Presentation
Bilateral chronic otitis media and conductive hearing loss.
Patient Data
Mastoid air cells are sclerotic, with marked anterolateral sigmoid protrusion and low temporal dura bilaterally.
Right ear shows: Near total opacification of middle ear cavity, filling the epitympanic recess, facial recess, and sinus tympani, as well as round and oval window niches. Opacified Eustachian tube. Tympanosclerotic foci around the malleus head. Ossicular chain shows eroded incus and ill defined stapes. Focal dehiscence of the tympanic segment of facial canal as well as marked rarefaction of the tegmen.
Left ear shows: Near total opacification of middle ear cavity; filling the epitympanic recess, facial recess and sinus tympani, as well as round and oval window niches. Opacified Eustachian tube. Tympanosclerotic foci around the malleus head.
Diffusion weighted MRI shows marked restricted diffusion of the middle ear and mastoid lesions bilaterally consistent with cholesteatoma.
Case Discussion
This case represents MRI imaging features of bilateral acquired cholesteatoma with marked diffusion restriction and bone destruction. CT is the modality of choice for detailed anatomical structure extension and erosion. CT gives information about the relationship to the ossicles, tegmen tympani erosion, potential membranous labyrinth fistula, the facial nerve canal erosions, and involvement of sinus tympani.
MRI with non-EPI diffusion is recommended for all cases with suspected cholesteatoma on CT for confirmation and detection of some possible complications as meningitis, intracranial abscess formation and sinus thrombosis. Cholesteatoma shows marked diffusion restriction.
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