Reviewing Imaging Modalities for Chronic Middle Ear Inflammatory Disorders: A Comparative Analysis of Non-Echoplanar Diffusion MRI and CT

Background: Chronic middle ear inflammatory disorders (CMED), including chronic otitis media (COM) and cholesteatoma, pose significant clinical challenges due to their persistent nature and potential to cause substantial morbidity. Accurate imaging is essential for diagnosing these conditions, guiding treatment decisions, and correlating with operative outcomes. While computed tomography (CT) has traditionally been used to evaluate bony structures, non-echoplanar diffusion MRI offers advanced soft tissue contrast that may enhance disease assessment. Objective: This narrative review aims to compare the efficacy of non-echoplanar diffusion MRI versus CT in the evaluation of CMED, focusing on their diagnostic capabilities and correlation with surgical outcomes. The review seeks to delineate how these imaging modalities differ in their effectiveness for assessing disease extent and predicting operative results. Conclusion: CT imaging excels in visualizing bony structures and is effective for initial diagnosis and surgical planning of CMED. However, it is limited in assessing soft tissue details. Non-echoplanar diffusion MRI provides superior contrast for evaluating soft tissue changes and subtle inflammatory processes, but may be less effective for bony assessment and involves more complex imaging protocols. A multimodal approach combining both CT and diffusion MRI is recommended for a comprehensive evaluation of CMED, integrating the strengths of each modality to enhance diagnosis and improve surgical outcomes.