40. Diseases of Ear
• Chronic Suppurative Otitis Media
• Cholesteatoma
• Otosclerosis
– CHOCHLEAR IMPLANT
41. Chronic Suppurative Otitis Media
• Poorly pneumatized mastoid air cells.
• Ear drum is thickened.
• Soft tissue seen around ossicles without
erosion.
• Calcification of ear drum, tendon of stapedius.
• Almost complete opacification of middle ear
cavity.
42. Chronic Suppurative Otitis Media
Loss of
pneumatization
Normal
Eardrum calcification
Stapes calcification
Eardrum calcification
44. Cholesteatoma
• Present as soft tissue mass with associated
erosions.
• Auditory ossicles, especially the long process
and lenticular processes of the incus as well as
the head of the stapes
• Wall of the lateral semicircular canal
• Lateral epitympanic wall (the scutum)
45. Cholesteatoma
Cholesteatoma: 20-year old woman with
recurrent Otitis. Granulations on left ear
drum. Soft tissue mass between ossicular
chain and lateral tympanic wall, which is
eroded. Right side for comparison.
Granulations on left ear drum. Soft tissue mass
between ossicular chain and lateral tympanic
wall, which is eroded. Right side for comparison.
46. Cholesteatoma
Automastoidectomy due to a large cholesteatoma
Cholesteatoma with erosion of the wall of
the lateral semicircular canal
There is a soft tissue mass with erosion of
the long process of the incus.
47. Cholesteatoma
The examination shows a mass with mixed intensity on sagittal T1 and high
intensity on transverse T2 weighted images. It has a high intensity on
diffusion weighted images, which indicates restricted diffusion. (arrows)
48. Otosclerosis
• Otosclerosis is a genetically mediated metabolic
bone disease of unknown etiology.
• conductive hearing loss and is considered to be the
hallmark of the disease.
• The process starts in the region of the oval window,
classically at the fistula ante fenestram, i.e. in front of
the oval window (fenestral otosclerosis).
• It can also occur around the cochlea
(retrofenestral otosclerosis).
49. Otosclerosis
There is a lucency anterior to the oval window
(arrow) and between the cochlea and the
internal auditory canal.
This is combined fenestral and retrofenestral
otosclerosis.
Otosclerosis anteriorly to the oval window
(arrow)
51. Cochlear Implant
• Cochlear implantation is performed in patients
with sensorineural deafness due to
degeneration of the organ of Corti.
• The electrode is inserted into the scala
tympani of the cochlea via the round window
or via a drill hole directly into the basal turn.
• Post-operatively its position can be evaluated
with plain films or with CT.
53. Nose And Para Nasal Sinuses
•
•
•
•
•
Deviated Nasal Septum
Nasal Bone Fracture
Enlarged Adenoids
Sino nasal Polyposis
Angiofibroma
54. Deviated Nasal Septum
• Nasal septum deviation is a common physical
disorder of nose involving a displacement of
nasal septum.
• Trauma is a frequent cause.
• Can be congenital.
• Poor drainage of sinuses.
55. Deviated Nasal Septum
Waters view (close-up view of the
patient in the previous image) shows a
deviated nasal septum, quadrangular
cartilage displaced from the maxillary
crest, and a nasal root deviated to the
right
58. Enlarged Adenoids
• The adenoids are sections of soft tissue found
at the back of the nasal cavities where they
meet the pharynx.
• Like tonsils, adenoids help to stop harmful
bacteria and airborne pathogens from
entering the airways and causing infections.
• Multiple sinus infections, snoring and
worsened breathing esp. in children.
60. Sinonasal Polyposis
• Polyps are soft tissue pedunculated masses of edematous
hyper plastic mucosa lining the upper respiratory tract…..nasal
cavity and sinuses.
• These are benign mucosal lesions.
• Commonest sites in order of frequency are;
1.
2.
3.
Ethmoids
Maxillary antra
sphenoids
63. Juvenile Nasopharyngeal Angiofibroma
• Benign highly vascular tumor
• Locally invasive, submucosal spread
• Vascular supply most commonly from internal
maxillary artery
– Also: internal carotid, external carotid, common
carotid, ascending pharyngeal
• Occurring almost exclusively in males
• Peak age of onset = 13-15 years old
• Intracranial Extension between 10-20%
• Recurrence Rates as high as 50%
64. Juvenile Nasopharyngeal Angiofibroma
Origen considered to be posterlateral nasal wall
at sphenopalatine foramen.
Medial growth
Nasal cavity
Nasopharynx
Lateral growth
Pterygopalatine fossa
Vertical expansion through inferior orbital fissure to orbit possible
Infratemporal fossa
Superior expansion through pterygoid process may involve middle cranial fossa
Lateral and posterior walls of sphenoid sinus can be eroded
Cavernous sinus may be involved
Pituitary may involve.
65. Coronal CT: Bone Window
• Widening of left
sphenopalatine
foramen
• Lesion fills left choanae
• Extends into sphenoid
sinus
66. Axial CT: Soft Tissue Window with Contrast
• Homogenous
enhancement
• Widening of left
sphenopalatine
foramen
• Extension into
– Nasopharynx
– Pterygopalatine fossa
67. Axial CT: Soft Tissue Window with Contrast
• Homogenous
enhancement
• Widening of right
sphenopalatine
foramen
• Extension into
– Nasopharynx
– Pterygopalatine fossa
68. Axial MRI: T1
• Heterogeneous
intermediate signal
• Flow voids represent
enlarged vessels
• Extension into
– Nasopharynx
– Masticator space
69. Coronal MRI: T1 with Contrast
• Diffuse intense
enhancement
• Multiple flow voids
within hypervascular
mass
• Extension into
– Nasopharynx
– Pterygopalatine fossa
70. Axial MRI: T2
• Heterogeneous
intermediate to high signal
enhancement
• Multiple flow voids within
hypervascular mass
• Extension into
– Nasopharynx
– Pterygopalatine fossa
73. Croup (acute laryngotracheobronchitis)
• Croup, also called acute laryngotracheobronchitis
is caused by viral infection of the upper airway
usually parainfluenza virus or respiratory
syncytial virus (RSV).
• It is common and has a peak incidence before
the age of 1 year (typically between 3 and 6
months of age).
• It is presented Clinically by protracted barking
cough and inspiratory strider due to tracheal
narrowing that is caused by mucosal edema .
