OTITIS MEDIA Prof. Mahmoud El Samaa Prof. of ENT, HN Surgery Ain Shams University

FLUID

CHOLESTEATOMA the Dangerous Ear

MRI CT scan T2 T1+ gad T1 contrast density Lesion    Schwannoma  CT & MRI Characteristics T2 T1+ gad T1 contrast density Lesion    Schwannoma  Vascular Cholesteatoma CSF cyst Cholesterol granuloma

CHOLESTEATOMA

CHOLESTEATOMA Scutal Erosion

ATTIC CHOLESTEATOMA Bone window Soft tissue window

Attic retraction sac with intact malleus Attic & mesotympanal cholesteatoma Ossicles erosion (malleus & stapes)

Cholesteatoma cavity with sequestrum Attic Cholesteatoma  Cholesteatoma cavity with sequestrum

Huge Cholesteatoma

COMPLICATIONS

Sinus plate erosion AXIAL CUT     CORONAL CUT

Tegmen Erosion CORONAL AXIAL

Mastoid Cortex erosion Erosion of cortex & sinus plate

hypodense subcutaneous collection MASTOID ABSCESS Soft tissue window: hypodense subcutaneous collection

Cholesteatoma, with exposure of facial nerve in tympanic portion Cholesteatoma, no exposure of facial nerve in tympanic portion

BUT?? Bone window: Cholesteatoma cavity Soft tissue: Cerebellar abscess

Bone Window Soft tissue window

Cerebellar abscess MRI

CT with extensive bone erosion, reaching to petrous apex & eroding SCC Bezold Abscess CT with extensive bone erosion, reaching to petrous apex & eroding SCC

AXIAL MRI T1: hypointense T1 Gd: hyperintense=pus T2: heterogenous (pus)

CORONAL MRI T2 T1Gd T2: showing the track of extension of infection beneath sheath of sternomastoid

Value of imaging in cholesteatoma: diagnosis extent lateral canal or cochlear fistula intracranial complications erosion of walls of middle ear and mastoid relation to facial nerve

DIABETIC EAR

Serious Condition

Cholesterol Granuloma Petrous Apex Cholesterol Granuloma