RADIOLOGICAL STUDY OF MIDDLE

Presented by:
EAR
Abhishek jain
Radiodiagnosis (JR1)
SBMCH,CHENNAI
Ear is divided into three parts :
• External ear- consists of pinna/auricle, external auditory
canal (divided into outer 1/3rd cartilaginous and inner 2/3rd
bony part) and tympanic membrane (divided into pars
tensa and pars flaccida).
• The middle ear or tympanic cavity is subdivided into three parts
defined in relation to the planes of the tympanic membrane. 
- Epitympanum, superior to the membrane
- Mesotympanum, medial to the membrane
- Hypotympanum, inferior to the membrane
PRUSSAK’S SPACE
This space is marginated by the
pars flaccida and scutum laterally,
superiorly by lateral malleal
ligament and neck of the malleus
medially. It is the most common
location for cholesteatoma.
cholesteatoma : Abnormal growth of the skin filled with air or fluid in the middle ear and temporal bone.

The pars flaccida cholesteatoma originates in Changes seen on CT scan:

the Prussak’s space.
while the pars tensa cholesteatoma originates in the • Blunting/erosion of
 mesotympanum. scutum .
A CT scan is also done to obtain bony details required for
preoperative planning (reconstruction of ossicles if • Expansion of prussak’s
needed) . Also it excludes perforation of the bony
tegmen.
space.
• Muscles and nerves in middle ear:
• tensor tympani muscle- it’s tendon gets attached
to the handle of the malleus.
• stapedius muscle- it’s tendon gets attached to the
neck of the stapes.
• The chorda tympani, leaves the facial nerve in the
facial canal and enters the tympanic cavity
through the posterior wall.
MIDDLE EAR ON CT SCAN
Bones in middle ear-
Middle ear ossicles consists of three bones:-
(the malleus, incus and stapes), which form a mobile chain across the
tympanic cavity from the tympanic membrane to the oval window.

Malleus

Incus

Stapes
Icecream cone appearance of middle ear ossicles:
Head of malleus and body of incus
ossicular chain disruption.
Causes for ossicular chain discontinuity

• Congenital
• Chronic middle ear infection
• Cholesteatoma(complication of unsafe
csom)
• temporal bone fractures,
especially longitudinal type
• blast injuries 
Otitis media
CT scan is routinely performed and
may show:
•soft tissue density in the middle ear
cavity
•bulging tympanic membrane
•thickened tympanic membrane
•tympanic perforation
Features seen in chronic other than
acute otitis media :

•air-fluid level in the middle ear

(effusion)

•bony erosion (less than 10%)

•Decreased pneumatization of the

mastoid.
Otomastoiditis is the inflammation of
the mastoid air cells.

1.Acute otomastoiditis: usually due to

bacterial infection.
2.Chronic otomastoiditis: usually due
to Eustachian tube dysfunction.
internal auditory meatus (IAM), is a bony canal
within the petrous portion of the temporal bone that
transmits nerves and vessels from the 
posterior cranial fossa to the auditory and vestibular
apparatus.
It is 4 mm in diameter. 
Until recently, CT has been the study of choice for
assessing the internal auditory canal and
diagnosing acoustic neuromas.

MRI has replaced CT for the study of the

cerebellopontine angle and for diagnosis of
acoustic neuromas.
THANK YOU
Middle ear- is a cavity with six walls:-
• Anterior wall- has canal for tensor tympani and opening of eustachian tube.
• Medial wall- has oval window, round window, facial canal (contains horizontal
segment of facial nerve), lateral semi circular canal and processus cochleariformis.
• Posterior wall- has aditus, pyramidal eminence(where stapedial tendon attaches),
canal for facial nerve (contains vertical segment of facial nerve).
• Lateral wall- is largely made up of tympanic membrane and to lesser extent by lateral
attic wall (scutum)
• Roof- is made up of tegmen tympani(separates middle cranial fossa from tympanic
cavity).
• Floor- is related to jugular bulb and internal carotid artery.
• Inner ear- contains vestibule (utricle and saccule) and semi-circular canals(lateral, superior
and posterior).
Facial nerve canal dehiscence