Computed tomography of temporal bone pneumatization: 1. Normal pattern and morphology

The pneumatization of 141 'normal' temporal bones on computed tomography (CT) was evaluated in 100 patients (age range, 6-85 years). Because of the controversy surrounding the sclerotic squamomastoid (mastoid), temporal bones with this finding were discarded. A CT index of pneumatization was based on the pneumatized area and the number of cells seen within a representative scanning section. Results suggest that squamomastoid pneumatization follows the classic normal distribution and does not correlate with age, gender, or laterality. A high degree of symmetry was found in 41 patients who had both ears examined. In 35% of all temporal bones, the petrous apex was pneumatized, concordant with the findings of other investigators. Pneumatization extending into other regions of the temporal bone corresponded linearly with squamomastoid pneumatization. Air-cell configuration was variable. Air-cell size tended to increase progressively from the mastoid antrum. The scutum 'pseudotumor' appearance caused by incomplete pneumatization was seen frequently, and should not be mistaken for mastoiditis or an osteoma. Thick sections producing partial-volume effect may also produce this spurious finding. Therefore, when searching for mucosal thickening due to mastoiditis, large air cells should preferably be analyzed.