Detection Of Cholesteatoma Research Articles

Differentiation between cholesteatoma and inflammatory process of the middle ear, based on contrast-enhanced computed tomography imaging

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Results, Hearing Rehabilitation, and Follow-up with Magnetic Resonance Imaging after Tympanomastoid Exenteration, Obliteration, and External Canal Overclosure for Severe Chronic Otitis Media

We sought to evaluate the results, auditory rehabilitation, and follow-up with magnetic resonance imaging (MRI) after tympanomastoid exenteration with obliteration of the mastoid cavity and overclosure of the external ear canal in patients with severe chronic otitis media that was resistant to medical therapy and conventional surgery and was associated with a profound sensorineural or severe conductive hearing loss. Twenty-nine patients were analyzed and underwent this surgical technique. Twelve patients had, during the same or later stage, either cochlear implantation, fixture implantation for a bone-anchored hearing aid, or middle ear implantation. For follow-up control of the obliterated cavity, delayed gadolinium-enhanced, T1-weighted MRI in combination with non-echo planar imaging diffusion weighted sequences were used. No patient had recurrent otorrhea after an average follow-up period of 4.75 years. One patient had a residual cholesteatoma as shown by new MRI techniques, and this was successfully resected. One patient developed complications 6 months after 1-stage tympanomastoid exenteration and cochlear implantation. This technique is very useful in selected patients with severe chronic otitis media that is resistant to medical therapy and surgery and is associated with a profound sensorineural or severe conductive hearing loss. New sequences in MRI are used for postoperative follow-up of these obliterated cavities and seem reliable for the detection of residual or recurrent cholesteatoma. Middle ear implantation and cochlear implantation can be relatively safely performed in these patients in a second stage.

Value of high-resolution computed tomography and magnetic resonance imaging in the detection of residual cholesteatomas in primary bony obliterated mastoids

Purpose The objective of this study was to assess the value of high-resolution computed tomography (HRCT) and that of magnetic resonance imaging (MRI), including postcontrast T 1-weighted images and echo-planar diffusion-weighted (EP-DW) images, in the detection of residual cholesteatomas after primary bony obliteration of the mastoid. Patients and methods Twenty-three patients underwent a second-look surgery 8 to 18 months after they underwent a primary bony obliteration technique. All patients were evaluated by HRCT and MRI before their second-look surgery. A retrospective analysis was performed. Results A residual cholesteatoma was found in 2 of the 23 patients; both cases of cholesteatoma had a diameter less than 4 mm. In these 2 patients, residual cholesteatoma was found in the middle ear cavity and not in the obliterated mastoid. In all cases, HRCT showed a homogeneous obliteration of the mastoid cavity. On MRI, only one cholesteatoma pearl was detected using contrast-enhanced T 1-weighted imaging. Findings from the EP-DW imaging were negative for all cases. Conclusion This study demonstrates that HRCT is still the imaging technique of choice for the evaluation of bony obliterated mastoids. It shows the low sensitivity and specificity of HRCT for the characterization of an associated opacified middle ear and those of contrast-enhanced T 1-weighted imaging and EP-DW imaging for the detection of small residual cholesteatomas after primary bony obliteration.

Imagerie des otites chroniques de l’adulte

Chronic otitis media (COM) can be divided into two subtypes: COM with cholesteatoma (including precholesteatomatous states) is an aggressive form of otitis. Surgical treatment is mandatory because of the risk for labyrinthine or cerebromeningeal complications. CT is very important in the preoperative work-up (extension of cholesteatoma, anatomic variants). In patients who have undergone middle ear surgery, CT and presently MRI play an increasing role in the detection of recurrent or relapsing cholesteatoma. COM without cholesteatoma does not have an osteolytic potential, but may leave auditive sequelae that in selected cases may warrant surgical treatment to improve hearing. CT is useful in the etiological work-up of patients with severe hypoacusis. CT also plays an important role in cases of surgical failure, to detect a dislocation of the ossiculoplasty or impairment of the middle ear caused by fluid effusion. The objective of this paper is to specify the indications, the results and the limits of pre- and postoperative imaging in COM.

Differentiation between cholesteatoma and inflammatory process of the middle ear, based on contrast-enhanced computed tomography imaging

To assess the usefulness of delayed post-contrast computed tomography (CT) examination for the detection of residual or recurrent cholesteatoma after canal wall up tympanoplasty. This prospective, non-randomized study, set within an academic medical centre, included 17 consecutive patients who had undergone canal wall up tympanoplasty for cholesteatoma, with possible recurrence. Pre-contrast CT scans and delayed post-contrast images were compared with second look surgical findings. A residual or recurrent cholesteatoma was found in eight of the 17 patients at revision surgery and was correctly diagnosed on post-contrast CT images in six patients (75 per cent). In the two misdiagnosed cases, cholesteatoma pearls smaller than 2.5 mm were not seen on post-contrast CT. The sensitivity of the imaging test was 75 per cent, the specificity was 60.1 per cent, the positive predictive value was 88.1 per cent and the negative predictive value was 81.8 per cent. Computed tomography with delayed post-contrast images is a sensitive imaging modality for the detection of residual cholesteatoma. If proven reliable, this method of non-invasive imaging could spare the patient unnecessary revision surgery.

Usefulness of Delayed Postcontrast Magnetic Resonance Imaging in the Detection of Residual Cholesteatoma after Canal Wall-Up Tympanoplasty

Imaging takes an increasing place in the follow-up of patients who have undergone surgery for cholesteatoma, with computed tomography (CT) as the first line imaging technique. However, in case of complete opacity of the tympanomastoid cavities, CT is not able to differentiate residual cholesteatoma from postoperative scar tissue. The aim of this study was to assess the usefulness of magnetic resonance imaging (MRI) using delayed postcontrast T1-weighted images for the detection of residual cholesteatoma after canal wall-up tympanoplasty (CWU) in cases where CT was not conclusive. Prospective study. MRI, with delayed postcontrast T1-weighted images (30-45 minutes after contrast injection), was performed before revision surgery in 41 consecutive patients who had undergone CWU for cholesteatoma and presenting with a nonspecific complete opacity of the mastoid bowl on CT. In all the cases, imaging results were compared with operative findings at surgical revision. A residual cholesteatoma was found in 19 of 41 patients at revision surgery and was correctly detected on MRI in 17 patients. In the two remaining cases, cholesteatoma pearls smaller than 3 mm were not seen. There was no false-positive case. Statistics were as follows: sensitivity 90%; specificity 100%; positive predictive value 100%; negative predictive value 92%. When postoperative CT is not conclusive because of complete opacity of the tympanomastoid cavities, MRI with delayed postcontrast T1-weighted images is a reliable additional technique for the detection of a residual cholesteatoma when its diameter is at least 3 mm.

Diffusion-weighted MR imaging of cholesteatoma in pediatric and adult patients who have undergone middle ear surgery.

The aim of this prospective study was to determine the role of diffusion-weighted MR imaging combined with conventional MR imaging for the detection of residual or recurrent cholesteatoma in patients who have undergone middle ear surgery. Twenty-two patients who had undergone resection of cholesteatoma were referred for MR imaging. MR imaging (1.5 T) was performed using a diffusion-weighted single-shot spin-echo echoplanar sequence, a proton density and T2-weighted double-echo turbo spin-echo sequence, and T1-weighted spin-echo sequences before and after IV injection of gadopentetate dimeglumine (0.1 mmol/kg of body weight). An experienced reviewer evaluated the diffusion-weighted MR images for the presence of a high-signal-intensity cholesteatoma. Imaging findings were correlated with findings from surgery in 17 patients and with findings from clinical follow-up examination in five patients. Diffusion-weighted MR imaging combined with conventional MR imaging depicted 10 of 13 cholesteatomas (sensitivity, 77%). The three lesions that were missed were smaller than 5 mm. All the MR images of patients without cholesteatoma were correctly interpreted as showing negative findings for cholesteatoma (specificity, 100%). The positive predictive value and negative predictive value were 100% and 75%, respectively. Diffusion-weighted MR imaging combined with conventional MR imaging can confirm residual or recurrent cholesteatoma in patients who have undergone middle ear surgery by showing a high-signal-intensity lesion. Because tumors smaller than 5 mm may be missed, a diffusion-weighted MR imaging study with negative findings does not exclude small residual or recurrent cholesteatoma.

Detection of postoperative residual cholesteatoma with delayed contrast-enhanced MR imaging: initial findings.

Our objective was to assess the value of delayed contrast-enhanced T1-weighted spin-echo MR imaging in the detection of residual cholesteatoma in patients who have undergone canal wall-up tympanoplasty procedure. The MR imaging was obtained prior to revision surgery in 18 patients with opacity of the post-operative cavity at CT examination 12-18 months after canal wall-up tympanoplasty. In each patient the following was performed: precontrast T1- and T2-weighted images; and early and delayed contrast-enhanced axial and coronal T1-weighted imaging. Early and delayed MR imaging results were separately compared with surgical second-look findings. Sensitivity, specificity, and predictive values were evaluated for early and delayed post-contrast MR imaging, compared with second-look surgery findings. A residual cholesteatoma was correctly identified in 8 of 9 cases with delayed contrast-enhanced T1-weighted MR imaging. Mean sensitivity, specificity, positive predictive value, and interobserver agreement (evaluated by kappa statistics) were, respectively, 85.2, 92.6, 92.6%, and kappa=0.78 for the delayed contrast-enhanced MR imaging technique. The same parameters were, respectively, 96.3, 33.3, 60.6, and 0.30 for the early contrast-enhanced T1-weighted MR images. We conclude that delayed contrast-enhanced T1-weighted MR imaging is reliable for the detection of residual cholesteatomas of the middle ear in patients who have undergone canal wall-up tympanoplasty.

Surgical strategy for cholesteatoma in children

Objective: We reviewed our experience with childhood cholesteatoma in children under 15 years old. Based on cumulative postoperative data, we propose a modified canal-wall-up technique in conjunction with a planned, staged operation. Methods: From 1982 to 1997, 56 children with cholesteatoma (58 ears, total) underwent surgery in our department. In the early period (1982–1990), canal wall-down mastoidectomy was performed in 52% (21 of 40 ears), and canal wall-up mastoidectomy in 48% (the remaining 19 ears). In the late period (1991–1997), 18 ears with cholesteatoma underwent surgery. The canal-wall up mastoidectomy was performed in 89% (16 ears), and canal-wall-down mastoidectomy in the remaining 11% (two ears). Results: In the early period (1982–1990), cholesteatoma recurred more frequently in the canal-wall-up mastoidectomy group than in the canal-wall down mastoidectomy group (53 vs. 14%). Other postoperative complications, such as erosion of the mastoid cavity, otorrhea, and perforation of the eardrum, occurred more frequently in the canal-wall-down mastoidectomy group than in the canal-wall-up mastoidectomy group. In the late period (1991–1997), in the canal-wall-up mastoidectomy group, ten ears underwent one-stage surgery. Planned staged tympanoplasty was completed in six ears. After one-stage surgery, four of ten ears experienced residual cholesteatoma. Two of the recurrent ears had undergone planned staged tympanoplasty. As revealed by postoperative computed tomography (CT) images, 12 of 15 ears had aeration in the attic and antrum as well as in the tympanic cavity. In these cases, no attic retraction pocket formation was observed. Conclusion: Our strategy for pediatric cholesteatoma in the future is to use canal-wall-up mastoidectomy when possible. If aeration in the attic and antrum is observed by preoperative CT-scan image and no erosion in the malleus and incus exists, the one-stage surgery will be chosen. If no aeration is observed by CT-scan and/or erosion exists in the surgical findings, planned staged tympanoplasty will be necessary. This strategy allows a high incidence of aeration of the attic and antrum, and prevents the formation of the attic retraction pocket while enabling the early detection of residual cholesteatoma by means of CT.

Detection and management of childhood cholesteatoma.

Childhood cholesteatoma is an aggressive disease that demonstrates higher rates of recidivism than its adult counterpart. The priorities in ideal management include total removal, followed by hearing restoration, followed by preserving the ear anatomy. Especially in children, one must endeavor to preserve ear anatomy if it does not jeopardize total removal of cholesteatoma. Absolute indications for CWD surgery include an only-hearing ear, a severely destroyed posterior canal wall, an extremely contracted mastoid, and matrix overlying a semicircular canal fistula. Reasons for staging childhood cholesteatoma include suspected residual disease, uncertainty about total removal of cholesteatoma, severe mucosal disease, and CWU procedures in which the cholesteatoma has diffusely invaded the bone. Adequate long-term follow-up is imperative. Patients and their families should be reminded frequently of the importance of close follow-up because recidivism is frequent. Successful management of cholesteatoma in children does not involve a rigid, "one-way" approach. The surgeon must be flexible and capable of employing the most appropriate procedure for the patient.

The surgical management of childhood cholesteatoma.

The results of treatment of 124 cases of childhood cholesteatoma are reported in the present study and compared with an adult group of patients. Intact canal wall tympanoplasty was performed in over 90 per cent of cases in children and the procedure was staged in nearly 80 per cent of cases. The children had a 43.8 per cent incidence of residual cholesteatoma and an 8.8 per cent incidence of recurrent cholesteatoma in intact canal wall tympanoplasty cases. Intact canal wall tympanoplasty remains the technique of choice in our hands for the treatment of childhood cholesteatoma; pre-planned staging of the operation is mandatory for the detection and elimination of residual cholesteatoma which occurs more frequently in children.

High resolution CT scanning for detection of cholesteatoma and complications in the postoperative ear.

Otologists who prefer intact canal wall surgery for removal of cholesteatoma recognize a 12.25% return rate. Revisions often indicated to correct hearing loss are frequently negative for recurrent cholesteatoma. To determine the reliabiity of a noninvasive method of diagnosing recurrent disease and possible complications, 40 patients previously operated on for cholesteatoma using the intact canal wall technique were scanned with a General Electric 8800 scanner. Second procedures were performed on 24 patients and findings compared with preoperative film interpretations. Scans correctly predicted no significant masses in 6 patients and cholesteatoma recurrence in 11; the remaining 6 with diffuse soft tissue changes were incorrectly diagnosed. Focal areas of bone erosion were detectable in 3 cases, indicating active or potential complications. Scans were reliable in detecting cholesteatoma depending upon the pathology.

Computed tomography of the temporal bone

HomeRadioGraphicsVol. 1, No. 2 Previous ArticlesComputed tomography of the temporal boneKatherine ShafferKatherine ShafferAuthor AffiliationsFrom the Department of Radiology, Medical College of Wisconsin, Milwaukee County Medical Complex, 8700 West Wisconsin Avenue, Milwaukee, Wis. 53226.Katherine ShafferPublished Online:Aug 1 1981https://doi.org/10.1148/radiographics.1.2.62MoreSectionsPDF ToolsImage ViewerAdd to favoritesCiteTrack CitationsPermissionsReprints ShareShare onFacebookTwitterLinked In Article HistoryPublished in print: Aug 1981 FiguresReferencesRelatedDetailsCited ByHigh-resolution computed tomography of the temporal bone of the Macaca mulatta monkeyD. G.Farwell, G. E.Krause, J. M.Fredrickson, F. J.Wippold1994 | European Archives of Oto-Rhino-Laryngology, Vol. 251, No. 5Value of high-resolution computed tomography in diagnosis of petrous bone fractureTarumiYamaki, EijiYoshino, ToshihiroHiguchi, YoshiharuHorikawa, KimiyoshiHirakawa1986 | Surgical Neurology, Vol. 26, No. 6Neuroradiology of the Skull BaseJoachim F.Seeger1984 | Otolaryngologic Clinics of North America, Vol. 17, No. 3CT of the Postsurgical EarDexter W.Johnson1984 | Radiologic Clinics of North America, Vol. 22, No. 1High Resolution CT Scanning for Detection of Cholesteatoma and Complications in the Postoperative EarRichard L.Voorhees, Dexter W.Johnson, Robert B.Lufkin, WilliamHanafee, RinaldoCanalis1983 | The Laryngoscope, Vol. 93, No. 5Recommended Articles RSNA Education Exhibits RSNA Case Collection Vol. 1, No. 2 Metrics Altmetric Score PDF download