Imaging in ENT
Muhammad Bin Zulfiqar
PGR II SIMS/SHL
New Radiology Department
BASIC ANATOMY
•

EAR
1) External
2) Middle
3) Inner
• NOSE AND PARANASAL SINUSES
•

THROAT
1) Oral cavity and mouth
2) Pha...
Imaging modalities
•
•
•
•
•

Plain Radiography(main)
Computerized tomography(main)
Magnetic resonance Imaging
Ultrasound
...
Anatomy of EAR
• External
• Middle
• Inner
Tympanic
Membrane
Separates external ear from
middle ear.
Middle Ear
Middle Ear

Stapes
Middle Ear
Middle Ear
Internal Ear
Internal Ear

Semicircular
Canals
Internal Ear
Cochlea
Internal Ear

Facial nerve
canal

The incus is seen connecting to the stapes
Internal Ear
Geniculate ganglion

The incus is seen connecting to the stapes
Nose and Para nasal Sinuses
• Nasal Bones
• Nasal Soft Tissue
• Nasopharynx
Nasal Anatomy
NASAL ANATOMY
Nasopharynx
Para Nasal Sinuses

•Frontal sinuses

•Maxillary sinuses
•Sphenoid Sinuses
•Ethmoid air cells
oAnterior

oMiddle
oposterio...
Para Nasal Sinuses
Para Nasal Sinuses
A.
B.
C.
D.
E.
F.

Frontal Sinus
Sphenoid Sinus
Nostril
Posterior Nasopharyngeal wall
Posterior esophag...
Osteomeatal Complex
Throat
1) Oral cavity and mouth
2) Pharynx
• Nasopharynx
• Pharynx
• Oropharynx
3) Larynx
•
•
•
•

Nasopharynx
Oropharynx
Pharynx
Larynx
Nasopharynx
Nasopharynx
Nasopharynx
Oropharynx
Pharynx
Pharynx
Oropharynx
Larynx
Larynx
Larynx
Larynx
Larynx
Larynx
Diseases of Ear
• Chronic Suppurative Otitis Media
• Cholesteatoma
• Otosclerosis

– CHOCHLEAR IMPLANT
Chronic Suppurative Otitis Media
• Poorly pneumatized mastoid air cells.
• Ear drum is thickened.
• Soft tissue seen aroun...
Chronic Suppurative Otitis Media
Loss of
pneumatization
Normal

Eardrum calcification

Stapes calcification

Eardrum calci...
Chronic Suppurative Otitis Media
Opacification of tympanic cavity
Cholesteatoma
• Present as soft tissue mass with associated
erosions.
• Auditory ossicles, especially the long process
and...
Cholesteatoma
Cholesteatoma: 20-year old woman with
recurrent Otitis. Granulations on left ear
drum. Soft tissue mass betw...
Cholesteatoma

Automastoidectomy due to a large cholesteatoma

Cholesteatoma with erosion of the wall of
the lateral semic...
Cholesteatoma

The examination shows a mass with mixed intensity on sagittal T1 and high
intensity on transverse T2 weight...
Otosclerosis
• Otosclerosis is a genetically mediated metabolic
bone disease of unknown etiology.
• conductive hearing los...
Otosclerosis
There is a lucency anterior to the oval window
(arrow) and between the cochlea and the
internal auditory cana...
Otosclerosis

Bilateral otosclerosis
Cochlear Implant
• Cochlear implantation is performed in patients
with sensorineural deafness due to
degeneration of the o...
Cochlear Implant

Status after cochlear implantation
Nose And Para Nasal Sinuses
•
•
•
•
•

Deviated Nasal Septum
Nasal Bone Fracture
Enlarged Adenoids
Sino nasal Polyposis
An...
Deviated Nasal Septum
• Nasal septum deviation is a common physical
disorder of nose involving a displacement of
nasal sep...
Deviated Nasal Septum

Waters view (close-up view of the
patient in the previous image) shows a
deviated nasal septum, qua...
Fracture of Nasal bone
Fracture of Nasal bone
Enlarged Adenoids
• The adenoids are sections of soft tissue found
at the back of the nasal cavities where they
meet the p...
Enlarged Adenoids
Sinonasal Polyposis
• Polyps are soft tissue pedunculated masses of edematous
hyper plastic mucosa lining the upper respir...
Causes of Sinonasal Polyposis
1.
2.
3.
4.
5.
6.

Allergic rhinitis
Asthma
Cystic fibrosis(child)
Kartagener syndrome
Nicke...
Sinonasal Polyposis
Juvenile Nasopharyngeal Angiofibroma
• Benign highly vascular tumor
• Locally invasive, submucosal spread
• Vascular suppl...
Juvenile Nasopharyngeal Angiofibroma
Origen considered to be posterlateral nasal wall
at sphenopalatine foramen.
Medial ...
Coronal CT: Bone Window
• Widening of left
sphenopalatine
foramen
• Lesion fills left choanae
• Extends into sphenoid
sinu...
Axial CT: Soft Tissue Window with Contrast
• Homogenous
enhancement
• Widening of left
sphenopalatine
foramen
• Extension ...
Axial CT: Soft Tissue Window with Contrast
• Homogenous
enhancement
• Widening of right
sphenopalatine
foramen
• Extension...
Axial MRI: T1
• Heterogeneous
intermediate signal
• Flow voids represent
enlarged vessels
• Extension into
– Nasopharynx
–...
Coronal MRI: T1 with Contrast
• Diffuse intense
enhancement
• Multiple flow voids
within hypervascular
mass
• Extension in...
Axial MRI: T2
• Heterogeneous
intermediate to high signal
enhancement
• Multiple flow voids within
hypervascular mass
• Ex...
THROAT Diseases
• Enlarged adenoids
• Pharyngitis
• CROUP(Laryngotracheobronchitis)
Pharyngitis and Tonsillitis
• Bacterial
• Viral
• Fungal
Croup (acute laryngotracheobronchitis)
• Croup, also called acute laryngotracheobronchitis
is caused by viral infection of...
Croup (acute laryngotracheobronchitis)

distension of the hypopharynx due to the patient's
attempt at decreasing airway re...
Croup (acute laryngotracheobronchitis)

Steeple Sign
QUESTIONS ?
THANK YOU
Imaging in ent
Imaging in ent
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Imaging in ent

  1. 1. Imaging in ENT Muhammad Bin Zulfiqar PGR II SIMS/SHL New Radiology Department
  2. 2. BASIC ANATOMY • EAR 1) External 2) Middle 3) Inner • NOSE AND PARANASAL SINUSES • THROAT 1) Oral cavity and mouth 2) Pharynx • Nasopharynx • Oropharynx • Pharynx 3) Larynx
  3. 3. Imaging modalities • • • • • Plain Radiography(main) Computerized tomography(main) Magnetic resonance Imaging Ultrasound Barium swallow
  4. 4. Anatomy of EAR • External • Middle • Inner
  5. 5. Tympanic Membrane Separates external ear from middle ear.
  6. 6. Middle Ear
  7. 7. Middle Ear Stapes
  8. 8. Middle Ear
  9. 9. Middle Ear
  10. 10. Internal Ear
  11. 11. Internal Ear Semicircular Canals
  12. 12. Internal Ear Cochlea
  13. 13. Internal Ear Facial nerve canal The incus is seen connecting to the stapes
  14. 14. Internal Ear Geniculate ganglion The incus is seen connecting to the stapes
  15. 15. Nose and Para nasal Sinuses • Nasal Bones • Nasal Soft Tissue • Nasopharynx
  16. 16. Nasal Anatomy
  17. 17. NASAL ANATOMY
  18. 18. Nasopharynx
  19. 19. Para Nasal Sinuses •Frontal sinuses •Maxillary sinuses •Sphenoid Sinuses •Ethmoid air cells oAnterior oMiddle oposterior
  20. 20. Para Nasal Sinuses
  21. 21. Para Nasal Sinuses A. B. C. D. E. F. Frontal Sinus Sphenoid Sinus Nostril Posterior Nasopharyngeal wall Posterior esophageal wall Nasal turbinate
  22. 22. Osteomeatal Complex
  23. 23. Throat 1) Oral cavity and mouth 2) Pharynx • Nasopharynx • Pharynx • Oropharynx 3) Larynx
  24. 24. • • • • Nasopharynx Oropharynx Pharynx Larynx
  25. 25. Nasopharynx
  26. 26. Nasopharynx
  27. 27. Nasopharynx
  28. 28. Oropharynx
  29. 29. Pharynx
  30. 30. Pharynx
  31. 31. Oropharynx
  32. 32. Larynx
  33. 33. Larynx
  34. 34. Larynx
  35. 35. Larynx
  36. 36. Larynx
  37. 37. Larynx
  38. 38. Diseases of Ear • Chronic Suppurative Otitis Media • Cholesteatoma • Otosclerosis – CHOCHLEAR IMPLANT
  39. 39. Chronic Suppurative Otitis Media • Poorly pneumatized mastoid air cells. • Ear drum is thickened. • Soft tissue seen around ossicles without erosion. • Calcification of ear drum, tendon of stapedius. • Almost complete opacification of middle ear cavity.
  40. 40. Chronic Suppurative Otitis Media Loss of pneumatization Normal Eardrum calcification Stapes calcification Eardrum calcification
  41. 41. Chronic Suppurative Otitis Media Opacification of tympanic cavity
  42. 42. Cholesteatoma • Present as soft tissue mass with associated erosions. • Auditory ossicles, especially the long process and lenticular processes of the incus as well as the head of the stapes • Wall of the lateral semicircular canal • Lateral epitympanic wall (the scutum)
  43. 43. Cholesteatoma Cholesteatoma: 20-year old woman with recurrent Otitis. Granulations on left ear drum. Soft tissue mass between ossicular chain and lateral tympanic wall, which is eroded. Right side for comparison. Granulations on left ear drum. Soft tissue mass between ossicular chain and lateral tympanic wall, which is eroded. Right side for comparison.
  44. 44. Cholesteatoma Automastoidectomy due to a large cholesteatoma Cholesteatoma with erosion of the wall of the lateral semicircular canal There is a soft tissue mass with erosion of the long process of the incus.
  45. 45. Cholesteatoma The examination shows a mass with mixed intensity on sagittal T1 and high intensity on transverse T2 weighted images. It has a high intensity on diffusion weighted images, which indicates restricted diffusion. (arrows)
  46. 46. Otosclerosis • Otosclerosis is a genetically mediated metabolic bone disease of unknown etiology. • conductive hearing loss and is considered to be the hallmark of the disease. • The process starts in the region of the oval window, classically at the fistula ante fenestram, i.e. in front of the oval window (fenestral otosclerosis). • It can also occur around the cochlea (retrofenestral otosclerosis).
  47. 47. Otosclerosis There is a lucency anterior to the oval window (arrow) and between the cochlea and the internal auditory canal. This is combined fenestral and retrofenestral otosclerosis. Otosclerosis anteriorly to the oval window (arrow)
  48. 48. Otosclerosis Bilateral otosclerosis
  49. 49. Cochlear Implant • Cochlear implantation is performed in patients with sensorineural deafness due to degeneration of the organ of Corti. • The electrode is inserted into the scala tympani of the cochlea via the round window or via a drill hole directly into the basal turn. • Post-operatively its position can be evaluated with plain films or with CT.
  50. 50. Cochlear Implant Status after cochlear implantation
  51. 51. Nose And Para Nasal Sinuses • • • • • Deviated Nasal Septum Nasal Bone Fracture Enlarged Adenoids Sino nasal Polyposis Angiofibroma
  52. 52. Deviated Nasal Septum • Nasal septum deviation is a common physical disorder of nose involving a displacement of nasal septum. • Trauma is a frequent cause. • Can be congenital. • Poor drainage of sinuses.
  53. 53. Deviated Nasal Septum Waters view (close-up view of the patient in the previous image) shows a deviated nasal septum, quadrangular cartilage displaced from the maxillary crest, and a nasal root deviated to the right
  54. 54. Fracture of Nasal bone
  55. 55. Fracture of Nasal bone
  56. 56. Enlarged Adenoids • The adenoids are sections of soft tissue found at the back of the nasal cavities where they meet the pharynx. • Like tonsils, adenoids help to stop harmful bacteria and airborne pathogens from entering the airways and causing infections. • Multiple sinus infections, snoring and worsened breathing esp. in children.
  57. 57. Enlarged Adenoids
  58. 58. Sinonasal Polyposis • Polyps are soft tissue pedunculated masses of edematous hyper plastic mucosa lining the upper respiratory tract…..nasal cavity and sinuses. • These are benign mucosal lesions. • Commonest sites in order of frequency are; 1. 2. 3. Ethmoids Maxillary antra sphenoids
  59. 59. Causes of Sinonasal Polyposis 1. 2. 3. 4. 5. 6. Allergic rhinitis Asthma Cystic fibrosis(child) Kartagener syndrome Nickel exposure Nonneoplastic hyperplastic hyperplasia of inflammed mucous membranes.
  60. 60. Sinonasal Polyposis
  61. 61. Juvenile Nasopharyngeal Angiofibroma • Benign highly vascular tumor • Locally invasive, submucosal spread • Vascular supply most commonly from internal maxillary artery – Also: internal carotid, external carotid, common carotid, ascending pharyngeal • Occurring almost exclusively in males • Peak age of onset = 13-15 years old • Intracranial Extension between 10-20% • Recurrence Rates as high as 50%
  62. 62. Juvenile Nasopharyngeal Angiofibroma Origen considered to be posterlateral nasal wall at sphenopalatine foramen. Medial growth Nasal cavity Nasopharynx Lateral growth Pterygopalatine fossa  Vertical expansion through inferior orbital fissure to orbit possible Infratemporal fossa  Superior expansion through pterygoid process may involve middle cranial fossa  Lateral and posterior walls of sphenoid sinus can be eroded  Cavernous sinus may be involved  Pituitary may involve.
  63. 63. Coronal CT: Bone Window • Widening of left sphenopalatine foramen • Lesion fills left choanae • Extends into sphenoid sinus
  64. 64. Axial CT: Soft Tissue Window with Contrast • Homogenous enhancement • Widening of left sphenopalatine foramen • Extension into – Nasopharynx – Pterygopalatine fossa
  65. 65. Axial CT: Soft Tissue Window with Contrast • Homogenous enhancement • Widening of right sphenopalatine foramen • Extension into – Nasopharynx – Pterygopalatine fossa
  66. 66. Axial MRI: T1 • Heterogeneous intermediate signal • Flow voids represent enlarged vessels • Extension into – Nasopharynx – Masticator space
  67. 67. Coronal MRI: T1 with Contrast • Diffuse intense enhancement • Multiple flow voids within hypervascular mass • Extension into – Nasopharynx – Pterygopalatine fossa
  68. 68. Axial MRI: T2 • Heterogeneous intermediate to high signal enhancement • Multiple flow voids within hypervascular mass • Extension into – Nasopharynx – Pterygopalatine fossa
  69. 69. THROAT Diseases • Enlarged adenoids • Pharyngitis • CROUP(Laryngotracheobronchitis)
  70. 70. Pharyngitis and Tonsillitis • Bacterial • Viral • Fungal
  71. 71. Croup (acute laryngotracheobronchitis) • Croup, also called acute laryngotracheobronchitis is caused by viral infection of the upper airway usually parainfluenza virus or respiratory syncytial virus (RSV). • It is common and has a peak incidence before the age of 1 year (typically between 3 and 6 months of age). • It is presented Clinically by protracted barking cough and inspiratory strider due to tracheal narrowing that is caused by mucosal edema .
  72. 72. Croup (acute laryngotracheobronchitis) distension of the hypopharynx due to the patient's attempt at decreasing airway resistance steeple sign
  73. 73. Croup (acute laryngotracheobronchitis) Steeple Sign
  74. 74. QUESTIONS ?
  75. 75. THANK YOU
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