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

2. 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.

3. 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.

4. 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

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

6. 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

7. Mucociliary drainage routes

8. Acute Rhinosinusitis

9. 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.

10. 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

11. 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.

12. 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

13. Nasal Polyposis
Antrochoanal polyp

14. Mucocoele
Sinonasal Tumours

15. 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.

16. Normal 7th & 8th nerves
Acoustic Neuroma

17. Acoustic Neuromas

18. Cholestatomas

20. Mets from SCC
Normal Lymph node

21. Met. Papillary Ca.
Tubercular node

22. Normal Thyroid

23. Papillary Carcinoma thyroid
Benign hyperplastic
nodule

24. Chronic Thyroiditis
Chronic Thyroid Cyst

26. Thank You