Overview of Imaging in ENT

1. Imaging in ENT
Muhammad Bin Zulfiqar
PGR II SIMS/SHL
New Radiology Department

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. Imaging modalities
• Plain Radiography(main)
• Computerized tomography(main)
• Magnetic resonance Imaging
• Ultrasound
• Barium swallow

4. Anatomy of EAR
• External
• Middle
• Inner

6. Tympanic
Membrane
Separates external ear from
middle ear.

7. Middle Ear

8. Middle Ear
Stapes

9. Middle Ear

10. Middle Ear

11. Internal Ear

12. Internal Ear
Semicircular
Canals

13. Internal Ear
Cochlea

14. Internal Ear
Facial nerve
canal
The incus is seen connecting to the stapes

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

16. Nose and Para nasal Sinuses
• Nasal Bones
• Nasal Soft Tissue
• Nasopharynx

17. Nasal Anatomy

18. NASAL ANATOMY

19. Nasopharynx

21. Para Nasal Sinuses
•Frontal sinuses
•Maxillary sinuses
•Sphenoid Sinuses
•Ethmoid air cells
oAnterior
oMiddle
oposterior

22. Para Nasal Sinuses

23. A. Frontal Sinus
B. Sphenoid Sinus
C. Nostril
D. Posterior Nasopharyngeal wall
E. Posterior esophageal wall
F. Nasal turbinate
Para Nasal Sinuses

24. Osteomeatal Complex

25. Throat
1) Oral cavity and mouth
2) Pharynx
• Nasopharynx
• Pharynx
• Oropharynx
3) Larynx

26. • Nasopharynx
• Oropharynx
• Pharynx
• Larynx

27. Nasopharynx

28. Nasopharynx

29. Nasopharynx

30. Oropharynx

31. Pharynx

32. Pharynx

33. Oropharynx

34. Larynx

35. Larynx

36. Larynx

37. Larynx

38. Larynx

39. Larynx

40. Diseases of Ear
• Chronic Suppurative Otitis Media
• Cholesteatoma
• Otosclerosis
CHOCHLEAR IMPLANT

41. 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.

42. Chronic Suppurative Otitis Media
Stapes calcification
Eardrum calcification
Eardrum calcification
Normal
Loss of
pneumatization

43. Chronic Suppurative Otitis Media
Opacification of tympanic cavity

44. 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)

45. 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.

46. 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.
Automastoidectomy due to a large cholesteatoma

47. 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)

48. 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).

49. 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)

50. Otosclerosis
Bilateral otosclerosis

51. 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.

52. Cochlear Implant
Status after cochlear implantation

53. Nose And Para Nasal Sinuses
• Deviated Nasal Septum
• Nasal Bone Fracture
• Enlarged Adenoids
• Sino nasal Polyposis
• Angiofibroma

54. 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.

55. 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

56. Fracture of Nasal bone

57. Fracture of Nasal bone

58. 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.

59. Enlarged Adenoids

60. 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. Ethmoids
2. Maxillary antra
3. sphenoids

61. Causes of Sinonasal Polyposis
1. Allergic rhinitis
2. Asthma
3. Cystic fibrosis(child)
4. Kartagener syndrome
5. Nickel exposure
6. Nonneoplastic hyperplastic hyperplasia of
inflammed mucous membranes.

62. Sinonasal Polyposis

63. 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%

64. 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.

65. Coronal CT: Bone Window
• Widening of left
sphenopalatine
foramen
• Lesion fills left choanae
• Extends into sphenoid
sinus

66. Axial CT: Soft Tissue Window with Contrast
• Homogenous
enhancement
• Widening of left
sphenopalatine
foramen
• Extension into
– Nasopharynx
– Pterygopalatine fossa

67. Axial CT: Soft Tissue Window with Contrast
• Homogenous
enhancement
• Widening of right
sphenopalatine
foramen
• Extension into
– Nasopharynx
– Pterygopalatine fossa

68. Axial MRI: T1
• Heterogeneous
intermediate signal
• Flow voids represent
enlarged vessels
• Extension into
– Nasopharynx
– Masticator space

69. Coronal MRI: T1 with Contrast
• Diffuse intense
enhancement
• Multiple flow voids
within hypervascular
mass
• Extension into
– Nasopharynx
– Pterygopalatine fossa

70. Axial MRI: T2
• Heterogeneous
intermediate to high signal
enhancement
• Multiple flow voids within
hypervascular mass
• Extension into
– Nasopharynx
– Pterygopalatine fossa

71. THROAT Diseases
• Enlarged adenoids
• Pharyngitis
• CROUP(Laryngotracheobronchitis)

72. Pharyngitis and Tonsillitis
• Bacterial
• Viral
• Fungal

73. 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 .

74. Croup (acute laryngotracheobronchitis)
steeple signdistension of the hypopharynx due to the patient's
attempt at decreasing airway resistance

75. Croup (acute laryngotracheobronchitis)
Steeple Sign

76. QUESTIONS ?

77. THANK YOU