Imagerie des otites chroniques de l’adulte

Temporomandibular joint (TMJ) disorders as first clinical manifestations in external auditory canal cholesteatoma. A case report

Introduction and importance

Cholesteatoma is a common occurrence in the middle ear, whereas cholesteatoma of the external auditory canal (EAC) is a rare condition. We report an unusual presentation of the cholesteatoma in the EAC.

Case presentation

We report a case of a 67-year-old male presented to the ENT casualty with a longstanding history of left sided squeaky type sound, aggravated whenever he talks or eats. He subsequently had a Computed Tomography (CT) scan of the left petrous bone which identified a left-sided EAC cholesteatoma. Clinical symptoms of EAC cholesteatoma are non-specific, and hence we recommend considering cholesteatoma when patients present with abnormal EAC symptoms and intact tympanic membrane.

Clinical discussion

His cranial nerves examination was normal, and the tympanic membrane was intact. His blood count and infective marker were normal. The CT scan of the brain showed a lesion in the left external auditory canal close to the tympanic membrane. The lesion was in contact with the anterior inferior canal wall which had features suggesting bony erosion. Gas bubble seen in the posterior part of the TMJ was in relation to bony erosion of the EAC.

Conclusion

The cholesteatoma of the EAC is very rare. CT scan can provide detailed information about the extent of external ear canal cholesteatoma, which can be used to identify complications of the disease, in addition to differentiating the external ear canal from the middle ear cholesteatoma. Early recognition of cholesteatoma and prompt treatment is essential to prevent catastrophic complications.

•

A cholesteatoma originating in the external auditory canal is a rare finding.

•

Cholesteatoma can present with atypic symptoms such as temporomandibular joint disorders.

Role of High Resolution Computed Tomography of Mastoids in Planning Surgery for Chronic Suppurative Otitis Media

Chronic suppurative otitis media (CSOM) presents with a typical history of recurrent otorrhoea with tympanic membrane perforation. The diagnosis of cholesteatoma is usually made on otologic examination. High resolution computed tomography (HRCT) is indicated to evaluate the extension and the complications of cholesteatoma. The aim of the work was to study the role of HRCT in detecting, evaluating diagnosing and managing CSOM. All patients presenting with CSOM who were planned for mastoid exploration surgery in department of ENT, Gauhati Medical College and Hospital within a period of 2 years-from 1st January, 2013 to 31th December, 2014, were taken up for the study. HRCT mastoids done routinely before cholesteatoma surgery, but with improved resolution, to characterize all middle ear structures and complications of the disease prior to surgery, might guide as road map during mastoid explorations for unsafe CSOM. The important role of HRCT lies on the early detection of cholesteatoma, and more conservative surgical procedures can be used to eradicate the disease.

Posttraumatic Cholesteatoma Complicated by a Facial Paralysis: A Case Report

The posttraumatic cholesteatoma is a rare complication of different types of the temporal bone damage. Its diagnosis is often done after several years of evolution, sometimes even at the stage of complications. A case of posttraumatic cholesteatoma is presented that was revealed by a facial nerve paralysis 23 years after a crash of the external auditory canal underlining the importance of the otoscopic and radiological regular monitoring of the patients with a traumatism of the temporal bone.

Childhood cholesteatoma

Although cholesteatoma was first described in 1683, its etiopathogeny remains unexplained. In children, there are two forms: acquired cholesteatoma, resembling the adult form, and congenital cholesteatoma. The acquired form has become less frequent in recent years, thanks to progress in the treatment of childhood otitic pathology. Diagnosis of congenital cholesteatoma, on the contrary, is increasing, due to improvements in information to health care professionals and in diagnostic tools. Clinical and histological evidence points to greater aggressiveness in childhood forms, although this difference cannot, at present, be precisely explained. Diagnosis is clinical, but CT and MR imaging is indispensable for preoperative assessment and postoperative follow-up. New delayed gadolinium-enhanced T1-weighted and diffusion-weighted MRI sequences have recently been developed and provide more precise radiological diagnosis. Treatment is surgical; alternatives, notably by laser, have proved unsuccessful. Complications concern involvement of neighbouring structures, and are mainly infectious; some can be life-threatening, and should be systematically screened.

Diffusion-weighted MR imaging for evaluation of pediatric recurrent cholesteatomas

OBJECTIVE

To compare the efficiency of diffusion-weighted MR imaging (MRI) vs. high resolution CT in predicting recurrent or residual cholesteatoma in children who underwent prior middle ear surgery.

DESIGN

Prospective study.

SETTING

Tertiary care university hospital.

PATIENTS

Seventeen patients (4 with 2 recurrences) aged 5-17 years (mean 11.4) previously surgically treated for a cholesteatoma of the middle ear, were included for follow-up with systematic CT scan and MRI, between 2005 and 2007.

METHODOLOGY

CT scan was performed on a Siemens Somaton 64 (0.5/0.2 mm slices reformatted in 0.5/0.3 mm images), parallel and perpendicular to the lateral semi-circular canal for each ear (100 mmx100 mm FOV). MRI was undertaken on a Siemens Avanto 1.5 T unit, with an adapted protocol for young children. Diagnosis of recurrent cholesteatoma was based on the evidence of a hyperintense image at B1000 on diffusion-weighted images. Results of CT scan and MRI were compared with operative diagnosis.

RESULTS

Nine patients had a positive MRI, among which 8 had cholesteatoma confirmed during revision surgery. In the 12 negative MRI cases, 5 were positive on revision surgery. None of these lesions was over 3mm. Two of them were diagnosed on the CT scan. CT scan alone had a positive predictive value of 75%, and a negative predictive value of 58%.

CONCLUSION

Diffusion-weighted MRI is associated with a high positive predictive value for the detection of recurrent cholesteatoma. CT scan remains the first choice imaging technique. In case of doubtful CT scan, diffusion-weighted MRI could confirm a recurrence or, when negative, avoid second-look surgery.