CT and MR imaging after middle ear surgery
Introduction
Middle ear surgery can be subdivided into three main types of procedures based on the underlying diseases. The most common indication of stapes surgery is otosclerosis. Mastoidectomy and reconstruction of ossicular chain were mostly performed because of chronic otitis media including cholesteatoma. Other indications are mastoiditis, tumor of the middle ear, translabyrinthine approach in acoustic neurinoma surgery, exposition of facial nerve in trauma, cochlear implantation and endolymphatic sac surgeries. The third main type is surgery for hearing improvement in malformation of the middle ear and/or external auditory canal. The aim of this article is to represent the current value of computed tomography (CT) and MRI in patients after stapes surgery and surgery because of chronic otitis media.
Section snippets
Imaging technique
Imaging of very small middle ear structures demands a high local resolution. The use of thin slice thickness is a basic demand on a high image quality for both CT and MRI. High reconstruction algorithms has to be used in CT. At present, the best image quality is obtained by multislice CT with collimation and slice thickness of 0.5 mm. All bony details including small canals, sutures and stapedial substructures can be visualized. Small increment of 0.3 mm is the prerequisite to get excellent
Imaging after stapes surgery
Microsurgical treatment of otosclerosis includes stapedectomy and stapedotomy. The latter is considered as the method of choice because of better hearing results and less postoperative vertigo and nystagmus [1], [2]. In stapedotomy, stapes suprastructure is resected and the footplate is perforated. The piston of the prosthesis is placed into the perforation of footplate and the loop of the wire is crimpted over the long process of the incus. The material of inserted prostheses changed over the
Imaging after mastoidectomy and tympanoplasty
Dependent on the extent of cholesteatoma two main types of surgical procedures can be differentiated: the open (canal-wall-up) and closed (canal-wall-down) technique of mastoidectomy. In contrary to the closed technique, the posterior wall of the external auditory canal is removed in open technique and a communication between the mastoid cavity and external auditory canal is established. The incidence of recurrence is about 3% in open technique and up to 18% in closed technique [9]. Five
Conclusion
Crossectional imaging is of high diagnostic value in the postoperative middle ear. Within the first week after stapes surgery most symptoms clear spontaneously or with conservative therapy. If progressive loss of inner ear function occurs, a clear indication for retympanotomy is given. Imaging is not needed in this period. CT should be chosen in symptomatic patients in the late postoperative phase at first. In a high percentage the cause of symptoms is detectable. MRI provides additional
Acknowledgements
The authors warmly thank Dr T. Kittner (Technische Universität Dresden, Klinik für Diagnostische Radiologie) for his help in preparation of this article.
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