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CT shows soft tissue located medially to the ossicles and external displacement of the ossicles. External auditory canal cholesteatoma occurs when squamous tissue invades a localized area of periosteitis in the canal wall; its etiology and pathophysiology are unknown.
Patients present with progressive conductive (fenestral type) or mixed (fenestral and cochlear type) hearing loss with normal findings on otoscopic examination. Fenestral otosclerosis spreads from the oval window anterior margin?(fissula ante fenestram) to the all margin of oval and round windows.
Continued active disease spreads to the otic capsule (both fenestral and cochlear present). Cochlear (or retrofenestral) otosclerosis is much less common but always associated with fenestral otosclerosis.
CT shows bilateral “halo” of radiolucency surrounding the cochlea (arrows); also note the bilateral lytic lesions anterior to the oval window (broken arrows). Incudomalleolar joint separation is most frequently observed in trauma cases and often associated with incudostapedial joint separation [1]. Developmental disorders that involve the ossicles and originate in the first and second branchial arches cause various ossicular anomalies. Bilateral conductive deafness is an indication for surgical reconstruction (tympanoplasty).
Fibrous dysplasia is a bone disorder in which dysplastic fibro-osseus tissue replaces normal bone. Stenosis of the external auditory canal causes infection that leads to cholesteatoma and hearing loss. MRI should be performed in all cases of sudden sensorineural hearing loss with uncertain cause [4]. Vestibular schwannoma is a benign tumor that arises when Schwann cells wrap the vestibular branches of CN8 in the cerebellopontine angle–internal auditory canal. Conductive or mixed hearing loss easily occurs when a tumor progresses into a temporal bone (inside the tympanic cavity) from the geniculate ganglion of the facial nerve.


Improvement of hearing loss is difficult because of damage to the inner ear or cochlear nerve. Labyrinthitis ossificans (LO) is the pathologic formation of new bone within the lumen of the otic capsule and associated with profound deafness and loss of vestibular function. LO is the final result of suppurative labyrinthitis regardless of the origin of the infection [5]. Approximately 20% of patients with congenital sensorineural hearing loss have radiographic abnormalities of the inner ear [11]. Sennarogu and Saatcu [12] have proposed a classification system for inner ear malformations based on radiological features.
2 clicks for more privacy: On the first click the button will be activated and you can then share the poster with a second click. Difficulties of timely diagnosis of the Pulmonary Embolism of patients with chronic obstructive lung disease: possibility MSCT. Delayed endolymphatic hydrops is essentially the development of Meniere's disease, after an ear injury.
It is interesting that neither of these criteria require hydrops -- following this logic, one could diagnose heart disease without requiring any damage to the heart.
Well anyway, with these very loose criteria in Japan, they identified 94 cases, most of whom had no identifiable cause at all. In this case, there was likely a temporal bone fracture, as air was found within the cranial cavity. This case is the only one the author can recall in the last 30 years, in which there was clearly an incident, a delay, and then hydrops. That being said, what we seem to be dealing with here is a combination of deafness and delayed episodic vertigo, possibly with hearing loss too, without any other obvious cause.
In about 10%, the initial hearing loss was due to mumps, and about 8%, due to middle ear infection. For the traumatic variant, DES is attributed to bleeding within the inner ear and subsequent scarring.


8: Axial (a) and coronal (b) CT images of attic cholesteatoma (Stage 4) show soft tissue, which erodes the scutum and ossicles, in the Prussak’s space. 9: Axial sequential CT images of advanced attic cholesteatoma (Stage 4) show destruction of the semicircular canals and cochlea.
10: Axial (a) and coronal (b) CT images of tensa cholesteatoma show soft tissue, which erodes the incus, located medially to the ossicles.
11: (a) Axial CT image of the external auditory canal cholesteatoma shows soft tissue that erodes the external auditory canal, (b) opposite side (normal).
13: Axial (a) and coronal (b) CT images of tympanosclerosis show destructive ossicles and calcification in the attic. 14: Axial (a) and coronal (b) CT images show hematoma in the tympanic cavity and malleoincudal disarticulations.
17: Axial CT image of fibrous dysplasia (pagetoid type) shows stenosis of the external auditory canal by expansile “ground-glass” density that invades the sphenoid and petrous bones. 19: MRI T2-weighted image (a) and T1WI with contrast medium (b) of acoustic nerve schwannoma show well enhanced small nodular lesion in the left internal auditory canal. 21: Axial CT of labyrinthitis ossificans (b, d) and normal opposed side (a, c) show severe ossification of the cochlea, lateral semicircular canal, and vestibule. 24: MRI of T2WI (a–d) and volume-rendered images (e, f) show bilateral small common cavity (arrows) with narrow internal auditory canal (broken arrows) and hypoplastic semicircular canals (arrowheads). There was a contusion of the L frontal lobe, fluid in the left mastoid, and air adjacent to the left cerebellar hemisphere and left posterior temporal lobe.
These are loose criteria, and one would reasonably wonder whether we are dealing with a disease here or just a group of people who share the same symptoms. Bone CT shows expansile mass lesion in right mastoid air cells extruding to the external auditory canal and an enlarged stylomastoid foramen.



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