Indications for Temporal Bone Imaging: The Clinician’s Approach
Recent progress in imaging technology has greatly improved the diagnostic quality and the therapeutic safety in the field of otology and neurotology. This makes imaging one of the cornerstones in the diagnostic work-up and follow-up of temporal bone pathology. By confirming the clinically and audiometrically suspected diagnosis, imaging helps to select the best and safest diagnostic option. It allows the ear surgeon to prepare for surgery in the most efficient way, it identifies contraindications and concomitant ear pathology and warns against potential surgical complications. This allows the clinician to counsel the patient in an honest and a realistic way. The chapter describes how the clinician can decide which imaging sequences to ask for, taking as a starting point the conventional diagnostic aids such as personal and family medical history, symptoms and clinical signs, micro-otoscopy, and audiological work-up. Two pathological situations are described in detail as examples: (1) the patient with conductive or mixed hearing loss with an intact tympanic membrane; (2) the pre-operative work-up and post-operative follow-up of the cholesteatoma patient. A close collaboration between clinician and radiologist is crucial to ensure a correct understanding of the indications for imaging by the clinician, and the selection and application of the correct sequences by the radiologist.