sagittal T1 and high intensity on transverse T2 weighted images.
When this process involves the oval window in the region of the footplate, the footplate becomes fixed, resulting in conductive hearing loss.Conductive hearing loss develops early in the third decade and is considered to be the hallmark of the disease.
There is a subtle otosclerotic focus in the characteristic site: the fissula ante fenestram (arrows).
There is a lucency anterior to the oval window (arrow) and between the cochlea and the internal auditory canal.

This is achieved through raising awareness, providing appropriate training and investigating allegations of abuse alongside various agencies such as the local authority and the police. If this patient would be a trauma victim, the canal could easily be confused with a fracture line (arrow).
This progression is reportedly associated with minor head trauma, which exposes the inner ear to pressure waves via the large vestibular aqueduct. The extent of ossicular chain malformation can vary from a fusion of the mallear head and incudal body to a small clump of malformed ossicles, which is often fused to the wall of the tympanic cavity.
Developmental arrest at a later stage leads to more or less severe deformities of the cochlea and of the vestibular apparatus. Erosion of the lateral wall of the epitympanum and of the ossicular chain is common in cholesteatoma (around 75%).
A small amount of soft tissue (arrow) is visible between the scutum and the ossicular chain but no erosion is present. CT shows a tympanostomy tube (yellow arrow) and almost opacification of the tympanic cavity and mastoid air cells with soft tissue.
CT demonstrates a soft tissue mass between the ossicular chain and the lateral tympanic wall, which is eroded.
All these findings favor the diagnosis of a cholesteatoma, but at surgery, chronic mastoiditis was found and no cholesteatoma was identified.
The CT shows erosion of the wall of the lateral semicircular canal (arrow) due to cholesteatoma. It has a high intensity on diffusion weighted images, which indicates restricted diffusion. However, involvement of other portions of the otic capsule can result in mixed sensorineural hearing loss. The large vestibular aqueduct is associated with an absence of the bony modiolus in more than 90% of patients. The mastoid portion of the facial nerve canal can be located more anteriorly than normal and this is important to report to the ENT surgeon in order to avoid iatrogenic injury to the nerve during surgery. An incomplete partition of the cochlea is called a Mondini malformationInstead of the normal two-and-one-half turns, there is only a normal basal turn and a cystic apex.
Scraps of cholesteatoma are visible in the external auditory canal.On CT a small cholesteatoma presents as a soft tissue mass. The process starts in the region of the oval window, classically at the fissula ante fenestram, i.e. Sometimes the whole otic capsule is surrounded by these 'otospongiotic' foci, forming the so-called fourth ring of Valvassori. Inferior orbital margin 1 3 4 2 AP WATERS VIEW This view is angled to project the maxillary sinuses free of the petrous ridge. Cholesteatoma can present with a non-dependent mass while chronic otitis shows thickened mucosal lining.
However, in both diseases the middle ear cavity can be completely opacified, obscuring a cholesteatoma.

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