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01.07.2015
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CT evaluation of congenital aural atresia: What the radiologist and the surgeon need to know.
Ear and temporal bone, I: Clinical considerations for non-neoplastic lesions of the ear and temporal bone. Daily we add hundreds of pictures, dozens of videos, flash games, celebrities and other great stuff. There we will offer you professional ear cleaning and rescue puppies for sale of the highest quality.


Most of these lesions can be diagnosed clinically; however imaging is often required to evaluate the extent of the lesion, feasibility for surgery, differential diagnosis and to rule out complications.
Preoperatively, the radiologist should look for contraindications for surgery such as atretic oval and or round window and unfavorable course of the facial nerve. Coronal HRCT image (B) shows atresia of the bony (arrow) and cartilaginous (arrowhead) parts. CT scan demonstrates the presence of an asymmetric soft tissue density in the EAC, with or without extension into the surrounding structures [Figure 3]A.
Involvement of the temporalis muscle leads to formation of a temporalis abscess, which is seen as diffuse muscle thickening with hypodensity [Figure 3]B. Involvement of the TM joint is seen as widening of the joint space, with irregularity of the articular margins. Temporal bone osteomyelitis is seen as increased density of the bone, with linear periosteal reaction [Figure 3]C, and accompanied by a soft tissue density around the EAC and mastoid.
Axial HRCT image (B) shows irregularity of the right TM joint (arrowhead) and mastoid (arrowhead). Multiple osteomas are associated with Gardner syndrome, which is a constellation of polyps of the colon, multiple osteomas, and multiple impacted or unerupted teeth, in association with skin and soft tissue tumors. Trauma is usually associated with injury to the pinna, with or without TM joint dislocation. Cerumen impaction is considered pathological only when it produces symptoms or prevents assessment of the ear canal, the audiovestibular system, or both.


Diagnosis is mainly clinical and CT scan is only indicated when impaction removal has been unsuccessful. Fat attenuation within the lesion and the presence of a rim of air around the lesion confirm the diagnosis. Secondary cases are due to trauma or inflammatory disease and are much more common than the primary form.
An EAC cholesteatoma is considered stage III if in addition to the EAC it involves the mastoid air cells [Figure 7]. 3D volume rendered image (C) shows a small, post-biopsy defect in the mastoid wallClick here to view EACC must be differentiated from malignant otitis externa. EACC is a slowly progressing chronic disease and is well localized, with a soft tissue density eroding one of the walls of the EAC. EACC show prompt diffusion restriction [Figure 8]A-D, whereas malignant otitis externa does not show restriction on diffusion. MDCT coupled with 3D reconstruction helps in better visual representation of these lesions and thus facilitates appropriate management.



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