A Pictorial Essay of Middle Ear Pathology Correlating Temporal Bone CT and MRI with Archived Otoscopic Photographs

The anatomy of the temporal bone is complex, and diagnosis of middle ear disease can be challenging when based on CT or MR imaging. The radiologic differential diagnosis can be enhanced by knowing the clinical and otoscopic examination results, but, often, this information is not readily available to the radiologist. Otoscopic imaging provides information that can prevent misinterpretation of the imaging findings based on CT or MR imaging alone. The medical image archive at our institution recently expanded to include otoscopic photographs taken by the otologist during the physical examination; these photographs are now available to the radiologist during interpretation of imaging examinations. In this report, we reviewed the temporal bone CT; MR imaging; and correlative otoscopic appearance of both common and uncommon inflammatory, vascular, neoplastic, traumatic, and congenital conditions of the middle ear. We showed that the radiographic differential diagnosis of middle ear disease can be refined by accessing the otoscopic images, which leads to a more accurate interpretation of temporal bone imaging findings and can guide further therapy and interventions. The impact of the otoscopic appearance on CT and MR imaging interpretation was qualitatively discussed. This strategy may be applied to other clinical specialties through the availability of standard photographic and endoscopic images.

Learning Objective: Describe the radiographic and otoscopic appearances of middle ear pathology, and recognize their complementary roles in achieving an accurate differential diagnosis.