Petrous Bone Normal anatomy
Petrous bone External ear Middle ear Inner ear
External ear Cartilaginous part Bony part End by the tympanic membrane (drum) The drum is attached to the tympanic annulus The anterior and superior part of tympanic annulus= scutum
Middle ear Medial to the drum Contents Ossicles (Incus, Muscles and nerves
malleous, stapes)
Middle ear Connections To the nasopharynx via Eustachian tube To the mastoid antrum via aditus ad antrum To the vestibule via oval window To the cochlea via the round window
ANATOMIC LANDMARK
Ice cream cone
Inner ear Vestibule Semicircular Cochlea Internal Cochlear Vestibular
canals auditory canal aqueduct aqueduct
Facial Middle ear Mastoid Lateral Posterior Dome of IAC Facial Geniculate nerve cleft SCC SCC cochlea nerve ganglion
Petrous BonePathology External ear Artesia and hypoplasia Abnormal embryogenesis of the 1st & 2nd branchial arches The canal is obstructed by bone or soft tissue CT to assess associated middle ear anomalies
Soft tissue filling the external canal with fused malleus and incus
Malignant ostitis externa Aggressive infection of the external ear Typically seen in diabetic, elderly, immune compromised patients Organism: pseudomonas aeruginosa Soft tissue mass at the external ear with bone Extensions to middle ear, mastoid, intracranially
destruction
Neoplastic lesions Surfers ear: Exostosis as a result of prolonged exposure to cold sea water, bilateral stenosis but not occlusion of the ear Osteoma: Unilateral solitary, found more laterally in the external ear Cutaneous malignancies: Squamous cell, basal cell, adenoid cystic carcinomas, melanoma
Middle ear anomalies Contracted middle ear cavity = small cavity < 3mm may be inadequate for ossicular reconstruction Ossicular anomalies [ Fusion, absence] Oval window normally 2mm [ coronal image] Anomalies of the facial nerve , carotid artery
Congenital cholesteatoma Ectopic rest of epithelial tissue When occur intracranially it is called epidermoid Cholesteatoma without history of middle ear infection Evaluation of external & middle ear anomalies should include assessment of the presence of congenital cholesteatoma
Congenital cholesteatoma May occur any where in the Near the Eustachian tube / [are common sites] Non enhancing mass with Enhancement of the labyrinth MR images when fistula occurs middle ear Near the stapes bone destruction on
Acquired cholesteatoma Pars flaccida [Prussaks Pars Tensa [ sinus A complication of chronic Non dependant, non erosion Ossicles intact in 30% attic 10% sinus space] [attic] cholesteatoma] otitis media enhancing + bone
cholesteatoma cholesteatoma
Acquired cholesteatoma complications Erosion of the facial canal facial palsy Erosion of the SCC labyrinthine fistula Erosion of the tegmen tympani intracranial extension Dural sinus thrombosis Brain abscess
Glomus tymanicum Male: Female = 1:3 Pulsatile tinnitus, CHL Vascular retro tympanic mass CT a nodule of soft tissue density in the middle ear Large lesions do not cause bone erosion (typical finding) MRI intense enhancement
Trauma Clinical Otorrhea, Conductive Vertigo, CSF hemo tympanum or SN HL facial nerve palsy leakage,
meningitis
Longitudinal fractures 79%- 90% involve the middle ear CHL Transverse fracture 10%- 30% involve the inner ear SNHL Facial nerve injury 50%
Inner ear Congenital anomalies Large endolymphatic duct and sac [LEDS] Congenital enlargement of the inner ear endolymphatic system Enlargement of the vestibular aqueduct [VAS] Normal diameter of the vestibular aqueduct = 1.5 mm One of the most common causes of SNHL
Inner ear Congenital anomalies Inner ear dysplasia [ 3rd-8th gestation week ]
Michel anomaly Mondini anomaly
total aplasia of the inner ear A range of morphologic anomalies of cochlea
Facial nerve Schwannoma Uncommon
May involve a segment [ geniculate ganglion] or multiple segments The motor axons of the facial nerve are less sensitive to compression facial neuroma inside the IAC SNHL facial neuroma inside the IAC cannt be differentiated from acoustic neuroma
Facial hemangioma Uncommon Present with facial palsy earlier than Schwannoma because the nerve is invaded rather than compressed Common at the region of geniculate ganglion CT widening of the GG fossa MRI Hyperintense in T1 and T2 with strong enhancement
Facial neuritis Non specific inflammation (Bells palsy) Idiopathic, herpes simplex infection Ramsay- Hunt syndrome: herpes Zoster infection painful vesicles around the external ear Classical clinical presentation no need for imaging Atypical clinical course [unresolving or progressive] ? tumor Enhanced MRI uniform enhancement of the intratemporal facial nerve with little or no enlargement .No Focal nodularity Comparison with the other ear is important
