The Prevalence of Incidental Mastoid Opacification and the Need for Intervention: A Meta-Analysis

Middle Ear Cleft Opacification in Acute Otitis Externa: Sequela or Incidentaloma?

BACKGROUND

The external and middle ear are anatomically distinct regions. Middle ear cleft opacification (MECO) observed following acute otitis externa (AOE) raises questions about its occurrence mechanism and clinical significance. Previous animal studies have demonstrated that irritation of the external ear canal can lead to the development of middle ear effusion via Pars Flaccida cells. The literature lacks clinical information on middle ear involvement in AOE.

METHODS

A retrospective analysis was conducted on 92 patients post-AOE who underwent brain imaging within 3 months post-uncomplicated AOE. Patients with anatomical disruptions between the external and middle ear were excluded. MECO rate and dynamics were evaluated. The involvement of middle ear cleft anatomic regions was assessed.

RESULTS

MECO was identified in 38.0% (35/92) of post-AOE ears compared to 10.8% (10/92) of contralateral ears (P = .002). The prevalence of MECO in post-AOE patients decreased from 58.9% (23/39) within 2 weeks post-AOE to 8.0% (2/25) 3 months post-AOE. Over time, complete middle ear opacification gradually transitioned to partial opacification. Opacification was noted in the upper middle ear cleft (epitympanum/mastoid) in 94.2% (33/35).

CONCLUSIONS

Middle ear effusion is a common, resolving sequela of AOE, rather than an indication of AOE deterioration or significant middle ear inflammatory involvement. This information is valuable for otolaryngologists as well as general practitioners who treat AOE patients, helping to better understand potential sequelae and avoid unnecessary treatments, and for radiologists who diagnose ME opacification in AOE patients. Further studies are warranted to explore the role of the pars flaccida in middle ear effusion.

Incidentalomas in the head & neck

Incidental findings (IFs) in the head & neck are a frequent challenge to the reporting radiologist. A combination of complex anatomy, widely varied imaging techniques and the high prevalence of benign pathology, makes safe and appropriate management of head & neck IFs problematic. The non-head & neck radiologist is unlikely to have prior personal experience of the relevant specialties or current involvement with the pertinent multidisciplinary teams, creating unfamiliarity with both the clinical aspects of head & neck disease and the value of examination techniques. This triumvirate of complex anatomy, pathology and imaging creates the perfect environment for excessive investigation and overdiagnosis. In this article, the most frequently encountered and clinically relevant head & neck IFs are summarised. To reflect daily clinical practice, we will firstly consider anatomic abnormalities identified on cross-sectional imaging and ultrasound, followed by a review of PET-CT incidental findings.

Sinus, middle-ear and mastoid radiological findings of severe acute respiratory syndrome coronavirus-2

OBJECTIVE

To assess the incidence of radiological inflammation within the paranasal sinuses, middle ear and mastoid in patients with confirmed severe acute respiratory syndrome coronavirus-2.

METHODS

A retrospective cohort study was conducted to examine consecutive adults (aged over 18 years) with coronavirus disease 2019 (confirmed on polymerase chain reaction within 7 days of imaging) who underwent computed tomography of the head between 1 March 2020 and 24 June 2020. Lund-Mackay and mastoid and middle-ear opacification scores were used to categorise the extent of sinus and mastoid opacification on axial and coronal computed tomography images.

RESULTS

Of 147 patients originally identified, only 83 met the inclusion criteria. Sinus opacification was present in 51.8 per cent of patients (n = 43), and middle-ear or mastoid opacification was observed in 24.1 per cent (n = 20). There was no statistically significant difference in sinus or middle-ear and mastoid opacification between patients after stratification based on 30-day all-cause mortality.

CONCLUSION

Radiological computed tomography findings suggest mild mucosal disease within the sinuses, middle ear and mastoid. There was no statistical correlation between such opacification and 30-day mortality.