Dr. V Malhotra Consultant Radiologist WHHT Imaging for ENT Dr. V Malhotra Consultant Radiologist WHHT

The introduction of cross-section imaging, CT and MRI has hugely expanded the scope and ability of head and neck radiology to recognize and assess disease. Plain radiographs and conventional tomography have virtually no place in the assessment of disease in the modern setting. Contrast medium studies still have a major role in the assessment of disorders of swallowing. Ultrasound in skilled hands is fast becoming the first line investigation for many neck conditions.

Role of Radiology:- Detection of disease . (Modern ENT clinics are equipped with advanced audiological and electrophysiological equipments already) Pathological characterization if possible. (FNAC) For ENT surgeon –to know the extent of disease.

THE NOSE AND PARANASAL SINUSES Rhinosinusitis This is an extremely common condition which is usually treated medically. Radiological investigation is rarely required unless surgical intervention is contemplated. Common problems requiring imaging include: Nasal Polyposis Antrochoanal polyp Mucocoeles Fractures Epistaxis Nasal and paranasal tumours

Osteomeatal complex (OMC) Common drainage pathways of the maxillary, anterior ethmoid and frontal sinuses

Mucociliary drainage routes Each sinus has its specific drainage route. Knowledge of these drainage routes is mandatory interpreting the different inflammatory patterns of the paranasal sinuses. Maxillary sinus Frontal sinus

Mucociliary drainage routes

Acute Rhinosinusitis

Concha bullosa * Middle meatus Uncinate process Ethmoid infundibulum Obstruction of the middle meatus and lateral displacement the uncinate process with narrowing of the ethmoid infundibulum.

Large ethmoid bulla Frontal recess Large ethmoid bulla Uncinate process Obstruction of the ethmoid infundibulum/ frontal recess and medial displacement the uncinate process. Ethmoid infundibulum

Agger nasi cells Frontal recess Agger nasi cells Pneumatization of the most anterior maxillary bone called the agger mound. Enlarged agger cells may cause obstruction of the frontal recess.

Uncinectomy, middle meatal anterostomies, partial ethmoidal resection Functional Endoscopic Sinus Surgery (FESS) Main goal: enlarge the natural sinus ostia Functional endoscopic sinus surgery, also called FESS, is based on the theory that the OMC is the key area in the pathogenesis of chronic sinusitis. The aim of FESS is to restore normal sinus drainage. Uncinectomy, middle meatal anterostomies, partial ethmoidal resection

Nasal Polyposis Antrochoanal polyp

Mucocoele Sinonasal Tumours

The EAR Acquired deafness and tinnitus are common problems and patients should be carefully selected for imaging. Conductive deafness is best imaged with HRCT and Sensorineural deafness with T2 weighted 3D MRI. Common causes of conductive deafness; cholesteatoma, ossicular fixation, ossicular erosion, traumatic subluxations and dislocations and otospongiosis. Investigation of acquired sensorineural deafness mainly revolves around excluding vestibular schwannoma and differentiating this from other causes of CP angle masses.

Normal 7th & 8th nerves Acoustic Neuroma

Acoustic Neuromas

Cholestatomas

Mets from SCC Normal Lymph node

Met. Papillary Ca. Tubercular node

Normal Thyroid

Papillary Carcinoma thyroid Benign hyperplastic nodule

Chronic Thyroiditis Chronic Thyroid Cyst

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