Otitis media CT or MRI

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Luke Rusowicz-Orazem, B.S.

Imaging in otitis media patients will reveal opacification of the middle ear, for acute, chronic, and otitis media with effusion. High Resolution CT scans of the temporal bone in acute otitis media patients may reveal complications, including otomastoiditis. MRI is used for patients with suspected intracranial complications, such as brain abscess. sinus thrombosis, and meningitis. For otitis media with effusion patients, contrast-enhanced MRI or CT scan imaging may reveal complete and homogenous middle ear and mastoid cavity opacification. Primary imaging findings for chronic otitis media include complications associated with and without cholesteatoma.

Imaging in otitis media patients will reveal opacification of the middle ear^[1]

• High Resolution CT scans of the temporal bone in acute otitis media patients may reveal complications, such as the following:^[1]
  • Acute coalescent otomastoiditis: Findings include mastoid septation and cortex erosion.
• MRI is used for patients with suspected intracranial complications, such as the following:
  • Brain abscess
  • Sinus thrombosis
  • Meningitis

• For otitis media with effusion patients, contrast-enhanced MRI or CT scan imaging may reveal complete and homogenous middle ear and mastoid cavity opacification.^[1]
  • A tumor in the nasopharynx may also be revealed as a cause for effusion.

• Primary imaging findings for chronic otitis media include the following:^[1]
  • Markers for inflammation.
  • Ossicle erosion or other possible causes for hearing loss.
  • Determination of cholesteatoma.
  • Intratemporal complications: petrositis, labyrinthitis, subperiosteal abscess, labyrinthine fistula
  • Intracranial complications: brain abscess, meningitis
• Without a presence of cholesteatoma, MRI or HRCT images may reveal the following indications of chronic otitis media:
  • Presence of fibrous tissue.
  • Tympanosclerosis.
  • Formation of new bone matter.
• With presence of cholesteatoma, MRI or HRCT images may reveal the following indications of chronic otitis media:
  • Ossicle erosion and displacement.
  • Extension of cholesteatoma to sinuses.

• 
  Selected CT images showing soft tissue density material occupying partially the right middle ear cavity without ossicular chain destruction. Mastoid air cells are obliterated on this side. Case provided by Dr. Bruno Di Muzio. From Radiopaedia Image Library. ^[2]
• 
  Fluid in the middle ear cleft on the right as well as the mastoid antrum and mastoid air cells. No overlying soft tissue swelling nor bone erosion to indicate osteomyelitis/gross mastoiditis. Note bulging of the upper tympanic membrane (pars flaccida) due to raised pressure in the tympanic cavity with pulling in at the umbo ie the malleolal attachment. Note the inferior pars tensa portion of the membrane does not bulge as dramatically as the upper flaccida. Case provided by Dr. Chris O’Donnell.From Radiopaedia Image Library. ^[2]
• 
  The left middle ear is filled by soft tissue completely encasing the auditory ossicles. There is some residual ventilation near the tympanic ostium of the Eustachian tube. In this region, a linear calcification can also be seen. In the right middle ear, there are also some strands with soft tissue attenuation neighbouring the tympanic membrane, which is retracted on both sides. The right ossicles are not affected. Bilateral mastoid sclerosis is also present. There are no bony destructions hinting at a cholesteatoma. Case presented by Dr. Roberto Schubert.From Radiopaedia Image Library. ^[2]
• 
  CT of the brain demonstrates right middle ear effusion with some minute gas locules likely percolating through effusion via pharyngotympanic tube. The opacification extends to the mastoid air cells with no evidence of bony destruction. Case presented by Dr. Steve Lau. From Radiopaedia Image Library. ^[2]

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