Published online Aug 28, 2025. doi: 10.4329/wjr.v17.i8.109447
Revised: June 4, 2025
Accepted: July 31, 2025
Published online: August 28, 2025
Processing time: 109 Days and 6.7 Hours
Chronic otitis media (COM) is a long-standing inflammatory condition affecting the middle ear and mastoid cavity, often resulting in progressive structural damage and functional deficits. Radiological imaging is fundamental in diagnosing the disease, assessing its severity, and identifying possible complications. The literature indicates that the prevalence rates of extracranial and intracranial complications range from 0.69% to 5%, while the mortality rate for intracranial complications is 26%. While magnetic resonance imaging is particularly useful in distinguishing soft tissue abnormalities and detecting intracranial extensions like meningitis, brain abscess, and sigmoid sinus thrombosis, high-resolution computed tomography remains the preferred modality for evaluating bony erosion, cholesteatoma, and mastoid involvement. Key complications such as ossicular chain destruction, facial nerve damage, and labyrinthine fistulae can be precisely identified using advanced imaging modalities, allowing for timely and effective surgical intervention. This minireview underscores the essential role of radiology in both diagnosing and managing COM, highlighting critical imaging findings that facilitate early detection and inform treatment decisions. A collaborative approach among radiologists, otolaryngologists, and infectious disease specialists is crucial for improving clinical outcomes in affected patients.
Core Tip: Chronic otitis media is a long-term inflammatory disease affecting the middle ear, which, if not properly managed, can result in both extracranial and intracranial complications. Magnetic resonance imaging is particularly valuable in assessing soft tissue involvement and distinguishing cholesteatomas from other inflammatory conditions, especially through the use of diffusion-weighted imaging (DWI). Recently, sensitivity of DWI in the diagnosis of cholestatoma was shown to be 88% and specificity of 96%. Meanwhile, high-resolution computed tomography remains the primary imaging modality for evaluating bony erosion, ossicular chain damage, and mastoid pathology, providing essential details for diagnosis and treatment planning.