A plain radiograph of the temporal bone in a child with unsafe chronic otitis media shows erosion of a spur of bone at the lateral angle of the attic. This structure, whose erosion is an early radiological sign of cholesteatoma, is the:

• A Ponticulus
• B Processus cochleariformis
• C Incus buttress
• D Scutum ✓

Explanation

The scutum is a sharp bony spur formed by the lateral wall of the epitympanum (outer attic wall) at its junction with the tympanic membrane. Attic cholesteatomas erode the scutum early, and its loss is a classic sign on Schuller or HRCT views. The processus cochleariformis and incus buttress lie deeper within the middle ear cleft and are not the lateral attic margin seen on plain films.

Reference: Dhingra's Diseases of Ear, Nose and Throat, 8th ed.

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Written and medically reviewed by the StethoPrep medical team.