What the surgeon cannot see and needs to see before middle ear surgery

To define the utility of imaging prior to middle ear surgery.

Different middle ear pathologies are subsequently described: conductive hearing loss with a normal tympanic membrane, labyrinthine fistulae, tegmen anomalies, opacified tympanic membrane, cholesteatoma, temporal bone fractures and glomus tumors. We discuss the indications and benefits of imaging in each of these pathologies.

Preoperative imaging shows interesting features and can be very helpful in the differential diagnosis and in surgical decision-making and planning. However, it is not mandatory and should not be systematic in every middle ear surgery.

The modern radiological era provides the otological surgeon with numerous imaging technologies. Yet, these techniques should by no means replace the surgeon's anatomical knowledge, clinical sense and surgical skills.