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KEY FACTS
Terminology
Imaging
Top Differential Diagnoses
Diagnostic Checklist
TERMINOLOGY
Definitions
- Mastoid procedure to remove diseased tissue (inflammatory or neoplastic) & preserve normal structures
- Closed cavity procedures leave wall of external auditory canal (EAC) intact
- Transcanal anterior atticotomy
- Removal of scutum & obliteration of aditus to treat cholesteatoma limited to attic
- Canalwall up mastoidectomy
- Uses facial recess approach
- Removal of mastoid air cells, lateral mastoid cortex, and Körner septum
- Surgically created cavity ("mastoid bowl") communicates with epitympanum & antrum
- Simple cortical mastoidectomy
- Similar to canal wall up mastoidectomy; however, epitympanum and antrum not entered
- Ossicles not visualized
- Translabyrinthine approach to internal auditory canal (IAC)
- Canal wall up mastoidectomy + semicircular canals removed, facial nerve canal skeletonized, sigmoid plate and posterior IAC removed
- Transcanal anterior atticotomy
- Open cavity procedures remove posterior EAC wall & scutum
- Canal wall down mastoidectomy
- Similar to canal wall up + removal of posterior EAC wall and scutum
- 1 large cavity: EAC, mastoid, mastoid antrum, epitympanum, and mesotympanum
- ± obliteration of middle ear orifice of eustachian tube with fascia or fat, to prevent exposure of surgical cavity to nasopharynx
- ± filling of "mastoid bowl" with fat
- ± reconstruction of EAC using thin sheet of hydroxyapatite
- Termed modified radical mastoidectomy when ossicular chain is preserved
- Termed radical mastoidectomy for treatment of holotympanic disease: Skeletonization of mastoid segment facial nerve canal and diseased ossicles
- Canal wall down mastoidectomy
- Open-close procedures remove and then replace/reconstruct posterior EAC wall
- Recent literature suggests mastoidectomy approach with posterior canal wall reconstruction and obliteration of mastoid cavity (MAPRO)
- To avoid disadvantages of both canal wall up and canal wall down mastoidectomy
- Recent literature suggests mastoidectomy approach with posterior canal wall reconstruction and obliteration of mastoid cavity (MAPRO)
- Rectosigmoid approach to IAC
- Suboccipital craniotomy ± bone flap over craniotomy defect
- + resection of posterior wall of IAC
- Closed cavity procedures leave wall of external auditory canal (EAC) intact
- Mastoid procedure to remove diseased tissue (inflammatory or neoplastic) & preserve normal structures
IMAGING
General Features
CT Findings
MR Findings
Imaging Recommendations
DIFFERENTIAL DIAGNOSIS
PATHOLOGY
General Features
CLINICAL ISSUES
Demographics
Natural History & Prognosis
DIAGNOSTIC CHECKLIST
Consider
Image Interpretation Pearls
Selected References
- Kronenberg J et al: Mastoidectomy reconstruction of the posterior wall and obliteration (MAPRO): preliminary results. Acta Otolaryngol. 132(4):400-3, 2012
- Yamashita K et al: Detection of middle ear cholesteatoma by diffusion-weighted MR imaging: multishot echo-planar imaging compared with single-shot echo-planar imaging. AJNR Am J Neuroradiol. 32(10):1915-8, 2011
- Cimsit NC et al: Diffusion-weighted MR imaging in postoperative follow-up: reliability for detection of recurrent cholesteatoma. Eur J Radiol. 74(1):121-3, 2010
- De Foer B et al: Middle ear cholesteatoma: non-echo-planar diffusion-weighted MR imaging versus delayed gadolinium-enhanced T1-weighted MR imaging--value in detection. Radiology. 255(3):866-72, 2010
- Plouin-Gaudon I et al: Diffusion-weighted MR imaging for evaluation of pediatric recurrent cholesteatomas. Int J Pediatr Otorhinolaryngol. 74(1):22-6, 2010
- Rajan GP et al: Preliminary outcomes of cholesteatoma screening in children using non-echo-planar diffusion-weighted magnetic resonance imaging. Int J Pediatr Otorhinolaryngol. 74(3):297-301, 2010
- Schwartz KM et al: Diffusion-weighted imaging for cholesteatoma evaluation. Ear Nose Throat J. 89(4):E14-9, 2010
- Lehmann P et al: 3T MR imaging of postoperative recurrent middle ear cholesteatomas: value of periodically rotated overlapping parallel lines with enhanced reconstruction diffusion-weighted MR imaging. AJNR Am J Neuroradiol. 30(2):423-7, 2009
- Thiriat S et al: Apparent diffusion coefficient values of middle ear cholesteatoma differ from abscess and cholesteatoma admixed infection. AJNR Am J Neuroradiol. 30(6):1123-6, 2009
- Trijolet JP et al: [Acute mastoiditis in children: can mastoidectomy be avoided?.] Ann Otolaryngol Chir Cervicofac. 126(4):169-74, 2009
- Venail F et al: Comparison of echo-planar diffusion-weighted imaging and delayed postcontrast T1-weighted MR imaging for the detection of residual cholesteatoma. AJNR Am J Neuroradiol. 29(7):1363-8, 2008
- De Foer B et al: Single-shot, turbo spin-echo, diffusion-weighted imaging versus spin-echo-planar, diffusion-weighted imaging in the detection of acquired middle ear cholesteatoma. AJNR Am J Neuroradiol. 27(7):1480-2, 2006
- Dubrulle F et al: Diffusion-weighted MR imaging sequence in the detection of postoperative recurrent cholesteatoma. Radiology. 238(2):604-10, 2006
- Aikele P et al: Diffusion-weighted MR imaging of cholesteatoma in pediatric and adult patients who have undergone middle ear surgery. AJR Am J Roentgenol. 181(1):261-5, 2003
- Kösling S et al: CT and MR imaging after middle ear surgery. Eur J Radiol. 40(2):113-8, 2001
- Castillo M et al: Imaging of Bezold's abscess. AJR Am J Roentgenol. 171(6):1491-5, 1998
- Mukherji SK et al: CT of the temporal bone: findings after mastoidectomy, ossicular reconstruction, and cochlear implantation. AJR Am J Roentgenol. 163(6):1467-71, 1994
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References
Tables
Tables
KEY FACTS
Terminology
Imaging
Top Differential Diagnoses
Diagnostic Checklist
TERMINOLOGY
Definitions
- Mastoid procedure to remove diseased tissue (inflammatory or neoplastic) & preserve normal structures
- Closed cavity procedures leave wall of external auditory canal (EAC) intact
- Transcanal anterior atticotomy
- Removal of scutum & obliteration of aditus to treat cholesteatoma limited to attic
- Canalwall up mastoidectomy
- Uses facial recess approach
- Removal of mastoid air cells, lateral mastoid cortex, and Körner septum
- Surgically created cavity ("mastoid bowl") communicates with epitympanum & antrum
- Simple cortical mastoidectomy
- Similar to canal wall up mastoidectomy; however, epitympanum and antrum not entered
- Ossicles not visualized
- Translabyrinthine approach to internal auditory canal (IAC)
- Canal wall up mastoidectomy + semicircular canals removed, facial nerve canal skeletonized, sigmoid plate and posterior IAC removed
- Transcanal anterior atticotomy
- Open cavity procedures remove posterior EAC wall & scutum
- Canal wall down mastoidectomy
- Similar to canal wall up + removal of posterior EAC wall and scutum
- 1 large cavity: EAC, mastoid, mastoid antrum, epitympanum, and mesotympanum
- ± obliteration of middle ear orifice of eustachian tube with fascia or fat, to prevent exposure of surgical cavity to nasopharynx
- ± filling of "mastoid bowl" with fat
- ± reconstruction of EAC using thin sheet of hydroxyapatite
- Termed modified radical mastoidectomy when ossicular chain is preserved
- Termed radical mastoidectomy for treatment of holotympanic disease: Skeletonization of mastoid segment facial nerve canal and diseased ossicles
- Canal wall down mastoidectomy
- Open-close procedures remove and then replace/reconstruct posterior EAC wall
- Recent literature suggests mastoidectomy approach with posterior canal wall reconstruction and obliteration of mastoid cavity (MAPRO)
- To avoid disadvantages of both canal wall up and canal wall down mastoidectomy
- Recent literature suggests mastoidectomy approach with posterior canal wall reconstruction and obliteration of mastoid cavity (MAPRO)
- Rectosigmoid approach to IAC
- Suboccipital craniotomy ± bone flap over craniotomy defect
- + resection of posterior wall of IAC
- Closed cavity procedures leave wall of external auditory canal (EAC) intact
- Mastoid procedure to remove diseased tissue (inflammatory or neoplastic) & preserve normal structures
IMAGING
General Features
CT Findings
MR Findings
Imaging Recommendations
DIFFERENTIAL DIAGNOSIS
PATHOLOGY
General Features
CLINICAL ISSUES
Demographics
Natural History & Prognosis
DIAGNOSTIC CHECKLIST
Consider
Image Interpretation Pearls
Selected References
- Kronenberg J et al: Mastoidectomy reconstruction of the posterior wall and obliteration (MAPRO): preliminary results. Acta Otolaryngol. 132(4):400-3, 2012
- Yamashita K et al: Detection of middle ear cholesteatoma by diffusion-weighted MR imaging: multishot echo-planar imaging compared with single-shot echo-planar imaging. AJNR Am J Neuroradiol. 32(10):1915-8, 2011
- Cimsit NC et al: Diffusion-weighted MR imaging in postoperative follow-up: reliability for detection of recurrent cholesteatoma. Eur J Radiol. 74(1):121-3, 2010
- De Foer B et al: Middle ear cholesteatoma: non-echo-planar diffusion-weighted MR imaging versus delayed gadolinium-enhanced T1-weighted MR imaging--value in detection. Radiology. 255(3):866-72, 2010
- Plouin-Gaudon I et al: Diffusion-weighted MR imaging for evaluation of pediatric recurrent cholesteatomas. Int J Pediatr Otorhinolaryngol. 74(1):22-6, 2010
- Rajan GP et al: Preliminary outcomes of cholesteatoma screening in children using non-echo-planar diffusion-weighted magnetic resonance imaging. Int J Pediatr Otorhinolaryngol. 74(3):297-301, 2010
- Schwartz KM et al: Diffusion-weighted imaging for cholesteatoma evaluation. Ear Nose Throat J. 89(4):E14-9, 2010
- Lehmann P et al: 3T MR imaging of postoperative recurrent middle ear cholesteatomas: value of periodically rotated overlapping parallel lines with enhanced reconstruction diffusion-weighted MR imaging. AJNR Am J Neuroradiol. 30(2):423-7, 2009
- Thiriat S et al: Apparent diffusion coefficient values of middle ear cholesteatoma differ from abscess and cholesteatoma admixed infection. AJNR Am J Neuroradiol. 30(6):1123-6, 2009
- Trijolet JP et al: [Acute mastoiditis in children: can mastoidectomy be avoided?.] Ann Otolaryngol Chir Cervicofac. 126(4):169-74, 2009
- Venail F et al: Comparison of echo-planar diffusion-weighted imaging and delayed postcontrast T1-weighted MR imaging for the detection of residual cholesteatoma. AJNR Am J Neuroradiol. 29(7):1363-8, 2008
- De Foer B et al: Single-shot, turbo spin-echo, diffusion-weighted imaging versus spin-echo-planar, diffusion-weighted imaging in the detection of acquired middle ear cholesteatoma. AJNR Am J Neuroradiol. 27(7):1480-2, 2006
- Dubrulle F et al: Diffusion-weighted MR imaging sequence in the detection of postoperative recurrent cholesteatoma. Radiology. 238(2):604-10, 2006
- Aikele P et al: Diffusion-weighted MR imaging of cholesteatoma in pediatric and adult patients who have undergone middle ear surgery. AJR Am J Roentgenol. 181(1):261-5, 2003
- Kösling S et al: CT and MR imaging after middle ear surgery. Eur J Radiol. 40(2):113-8, 2001
- Castillo M et al: Imaging of Bezold's abscess. AJR Am J Roentgenol. 171(6):1491-5, 1998
- Mukherji SK et al: CT of the temporal bone: findings after mastoidectomy, ossicular reconstruction, and cochlear implantation. AJR Am J Roentgenol. 163(6):1467-71, 1994
