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Free Content Lesions of the Middle Ear Ossicles: Acquired, Traumatic, Congenital, and Postsurgical Pathology

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When interpreting temporal bone CT, middle ear ossicular pathology is the focus in 4 clinical scenarios: trauma, inflammation, congenital dysplasia, and postoperative assessment of ossicular reconstruction surgery. In the setting of trauma, ossicular dislocations are more common than ossicular fractures, and there are 5 dislocation types to consider. In the case of middle ear inflammation, ossicular motion may be mechanically restricted, as seen with tympanosclerosis, or ossicular motion may be interrupted by ossicular erosion, as seen with cholesteatoma or resorptive osteitis. In patients with congenital dysplastic lesions, the ossicles often demonstrate characteristic imaging patterns, which can be recognized on high-resolution imaging. Some typical patterns of dysplasia will be highlighted in this article. Last, postoperative evaluation of ossicular reconstruction surgery requires imaging to assess prosthesis position and identify causes of prosthesis failure. The normal imaging appearance of common ossicular prosthesis will be reviewed, followed by examples of prosthesis dislocation, which is a potential cause of surgical failure.

Learning Objectives: Identify pathology affecting the middle ear ossicles and recognize the expected postoperative appearance of the middle ear following ossicular reconstruction surgery.
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Keywords: PORP = partial ossicular replacement prosthesis; TORP = total ossicular replacement prosthesis

Document Type: Research Article

Publication date: December 1, 2014

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  • Neurographics is the peer-reviewed, bimonthly educational journal of the American Society of Neuroradiology. The journal comprises articles selected from material presented at the ASNR Annual Meeting. Neurographics also publishes other high-quality submissions that are primarily educational and have a high emphasis on a pictorial approach. Neurographics offers CME credit for reading review articles and completing quiz-based self-assessment activities. CME credit for review articles may be claimed up to 3 years after an article's publication date. Visit to view all available CME courses.
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