الفهرس 
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Abstract
in the present study, MDCT enabled the pre-operative delineation of the cholesteatoma and the recognition of its manifestations and complications.
The proximity of these tissue density masses to the neighboring structures and facial nerve is best appreciated when the area is viewed in axial and coronal sections using 1x1 mm (MDCT).
Excellent contrast between bone, air and soft tissues can be demonstrated. On imaging of the cholesteatoma, the presences of a soft tissue densification with bone erosions and an expansile effect on the adjacent bony borders of part or the entire middle ear cavity or air cells are considered diagnostic.
In addition, the demonstration of the characteristic appearance of the cavity may be pathognomonic.
MDCT is confirmed to be valuable in the diagnosis and in guiding the surgical management of cholesteatoma. Also, the role of MDCT early in the course of the disease can potentially reduce the risks of late complications associated with under diagnosed cholesteatoma.
CT imaging has proven to be an accurate method of depicting the characteristic findings of middle ear cholesteatoma, including the extent and complications.
Therefore, MDCT is the method of choice for the examination of the middle ear structures and pathology such as cholesteatoma. In the present study, results are consistent with those of previously recognized series and suggest that the diagnosis of middle ear cholesteatoma may be indicated by certain characteristic findings in CT.
Thin sections of MDCT provide higher resolution so enable us to detect subtle bony erosion (9% of cases) not detected by routine CT as well as displacement of the ossicular chain (9% of cases).
It is essential in visualization of different segments of facial nerve canal, vestibular aqueduct as well as the whole length of the superior semicircular canal in sagittal oblique views. Also, it is essential in cases of complicated otitis media and cholesteatoma such as lateral semicircular canal fistula. Now MDCT enable the examiner to obtain high quality processed views from axial images and provides shorter time of examination.
In routine CT examination of temporal bone coronal views were taken in prone position where it is difficult in case of children, short neck and in trauma patients where 3D views provided by MDCT are essential.
Number of patients, difficulty in follow up and cost of the study was the commonest limitations in this study. To obtain maximum benefit from MDCT in CSOM, certain guidelines should be followed. In most cases, it is advisable to obtain two planes of view.
It is also important to obtain similarly oriented and processed views (sagittal, coronal and oblique views) of both temporal bones.