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

Adamo, D.A.; Fender, Q.A.; Hyde, B.J.; Carlson, M.L.; Koeller, K.; Lane, J.I.

View Article on Neurographics Website

Date of Activity Release: Apr. 1, 2017
Date of Activity Expiration: Apr. 1, 2020

Target Audience:
Intended for neuroradiologists and neuroradiology trainees with varying degrees of experience.

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

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.

Commercial Support
No commercial support was received for this activity.

Credit Designation Statement

The American Society of Neuroradiology is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.

The American Society of Neuroradiology designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 Credit(s)TM. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Method of Physician Participation:
Each participant will review the corresponding Neurographics article located at Upon completion, each physician will complete and pass a post-test with a score of at least 80% to receive a CME certificate.

All individuals in control of content have disclosed the following relevant financial relationships. All of these relationships were treated as a conflict of interest, and have been resolved (C7 SCS 6.1-6.2, 6.5)

Authors have no relevant financial relationships.





Barton Branstetter 

Editor in Chief

None, N/A

Adam Flanders

Deputy Editor

Royalties, Lippincott Williams and Wilkins

Robert Quencer 

Consulting Editor

None, N/A

Mark Mullins

Associate Editor

Non-remunerative position, AUR6

Meng Law

Associate Editor

Stockholder, Clinical Imaging

Michele Johnson

Associate Editor

Consultant, Boston Scientific, Inc.

Edward Escott

Associate Editor

Grant, Atherysys, Inc.; Royalties, Thieme Medical Publishers

Scott Faro

Associate Editor

None, N/A

Tina Young Poussaint

Associate Editor

None, N/A

Dheeraj Ghandi

Associate Editor

Grant, Arstasis, Axera Inc.; Consultant, Covidien, EV3

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