Imaging

Otitis Media

Preliminary Diagnosis: Otitis Media

I. What imaging technique is first-line for this diagnosis?

  • CT temporal bone without contrast

II. Describe the advantages and disadvantages of this technique for diagnosis of otitis media.

Advantages

  • Relatively inexpensive, fast imaging modality

  • Highly specific and sensitive in evaluating the osseous structures and exquisitely details any osseous erosion, sclerosis, or destruction

  • Highly specific for detailing destruction or inflammation of the ossicular chain and can differentiate otitis media from cholesteatoma with a high degree of specificity

Disadvantages

  • Exposes a patient to ionizing radiation.

  • Less sensitive for detecting any subtle osseous edema noted in early infection

III. What are the contraindications for the first-line imaging technique?

  • May be contraindicated in pregnant patients

IV. What alternative imaging techniques are available?

  • Contrasted MR of the temporal bone and middle ear

V. Describe the advantages and disadvantages of the alternative techniques for diagnosis of otitis media.

Contrasted MR of the Temporal Bone and Middle Ear

Advantages

  • Does not expose the patient to ionizing radiation

  • More sensitive and specific in detailing any subtle osseous edema or enhancement noted in early infection and/or inflammation

  • Better adept in identifying any surrounding or underlying phlegmon and/or abscess

Disadvantages

  • Expensive

  • Time consuming

  • Requires significant patient cooperation to minimize motion artifact

  • Less adept in detailing surrounding osseous structures

VI. What are the contraindications for the alternative imaging techniques?

Contrasted MR of the Temporal Bone and Middle Ear

  • Contraindicated in patients with non–MR-compatible hardware

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