Abstract
Direct otoscopic visualisation, audiogram evaluation and radiological assessment provide a complimentary approach for assessing the temporal bones in hearing loss. Temporal bone anatomy is intricate and complex and best evaluated on high-resolution CT imaging. However, the roles of CT and MRI imaging should both be considered with the appropriate tool utilised based on the differential diagnosis in view of the clinical history and examination. Categorising cases into conductive and sensorineural hearing loss can also help narrow the differential and direct the choice of imaging.
Illustrative examples are provided in this chapter with cases of both conductive hearing loss (e.g. osteoradionecrosis, otosclerosis, glomus tumours, temporal bone trauma and semicircular canal dehiscence) and sensorineural hearing loss (e.g. vestibular schwannomas, arachnoid cysts and congenital defects) including management plans and justification for imaging. Emphasis is also placed on discussing complex cases at a combined meeting with members of the surgical and radiology team present.
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Notes
- 1.
Defined as hearing loss >35 DB in the better hearing ear.
- 2.
Modified radical mastoidectomy is a canal wall down mastoidectomy procedure to remove diseased mastoid air cells (usually for cholesteatoma).
- 3.
Mastoid obliteration: Mastoid cavities are occasionally obliterated with material such as cartilage or fat in order to decrease the size of the mastoid cavity make them easier to clean or so that they become self cleaning.
- 4.
Total ossicular reconstruction—a (usually titanium) prosthesis is placed over the stapes footplate with cartilage or fascia overlying it in order to reconstruct the ossicular chain where this has been destroyed by disease (e.g. cholesteatoma) or the surgery needed to eradicate the disease.
- 5.
T2 shine through effect—refers to the high signal on a restricted diffusion map which is not due to restricted diffusion but is due to high T2 signal which shines through to the DWI image. To confirm true restricted diffusion the lesion should have low signal on the ADC map [16].
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Warner, E., Dziedzic, M., Lingam, R.K., Singh, A. (2021). Imaging of the Temporal Bone in Hearing Loss. 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_7
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