CT and MR imaging after middle ear surgery

doi:10.1016/S0720-048X(01)00379-5

European Journal of Radiology

Volume 40, Issue 2, November 2001, Pages 113-118

https://doi.org/10.1016/S0720-048X(01)00379-5 Get rights and content

Abstract

This article describes the current value of imaging in patients after stapes surgery and surgery after chronic otitis media including cholesteatoma. Possibilities and limits of computed tomography (CT) and MRI are described and most important investigation parameters are mentioned. After otosclerosis surgery, CT is the method of first choice in detection of reasons for vertigo and/or recurrent hearing loss in the later postoperative phase. CT may show the position and condition of prosthesis, scarring around the prosthesis and otospongiotic foci. Sometimes, it gives indirect hints for perilymphatic fistulas and incus necrosis. MRI is able to document inner ear complications. CT has a high negative predictive value in cases with a free cavity after mastoidectomy. Localized opacities or total occlusion are difficult to distinguish by CT alone. MRI provides important additional information in the differentiation of cholesterol granuloma, cholesteatoma, effusion, granulation and scar tissue.

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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There are more references available in the full text version of this article.

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Evaluation of diffusion weighted MRI sequence as a predictor of middle ear cleft cholesteatoma: Imaging, operative and histopathological study
2017, Egyptian Journal of Ear, Nose, Throat and Allied Sciences
Non-echoplanar imaging (Non-EPI) MRI has been recently introduced to improve the detection of small sized cholesteatoma and decrease different artifacts occurring in the echo-planar diffusion weighted image (EPI DWI) technique. It is a time saving procedure in comparison to the delayed post-contrast imaging. We prospectively assessed the diagnostic accuracy of Non-EPI-DW sequences in the detection of middle ear cleft cholesteatoma.
Forty patients suspected to have cholesteatoma were collected from the ENT outpatient clinic of a tertiary referral center. Twenty patients underwent primary mastoid surgery, ten patients scheduled for revision mastoid surgery, while the remaining patients underwent second look operation after one year of their first surgery. All patients underwent Non-EPI-DW sequences prior to their planned surgery. Diagnosis of cholesteatoma was based on evidence of a hyperintense lesion on diffusion-weighted images that were correlated with the surgical findings and histopathological examination, which was used as the gold standard for diagnostic confirmation. Sensitivity, specificity and predictive values of MRI were estimated.
Diffusion weighted imaging accurately predicted the presence of cholesteatoma in 88.2% of cases, and it correctly excluded it in 100% of cases. Sensitivity, specificity, positive and negative predictive values were 88.24%, 100%, 100% and 60%, respectively. Non-echo-planar DWI has been shown to have a high sensitivity and specificity for detecting recurrent cholesteatoma.
Non-echoplanar DWI is an effective technique in cholesteatoma diagnosis. It is capable of detecting lesions larger than 2 mm.
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2017, Diagnostic Imaging: Head and Neck
The accuracy and sensitivity of diffusion-weighted magnetic resonance imaging with Apparent Diffusion Coefficients in diagnosis of recurrent cholesteatoma
2017, European Journal of Radiology Open
Citation Excerpt :
The detection of cholesteatoma in patients who have undergone middle ear surgery is often difficult for the follow-up of patients operated for cholesteatoma [4]. High resolution computerized tomography (CT) scan is considered the basic method for imaging the nonoperated middle ear and can be complemented by magnetic resonance imaging (MRI) [3–6]. However, following mastoid surgery, both imaging modalities cannot reliably distinguish residual or recurrent disease from postoperative changes such as granulation tissue, fluid or fibrous tissue [6].
To evaluate the accuracy and sensitivity of diffusion-weighted magnetic resonance imaging with ADC value combined with MDCT in evaluating recurrent cholesteatoma.
Thirty patients (20 females and 10 males), their age ranged from 10 to 40years, had undergone a tympanomastoid surgery for a cholesteatoma of the middle ear underwent MDCT and MR DWI examination before second- or third-look surgery from May 2015 to October 2016.
CT showed partial opacification of the tympanomastoid cavity in 10 ears and complete opacification in 21 ears. CT detects 10 cases out of 20 cases of recurrent cholesteatoma with sensitivity 47.6%, specificity 100%, and NPP 47.6%. DWI depicted 21 out of 20 cases proved cholesteatoma patients (sensitivity 100%, specificity 90%, PPV 95.2% and P value is 0.001). All MRI of patients without cholesteatoma were correctly interpreted as showing negative findings for cholesteatoma (specificity = 100%). The ADC of cholesteatoma group (21 ears) were ranged from 553 to 759 × 10⁻³ mm²/s and the ADCs of non cholesteatoma group (10 ears) was ranged from 1495.8 to 1766.8 × 10⁻³ mm²/s. Cut off value of cholesteatoma is ≤759 × 10⁻³ mm²/s.
MR DWI with ADC combined with MDCT has high sensitivity, specificity, accuracy in detecting recurrent cholesteatoma.
Chronic inflammatory middle ear disease: Postoperative CT and MRI findings
2015, Egyptian Journal of Radiology and Nuclear Medicine
Citation Excerpt :
However, DWI has its pitfalls. High b value DWI that does not correspond to a cholesteatoma has been described in the following situations: after recent surgery due to residual hemorrhage, in ears containing Silastic sheets or bone pate (19,24), cerumen located in the EAC (25), cholesterol granuloma (9), artifacts due to metallic dental braces (26), and in cases of middle ear or mastoid abscess (27). Intracranial extension is the most worrisome complication of middle ear infection.
To prospectively evaluate the value of CT and MRI in diagnosis of middle ear pathologies following operation for chronic otitis media (COM).
Fifty patients, who had been operated on for chronic middle ear disease, were referred for either CT alone or followed by MRI depending on the different case scenarios. Imaging findings were correlated with surgical findings.
CT alone was done in 10 patients; 6/10 showed a free mastoidectomy cavity and 4/10 showed a clear cavity with abnormal position of the prosthesis. The rest of the 40 patients did a CT followed by MRI which showed granulation tissue in 17 patients, cholesteatoma in 13/14 patients of which one showed intracranial extension, combined granulation tissue with cholesteatoma in 5/6 patients, cholesterol granuloma in 2 patients and meningocele in another 2 patients. Overall CT sensitivity and specificity was 46.25% and 90.77% and MRI sensitivity and specificity was 95.23% and 99.16% respectively.
CT and MRI are both safe non-invasive diagnostic methods. Both procedures can provide radiologists a confident diagnosis of postoperative middle ear complications, assisting otologists with a provisional diagnosis for a better management.
Imaging innovations in temporal bone disorders
2015, Otolaryngologic Clinics of North America
Citation Excerpt :
It is compelling to look for alternatives to second-look surgery. If HRCT shows no abnormal soft tissue at 6 or 9 months following the initial stage, clinicians may be comfortable holding off on a second look.8,10,11,37 However, it is rare that an HRCT study shows no nonspecific, potentially suspicious soft tissue.

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View full text

CT and MR imaging after middle ear surgery

Abstract

Introduction

Section snippets

Imaging technique

Imaging after stapes surgery

Imaging after mastoidectomy and tympanoplasty

Conclusion

Acknowledgements

Auris Nasus Larynx

Hearing gain after stapedotomy, partial platinectomy, or total stapedectomy for otosclerosis

Ann. Otol. Rhinol. Laryngol.

Long-term results after stapedectomy and stapedotomy

HNO

Diagnosis in the presence of persistent vertigo following stapes surgery

Laryngo-Rhino-Otologie

Otosclerosis—diagnosis and therapy

WMW

Persistent vertigo after otosclerosis surgery—a diagnostic challenge

HNO Aktuell.

Value of computed tomography in patients with persistent vertigo after stapes surgery

Invest. Radiol.

Imaging in patients with vertigo

JBR-BTR

Causes of failure of mastoidectomy for chronic otitis media

Laryngoscope

Evaluation of high-resolution CT after tympanoplasty

J. Comput. Assist. Tomogr.