0:01

Okay,

0:01

so let's take a look at this first pathologic case.

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And what we notice almost immediately

0:07

is that there is opacification,

0:09

which is present in the middle ear cavity bilaterally.

0:13

So, let's stop at this level.

0:14

So at this level,

0:16

we see, on the right side, the head of the malleus

0:18

and the short process of the incus,

0:21

the ice cream and the ice cream cone.

0:23

And there is opacification in the middle ear cavity,

0:26

as well as in the anterior epitympanic space.

0:30

And we also see the opacification of the mastoid

0:33

air cells with the aditus ad antrum,

0:35

the connection between the middle ear

0:37

cavity and the mastoid antrum.

0:39

And we don't really see destruction of these mastoid septae.

0:45

Might be a little bit concerned down here,

0:47

but it looks almost symmetrical.

0:49

That might just be normal variation.

0:51

And you see that there is soft tissue which is all

0:56

around the neck of the malleus and the long process of

1:00

the incus extending to the stapes.

1:02

And even at the oval window, there is soft tissue there.

1:05

And this is also seen on the left side.

1:09

So on the left side, not as bad.

1:11

We see mastoid fluid.

1:13

We do see some soft tissue around the incudostapedial

1:17

joint and the stapes.

1:19

And I'm saying soft tissue,

1:21

but this is usually just fluid.

1:24

And in this situation,

1:26

we would comment about the otomastoiditis without any

1:31

complications identified that would suggest

1:33

either coalescent mastoiditis or mass effect

1:36

that might suggest a cholesteatoma.

1:39

Now, as I mentioned, we want to look at the scout view.

1:43

And why do we want to look at the scout view?

1:45

So the scout view, in this case, is to identify that this

1:49

is an adult. So once we have an adult with otomastoiditis,

1:53

we want to make sure that we're going to be looking

1:55

at the nasopharynx. And once again, this patient,

2:00

for what looked like an older person on the scout image,

2:06

has an awful lot of nasopharyngeal adenoidal tissue,

2:10

and it's somewhat asymmetrical to the left side.

2:14

So this is the case that although we would have a good

2:17

description of the middle ear cavity and mastoid issues,

2:22

we would also talk about the prominence of the adenoidal

2:26

tissue greater than expected for a 60-year-old,

2:28

with some asymmetry to the left side.

2:31

Recommend endoscopic evaluation.

2:34

And this may be a patient who,

2:36

in this case, was an HIV patient

2:39

who had adenoidal hypertrophy,

2:41

which may have occluded the eustachian tube orifices

2:44

bilaterally and led to eustachian tube dysfunction

2:48

and bilateral otomastoiditis.