chronic otitis media

External and

middle ear diseases: radiological diagnosis based on clinical signs and symptoms. Chronic middle ear inflammation. a Coronal CT in bone window shows opacification around oval window niche, encasing stapes superstructure (arrow). b Soft tissue around stapes crura is visible on axial slice at the level of oval window. This represents fibrous tissue, which develops in the course in chronic inflammation and may cause conductive hearing loss

insightsimaging.springeropen.com • CC-by-2.0

External and

middle ear diseases: radiological diagnosis based on clinical signs and symptoms. Chronic middle ear inflammation. Axial CT scan demonstrates focal calcifications in thickened tympanic membrane (arrow). This is called myringosclerosis

insightsimaging.springeropen.com • CC-by-2.0

External and

middle ear diseases: radiological diagnosis based on clinical signs and symptoms. Chronic middle ear inflammation. Axial CT in bone window demonstrates focal calcifications (arrow) in the tympanic cavity, close to ossicular chain. This is called tympanosclerosis

insightsimaging.springeropen.com • CC-by-2.0

External and

middle ear diseases: radiological diagnosis based on clinical signs and symptoms. Chronic middle ear inflammation with cholesteatoma. Coronal CT scan demonstrates lateral semicircular canal fistula (arrowhead), caused by erosion of bone covering the canal due to growing cholesteatoma

insightsimaging.springeropen.com • CC-by-2.0

External and

middle ear diseases: radiological diagnosis based on clinical signs and symptoms. Chronic middle ear inflammation with cholesteatoma. a Axial CT scan, bone window. Lobulated soft tissue mass is visible laterally to ossicular chain (arrow). b Coronal CT scan: erosion of scutum is well visible (arrow). The second arrow points at cholesteatoma, growing typically in Prussak’s space

insightsimaging.springeropen.com • CC-by-2.0

External and

middle ear diseases: radiological diagnosis based on clinical signs and symptoms. Chronic middle ear inflammation with cholesteatoma. Axial CT scan shows typical pars tensa cholesteatoma growing medially to ossicular chain

insightsimaging.springeropen.com • CC-by-2.0

External and

middle ear diseases: radiological diagnosis based on clinical signs and symptoms. Chronic middle ear inflammation with cholesteatoma. MRI coronal image, diffusion-weighted sequence (B 1,000). The image shows a hyperintense mass in middle ear cavity representing cholesteatoma. Case courtesy of Dr Bert De Foer, Department of Radiology, AZ Sint-Augustinus, Wilrijk, Belgium

insightsimaging.springeropen.com • CC-by-2.0

Lizenz: CC BY-SA 4.0

chronische Mittelohrentzündung
chronic otitis media

Otitis media Radiopaedia • CC-by-nc-sa 3.0 • de

Otitis media refers to inflammation or infection of the middle ear cavity.

Terminology

The specific type of otitis media depends on various clinical findings and setting:

acute otitis media: acute infection of the middle ear
otitis media with effusion: middle ear fluid without signs or symptoms of acute infection
adhesive otitis media: retracted tympanic membrane with adhesions to medial wall of tympanic cavity, with or without perforation
chronic otitis media: tympanic membrane perforation in the setting of recurrent infections of the middle ear
- benign/inactive chronic otitis media: dry tympanic membrane perforation
- chronic suppurative otitis media (CSOM): purulent drainage through perforated tympanic membrane
- chronic otitis media with effusion (formerly chronic serous otitis media): serous drainage through the perforated tympanic membrane
otomastoiditis: inflammation or infection from acute or chronic otitis media has spread to involve the mastoid

Epidemiology

It is most commonly seen in children.

Clinical presentation

In acute otitis media, otalgia is the most common complaint. Other common signs and symptoms include otorrhea, hearing loss, headache, fever, and irritability. The otoscopic signs with the highest positive predictive value for acute otitis media are a bulging tympanic membrane followed by impaired mobility on pneumatic otoscopy . The redness of the tympanic membrane is less reliable but may be used to make the diagnosis in combination with other signs such as the presence of middle ear effusion.

In otitis media with effusion, most cases are asymptomatic. When patients are symptomatic, the most common finding is mild conductive hearing loss.

In chronic otitis media, the most common complaints are persistent otorrhea and hearing loss. Otoscopic examination demonstrates a perforated tympanic membrane.

Pathology

A mixture of factors predispose to otitis media, but Eustachian tube dysfunction or obstruction is thought to be one of the most important factors. Congenital palate defects, host immunity, and viral or bacterial infection may all be contributing factors.

Radiographic features

Imaging is not usually required in cases of acute otitis media as the diagnosis is clinical. However, patients with chronic otitis media that present with hearing loss in whom the tympanic membrane cannot be visualized may require imaging. Exact imaging features vary depending on the form but in general includes

CT

High-resolution temporal bone CT is routinely performed and may show:

soft tissue density in the middle ear cavity
thickened tympanic membrane
bulging tympanic membrane
tympanic perforation

Features seen in chronic rather than acute otitis media include:

air-fluid level in the middle ear (effusion)
bony erosion (less than 10%)
adjacent sclerosis and hypopneumatisation of the mastoid

MRI

fluid signal in the middle ear cavity and mastoid antrum.

Differential diagnosis

cholesteatoma
- causes disruption and erosion of the auditory ossicles
- mass-like appearance rather than dependent fluid
- can be difficult to exclude if the middle ear cavity is diffusely opacified
hemotympanum
- following trauma
- associated with skull base fracture