Abstract
Acquired and congenital cholesteatoma result in aggressive bony erosion affecting middle/inner ear structures. While the diagnosis is made clinically at otoscopy, this chapter explores the role of imaging with CT and MRI is to confirm presence, extent, identify complications and plan surgery.
The role of CT of temporal bones as the initial imaging modality of choice is discussed, typically demonstrating non-dependent soft tissue with associated bony erosion. However, as CT does not differentiate cholesteatoma from fluid or inflammation, both staging and follow-up are augmented with non-echo planar (EP) diffusion-weighted (DW) MRI.
In post-surgical follow-up, imaging interpretation requires knowledge of surgical technique employed, so the implications for clinic-radiological evaluation of ‘wall-up’, ‘wall-down’ or ‘combined approach’ are outlined. As a canal ‘wall-up’ approach is associated with more challenging disease clearance, routine ‘second-look’ procedures were previously routine to assess for residual or recurrent disease. Increasingly, however, non-EP DW-MRI has been used in this context.
The strengths and limitations of non-EP DW-MRI are presented (including common causes of false-positive results), emphasizing that imaging should be interpreted in conjunction with detailed information from the surgical team and with reference to temporal bone anatomy on CT, for which image fusion can assist.
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Hall, A., Lingam, R.K., Singh, A. (2021). The Problematic Middle Ear and Cholesteatoma. In: Tatla, T.S., Manjaly, J., Kumar, R., Weller, A. (eds) Head and Neck Imaging. Springer, Cham. https://doi.org/10.1007/978-3-030-80897-6_16
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