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Radiological differentiation between chronic otitis media and cholesteatoma
For the ENT-surgeon the differentiation between chronic otitis media (lower image) and cholesteatoma (upper image) is important. Both diseases often occur in poorly pneumatized mastoids.An important finding which can help differentiate the two conditions is bony erosion. Erosion of the lateral wall of the epitympanum and of the ossicular chain is common in cholesteatoma (around 75%). Erosion can occur in chronic otitis, but reportedly in less than 10% of patients. Displacement of the ossicular chain can be seen in cholesteatoma, not in chronic otitis. Cholesteatoma can present with a non-dependent mass while chronic otitis shows thickened mucosal lining. However, in both diseases the middle ear cavity can be completely opacified, obscuring a cholesteatoma.
Radiological differentiation between chronic otitis media and cholesteatomaFor the ENT-surgeon the differentiation between chronic otitis media (lower image) and cholesteatoma (upper image) is important. Both diseases often occur in poorly pneumatized mastoids.An important finding which can help differentiate the two conditions is bony erosion. Erosion of the lateral wall of the epitympanum and of the ossicular chain is common in cholesteatoma (around 75%). Erosion can occur in chronic otitis, but reportedly in less than 10% of patients. Displacement of the ossicular chain can be seen in cholesteatoma, not in chronic otitis. Cholesteatoma can present with a non-dependent mass while chronic otitis shows thickened mucosal lining. However, in both diseases the middle ear cavity can be completely opacified, obscuring a cholesteatoma.
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