Objective:To explore the application value of high-resolution temporal bone CT and DW-MRI fusion technology in achieving precise diagnosis and anatomical localization of middle ear cholesteatoma during endoscopic surgery. Methods:Eighteen patients initially diagnosed with middle ear cholesteatoma in the Department of Otolaryngology Head and Neck Surgery, Shaanxi Provincial People's Hospital, from January to June 2024 were enrolled.Preoperative high-resolution temporal bone CT and DW-MRI were performed, and rtStation software was used for image fusion to construct CT-MRI fused images. The involvement of cholesteatoma in six anatomical subregions of the temporal bone was evaluated. Using surgical pathology as the gold standard, and combining surgical videos and anatomical records, the sensitivity, specificity, and accuracy of pure CT, pure DW-MRI, and CT-MRI fused images in evaluating middle ear cholesteatoma lesions were compared. Results:A total of 18 patients were included, and 17 cases were pathologically confirmed as middle ear cholesteatoma postoperatively. The sensitivity of the preoperative of preoperative CT was 100%, but the specificity was only 44.44%, with an overall accuracy of 72.22%; the sensitivity and specificity of DW-MRI evaluation were 81.46% and 85.19%, the accuracy was 83.33%, respectively. In contrast, the sensitivity and specificity of CT-MRI fusion image to the spatial localization of cholesteatoma were higher than that of DW-MRI alone（92.59% vs 81.46%; 98.15% vs 85.19%）, and the diagnostic accuracy was also significantly improved（95.37% vs 83.33%）. The Kappa values for the agreement between HRCT, DW-MRI, and CT-MRI segmentation localization and pathological results were 0.444, 0.667, and 0.907 respectively. The chi-square paired t-test confirmed statistically significant diagnostic differences between groups（P<0.001）. Results demonstrated that CT-MRI significantly outperformed HRCT and DW-MRI in diagnostic efficacy for segmental localization of primary posterior congenital middle ear cholesteatoma. Conclusion:High-resolution temporal bone CT combined with DW-MRI fusion technology demonstrates higher sensitivity, specificity, and accuracy in the diagnosis and spatial localization of middle ear cholesteatoma than single imaging modalities. It can provide more precise evaluation of lesion scope for endoscopic surgery, showing important clinical application value.
Humans ; Cholesteatoma, Middle Ear/diagnostic imaging* ; Tomography, X-Ray Computed ; Temporal Bone/diagnostic imaging* ; Diffusion Magnetic Resonance Imaging ; Female ; Male ; Adult ; Sensitivity and Specificity ; Middle Aged ; Endoscopy

Objective:To observe the position and morphology of tubular cell in lateral facial recess by CT scanning and surgical finding, and its clinical significance. Methods:Thirty patients（32 ears） with cholesteatoma and/or adhesive otitis media requiring radical mastoidectomy and tympanoplasty were included in this study. To observe the morphology of the tubular cell in the lateral facial recess cavity through temporal bone HRCT and surgery, and to analyze its relationship with the facial nerve. Results:Tubular cell were found in 59.4%（19/32） ears by temporal bone HRCT and through surgeon. The length ranged from 1.5-6.5 mm, with median length of 2.5 mm. All of them opened in the facial recess, ran on the posterior wall of the facial recess, and even reached the bottom of the inferior tympanic cavity or the level of the inferior wall of the external auditory canal（sagittal view and surgical findings）. Probing from the inside out, the tubular cell located between the second genu of the facial nerve and the chorda tympani, which was a part of the lateral wall of the facial nerve（facial crest）. When the tubular cell is occupied by granulation tissue, it is easy to be regarded as the facial nerve. Fully drilling out the tubular cell is helpful to cut down the facial nerve crest. In the study, the follow-up and/or postoperative no facial paralysis happens during the operation and in the follow up. Conclusion:Preoperative temporal bone HRCT can clearly show the tubular cell in the lateral facial recess cavity. Comprehensive and accurate identification of these structures is helpful to fully cut down the facial nerve crest and remove the hidden lesions in the posterior tympanic cavity.
Humans ; Facial Nerve/diagnostic imaging* ; Tomography, X-Ray Computed ; Male ; Adult ; Temporal Bone/diagnostic imaging* ; Otitis Media/surgery* ; Female ; Middle Aged ; Cholesteatoma, Middle Ear/diagnostic imaging* ; Mastoidectomy/methods* ; Tympanoplasty/methods* ; Young Adult ; Adolescent ; Clinical Relevance

Objective: To elucidate the clinical manifestations of temporal bone tympanic plate fracture and the correlation between treatment time after injury and its prognosis, and to discuss the importance of early treatment of tympanic fracture. Methods: Retrospective analysis was carried out on the clinical data of 15 patients(17 ears)with temporal bone tympanic plate fracture from March 2006 to July 2019. The course of disease was less than 1 month (initial stage) in 7 cases (7 ears), 1 month to 6 months (middle stage) in 2 cases (3 ears), and 6 months or more (late stage) in 6 cases (7 ears). The symptoms, signs, CT findings, pure tone audiometry results, surgical methods and clinical efficacy of each group were summarized. Results: Most patients with temporal bone tympanic plate fracture were referred to otology department by maxillofacial surgery. Fracture occured indirectly with the chin or zygomatic region as the direct stress point. Thirteen of the 15 patients had mental region wounds or scars, and 14 patients had external acoustic canal bleeding immediately after injury. In the initial-stage group, hearing was mostly unchanged, while in the middle and late-stage groups, hearing loss was mainly caused by conduction factors. In the initial stage group, 6 cases/7 cases were cured by external acoustic canal packing; External acoustic canal stenosis or atresia occurred in 2 cases in the middle-stage group and were cured by external acoustic canal plasty. All the 6 patients in the late-stage group had external acoustic canal stenosis or atresia, among whom 5 patients with external acoustic canal cholesteatoma were cured by external acoustic canal plasty, and the other one patient with middle ear cholesteatoma was cured by modified radical mastoidectomy and tympanoplasty after external acoustic canal plasty for three times. Conclusions: Temporal bone tympanic plate fracture is a special type of temporal bone fracture. In the early stage of temporal bone tympanic fracture, bleeding of the external acoustic canal is the main symptom, and hearing is normal mostly. Advanced conductive deafness may result from external acoustic canal stenosis and/or cholesteatoma formation later. Bleeding of the external acoustic canal and irregular bulge of the anterior wall of the external acoustic canal with mental region wound are important signs for early diagnosis of temporal bone fracture. Temporal bone tympanic fracture should be paid attention to, early detection and timely treatment can avoid external acoustic canal stenosis and atresia.
Cholesteatoma, Middle Ear/surgery* ; Ear Canal ; Humans ; Mastoid ; Mastoidectomy ; Retrospective Studies ; Temporal Bone/diagnostic imaging* ; Treatment Outcome ; Tympanoplasty

OBJECTIVE: To evaluated the characteristics, stage classification and treatment of external auditory canal cholesteatoma (EACC). METHOD: Fifty-nine cases (60 ears) with EACC undergoing surgery were retrospectively analyzed in our study. RESULT: Hearing impairment, otalgia and otorrhea were common symptoms of EACC patients. A total of 60 ears were classified into 4 stages: Stage I (26 ears) underwent canaloplasty, stage II (14 cars) underwent both canaloplasty and tympanoplasty, stage III (19 ears) underwent mastoidectomy, and stage IV (1 ear) required both canaloplasty and neoplasty of capsula articularis articulations temporomandibular. CONCLUSION Besides the lesion in external auditory canal, EACC also invaded into the middle ear and the temporal bone. Stage classification by the signs of the temporal bone computed tomography and the patients' clinical findings was helpful for surgery.
Adolescent ; Adult ; Aged ; Aged, 80 and over ; Child ; Child, Preschool ; Cholesteatoma ; diagnostic imaging ; surgery ; Ear Canal ; diagnostic imaging ; surgery ; Female ; Humans ; Male ; Middle Aged ; Neoplasm Staging ; Radiography ; Retrospective Studies ; Temporal Bone ; diagnostic imaging ; Tympanoplasty ; Young Adult

OBJECTIVE: To define the clinical and imaging features of external auditory canal cholesteatoma (EACC) and determine the characteristics most important to its clinical management. METHOD: Seventeen cases (21 ears) of EACC were retrospectively reviewed. Clinical data were collected for the history, presentation, physical examination findings and CT scans. The surgical management approaches were reviewed. RESULT: Patients presented with otalgia (n = 21), otorrhea (n = 16), ear-canal stenosis (n = 11), facial nerve dysfunction (n = 4). CT scans showed a soft tissue mass with adjacent bone erosion (n =21). Middle ear and mastoid involvement (n = 9), facial canal erosion (n = 4), sigmoid sinus erosion (n = 1) and jugular bulb dehiscence (n = 1) were observed. EACC excision and canaloplasty through transcanal approaches were performed in 12 ears, while postauricular incision and canal wall down mastoidectomy were used in 9 ears. CONCLUSION The possible causes of EACC and its possible extension may influence clinical management. Preoperative high-resolution temporal bone CT scans can be helpful in the diagnosis and management of EACC.
Adolescent ; Adult ; Aged ; Child ; Cholesteatoma ; diagnosis ; diagnostic imaging ; surgery ; Ear Canal ; diagnostic imaging ; pathology ; Female ; Humans ; Male ; Middle Aged ; Retrospective Studies ; Tomography, X-Ray Computed ; Young Adult

OBJECTIVE: To discuss the application of spiral CT imaging of temporal bone in diagnosing the chronic otitis media with cholesteatoma. METHOD: The clinical data and spiral CT manifestation of 104 cases of chronic otitis media with cholesteatoma were retrospectively analyzed. All the diagnoses were confirmed by operation and pathology. RESULT: Spiral CT imaging could accurately show the signs of soft-tissue occupancy and bony-erosion of by cholesteatoma in middle ear which originated from various sites and of various sizes. Comparing the CT imaging before surgery and the findings during the operation, the consistency in bone erosion was 89.1%, in soft-tissue occupancy was 94.4% and in invasion of ossicle chain was 89.3%. CONCLUSION Spiral CT imaging plays an important role in diagnosing cholesteatoma and especially the bony-erosion and the soft-tissue occupancy, which can provide crucial information for the surgery.
Adolescent ; Adult ; Aged ; Child ; Child, Preschool ; Cholesteatoma, Middle Ear ; diagnosis ; diagnostic imaging ; Female ; Humans ; Male ; Middle Aged ; Retrospective Studies ; Tomography, Spiral Computed ; Young Adult