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Radiation diagnosis of ear diseases helps to identify acute mastoiditis, chronic purulent otitis media, intracranial complications, fracture of the temporal bone, tumors and anomalies of the ear. Modern methods of radiation diagnostics - computed and magnetic resonance imaging, which have a higher resolution compared to traditional methods of x-ray, can detail the nature of the destructive process of the bone, establish the prevalence of otosclerosis, and clarify indications for surgical treatment of Meniere's disease. A radioisotope study allows you to identify the activity of the pathological process in the ear and differentiate its various diseases by the nature of the absorption of radiopharmaceuticals by the bones of the skull.
For radiography of the temporal bones, three special stylings are used: according to Schuller, Mayer and Stenvers. The last two are technically more complex, and the interpretation of their results requires sufficient qualifications of the otolaryngologist and radiologist. The main condition for traditional radiography of the temporal bones is the symmetry of the image, the absence of which leads to diagnostic errors.
Of the simpler methods of radiation diagnostics for a military doctor, we can recommend a direct survey radiography of the skull and lateral radiography of the temporal bones according to Schuller.
Direct panoramic x-ray of the skull in the nasolobe projection (Fig. 1.4.3) allows you to simultaneously get an image of both temporal bones projecting into the orbits. It can be used to tentatively judge the degree of pneumatization of the mastoid processes and the width of the internal auditory canals, which is important for the diagnosis of acute mastoiditis, chronic purulent otitis media and neuroma of the vestibulo-cochlear (VIII) nerve. The upper edges of the pyramids, their tops, semicircular canals and the snail of the maze are distinguishable. A temporal bone fracture line may be visible. Radiography is performed while lying on your stomach or sitting. The patient tilts his head to his chest so that the plane passing through the lower edges of the orbits and the upper edges of the external auditory canals is perpendicular to the cassette.
Radiographs in axial projection according to Mayer to comply with the installation conditions require the use of special devices. In the photographs (Fig. 1.4.4), the cave and the entrance to it are determined in the form of an X-ray symptom of a “petal with a stalk”, the bone walls of the external auditory canal and the attic. The drum cavity due to the imposition on the auditory meatus is poorly visible. Stacking is used to diagnose chronic purulent epithympanitis.
Radiographs according to Stenvers give an undistorted longitudinal image of the pyramid of the temporal bone (Fig. 1.4.5). The upper, lower faces and the top of the pyramid, the arched elevation of the labyrinth and its structure: the cochlea and semicircular canals are clearly traced. A mastoid is defined behind the bones of the base of the skull. Of greatest importance is the assessment of the internal auditory meatus, the length of which is 10-15 mm, and the width is 3-5 mm. In the diagnosis of neuroma of the VIII nerve, their symmetry is assessed, provided that the placement of the right and left ears is identical. Often there is normally a slight asymmetry of the internal auditory canals. Stacking is also used to diagnose transverse fractures of the pyramids, most often a continuation of fractures of the occipital bone.
Lateral radiography of the temporal bones according to Schuller (Fig. 1.4.6) is a special two-stage stacking. The image of the right and left temporal bone is alternately projected onto the cassette. The opposite half of the cassette is covered with lead rubber. For a better image, use a narrow tube or maximum aperture of the rays. The patient lies on his stomach, his head is laid with the studied ear on the cassette so that the sagittal plane of the skull is parallel to the plane of the table. The central ray should pass through the inner and outer auditory canals of the studied ear. To do this, he is sent craniocaudally at an angle of 25-300 to a point located 3-4 cm higher and 1-2 cm posterior to the overlying auditory meatus.
A high-density stony part of the temporal bone in the form of an irregular triangle, in the center of which there are two rounded enlightenments from the external and internal auditory canals, is highlighted on the x-ray. With proper installation of the projection, they coincide. The mastoid process with a system of pneumatic cells, the temporomandibular joint is clearly visible. Using X-ray images of the temporal bones according to Schuller, it is possible to evaluate the options for pneumatization of the mastoid process, the destruction of bony septum with mastoiditis and the shading of antrum in chronic suppurative otitis media. Determining the height of the roof of the tympanic cavity and antrum, the distance to the anterior wall of the sigmoid sinus is important for choosing a surgical approach to the cave. With a glomus tumor of the jugular vein bulb, an increase in the fossa of the jugular vein is observed. This styling is also used to diagnose longitudinal fractures of the pyramid passing to it from the scales of the temporal bone.
More clearly, the structures of the temporal bone and ear are visualized using computed tomography and magnetic resonance imaging.
Computed tomography during scanning in axial and frontal projections with high resolution (cut thickness 1-2 mm) through the use of various image processing modes allows to detect both bone and soft tissue changes. In the presence of cholesteatoma in patients with chronic purulent epithympanitis, it is possible to determine its shape and distribution with great accuracy, establish the fistula of the lateral semicircular canal, caries of the malleus, and anvil. The canal of the facial nerve, the bone labyrinth and its windows are visible. With otosclerosis, an altered foot plate of the stapes is determined, which is normally not visible, and demineralization of bone tissue in active otosclerotic foci. A narrowing of the lumen of the vestibule is observed in Meniere's disease, and bone obliteration of the endolymphatic duct is a contraindication to performing surgery on the endolymphatic sac. Small neuroma of the VIII nerve without expansion of the internal auditory canal is best diagnosed by contrasting after suboccipital air injection. Given the great diagnostic capabilities of computed tomography, it is finding wider application in the diagnosis of ear diseases, displacing traditional methods of radiation diagnostics.
Magnetic resonance imaging has advantages over computed tomography in detecting soft tissue formations, differential diagnosis of inflammatory and tumor lesions, vascular pathology. It is the method of choice for the diagnosis of neuroma of the VIII nerve, especially in combination with the introduction of contrast agents that increase the information content of the image.
Computer and magnetic resonance imaging are extremely important for the diagnosis of otogenic intracranial complications, tumors and anomalies of the ear.
A radioisotope study is carried out in a gamma camera with computer processing of the scintigraphic picture after 30-40 minutes. after intravenous administration of colloidal radiopharmaceuticals labeled with radioactive technetium (99mTc-phosphon) or indium (113mIn-eieiieu). This method of radioimmunological diagnosis of macrophage pinocytosis allows you to evaluate the activity of the system of mononuclear phagocytes. 70-90% of the drug is captured by the liver and spleen. Its distribution in the bones of the skull is determined by the mass and functional activity of the bone marrow. With otosclerosis, there is an increased fixation by the temporal bones of the drug labeled with indium, and the activity of the otosclerotic process is directly proportional to the degree of absorption of the drug (Artyushkina E.A. et al., 1986). V.R. Hoffman (1989) found that dysfunction of the mononuclear phagocyte system contributes to the development of sensorineural hearing loss when exposed to noise and ototoxic antibiotics. Asymmetric hyperfixation in the temporal bones of a technetium-labeled drug is observed in inflammatory diseases of the middle ear and mastoiditis (Artyushkina E.A., Hoffman V.R., 1990).
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