Ear Diseases and CT

Review by L Flood
Middlesbrough, UK

For once I had the chance of comparing the print and the e version of a book. This is very much an atlas, with the text almost solely presented as legends to the illustrations. Their print quality is excellent, but the on-line version on my PC monitor did have the edge and it is the images that we need to see, this time, not pages of paragraphs.

It is the work of a Chinese editor, two assistant editors and eight contributors, all from Beijing, and understandably there are some minor errors with the English, but nowhere does it compromise intelligibility. There are nice colour photographs of temporal bone prosections, (showing some very skilled drilling in many) which are presented adjacent to the corresponding cadaver CT scan, as a classical way of teaching anatomy. This works very well for the coronal sections, which are probably also of the greatest value to the surgeon dealing with chronic middle ear infection. Curiously, for the axial images, the two are transposed as mirror images of each other, which may confuse the novice. Sagittal sections are too unfamiliar to most of us to be of clinical value, but, again show the anatomy so well. They are all very well labelled, but I was surprised to see what we call the superior semicircular canal entitled throughout as the anterior canal. Again this is a very minor issue.

After 65 pages of a nice tuition in anatomy, we get to the meat of the title, imaging in disease. This was a topic that got me standing in front of audiences with many a Powerpoint presentation over decades and also led to a number of articles in this journal. Hence I was particularly keen to review this book. For surgery of cholesteatoma, I was often challenged, especially by Iain Swan, that pre-op imaging was pointless, as it did not change management (and he did have a point, but one I never did concede and one that did not stop me continuing to speak with great authority). CT is not 100% sensitive to an exposed facial nerve or a dehiscent lateral canal and a surgeon should proceed assuming such in every mastoid opened. I could argue about choice of surgical approach, patient counselling etc. and would love to have seen some such discussion here. Somehow the lesson that emerged was that MRI can be even more spectacular and those shown here really appealed. The lateral sinus thrombosis images, especially the MRVenography scan, were very familiar to me, if actually more dramatic than my own star case. Even an enthusiast like me would have to question the role of CT in most foreign bodies in the external ear canal, as shown.

As expected, there is coverage of every lesion that can remove bone or add to it, whether neoplastic, congenital malformation (very comprehensive), infective or traumatic. I did wonder if one case of bilateral osteomata of the external canal might instead represent exostoses, which are not mentioned. Per-operative colour photographs nicely complement many of the sequences presented. Another surprise was seeing the jugular bulb referred to as the jugular glomus, with no abnormality other than its height and dehiscence, and certainly no neoplasia. That led me to an on-line search wondering about the origin of the term and Google took me back to its Latin roots. Superior (or here anterior) canal dehiscence did not rate a mention, although I do wonder about image 2.36. Image 5.5 shows a CT of an opaque middle ear due to a cholesterol granuloma, but I think the contralateral ear has a greater problem. That was what made working through this book so interesting, spotting the unexpected. I thought the scanning of the temporal bone for otosclerosis merited greater text coverage, although the images presented are classical. I did wonder if there was enough explanation for the novice. Finally an index would have been welcome.

I greatly enjoyed working through this book and, especially trying to interpret each image before reading the legend. Obviously the arrows and chapter headings did help just a bit. It is a valuable reference for our speciality, but also to radiologists and neurosurgeons in training and very well presented. I never thought I would favour an e-book over the print version, but for something this visually attractive I will reluctantly concede that.

Amazon Link: Ear Diseases and CT
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