When is an X-ray needed?

This is an automatically translated article.

The article is professionally consulted by Master, Doctor Trinh Thi Phuong Nga - Radiologist - Department of Diagnostic Imaging and Nuclear Medicine, Vinmec Times City International Hospital.
X-ray of the ear, nose and throat is a technique performed when the doctor needs to monitor and evaluate the pathologies in these organs. There are many different radiographic techniques in otolaryngology and are indicated on a case-by-case basis.

1. When to take X-ray of the ear, mastoid bone?

1.1 With Schuller's position (temporary - atrium) X-ray taking Schuller's position, also known as the temporal and Auricular position, is the commonly applied and common position. An X-ray will project the mastoid bone through the apex-temporal. This position is performed when the doctor suspects mastoid otitis in order to identify the lesions accurately.
Patient position: The patient lies on his side. The main beam source will be about 25 - 30° from the binaural axis, the center of the source is 7cm away from the contralateral ear canal, the ray penetrates the ear canal on the shooting side. Bend the ear on the X-ray side forward, not over the mastoid; Reading criteria: The inner ear canal and the outer ear canal are closely overlapping, clearly showing the temporomandibular joint; the ear flaps fold forward; Result: Normal if on X-ray film clearly see the cells, their septum; Acute mastoiditis if the image of the septum is not clear, the cells are blurred; Chronic mastoiditis has cholesteatoma if the septum is blurred, the septum is lost, there are bright areas around and blurred, the edges are sharp and clear like clouds. 1.2 With the Stenvers position The Stenvers position X-ray technique shows the projection of the entire stony bone on the X-ray film, from the outer part to the inner part of the squamous mastoid process. This technique is performed when the doctor needs to study traumatic brain injuries that cause transverse scapular fractures, tumors in the cerebellar pons (e.g. VIII neuroma), or osteomyelitis.
Patient position: The patient lies on his stomach, resting his head on the table along the upper border of the orbit, cheekbones and nose. Thus, the vertical plane of the skull will make an angle of 45° with the vertical line without touching the table. Main ray axis in the posterior to anterior direction, focusing on the contralateral occipital region; Standard reading: 2 sides of semicircular tube overlap; Results: Normal if the inner ear, vestibule, cochlea, superior and outer semicircular canal are all visible. The posterior semicircular canal alone is not visible. Inner ear canal and stony process can be seen; If the bone is broken, there will be a fracture line; If you have neuroma VIII, the inner ear canal is dilated. In addition, the Meyer position and the Chausse III X-ray position can be applied for each specific disease to be investigated.

2. When to take X-ray of the nose and sinuses?

2.1 With Blondeau position (nose - chin film) This is a position that helps doctors evaluate pathologies in the maxillary sinuses, frontal sinuses and nasal cavities. In addition, this technique also helps the doctor to see the dental arch, septum, ethmoid sinus, posterior tear hole, eye socket. X-ray images of sinusitis are also obtained through this technique.
Patient's position: The patient lies on the stomach, with the mouth open as much as possible, with the nose and chin touching the film. X-rays go from back to front; Reading standards: Film obtained must be balanced left - right; The 2 upper edges of the stony bones need to be brought close to the floor of the 2 sinuses, the maxillary sinuses should not be obscured by the stony bones; Result: Normal if nasal cavity shows clear space of slit; the maxillary, forehead, and sphenoid sinuses are bright compared to the orbit and have clear bone walls; Tumor or overgrown nose if imaging shows a missing or narrowed nasal cavity; Suspected inflammation, tumor lesions (may be malignant) if the maxillary sinuses or frontal sinuses are blurred due to mucosal edema, thickened due to pus in the sinuses, thick or irregular margins due to thickening, erosion or bone wall destruction, missing or unknown. 2.2 With Hirtz position (chin - top of film) Hirtz X-ray position allows the doctor to clearly observe the entire anterior ethmoid sinus, posterior ethmoid sinus and sphenoid sinus. It helps to provide detailed information for the evaluation of the anterior base of the skull and the pterygium.
Patient's position: The patient needs to lie on his back, take his head away from the table, the top of his head touches the film and the X-ray goes from top to bottom; Reading standards: X-ray films need to be balanced on the left and right sides (the protrusion of the 2nd cervical vertebra needs to shine directly on the nasal septum, the 2 arches of the upper and lower teeth overlap into an arc); the projection of 2 anterior and posterior ethmoid sinuses are on the same plane, the demarcation point is the slit of 2 teeth 6 - 7; Results: Normal if the anterior-posterior ethmoid sinuses are bright and the septal cell septum clear; Suspect nasal polyps or malignancy if the septal septum is unclear, absent, and the ethmoid cells are uniform or solid. In these 2 x-ray positions of the nose and sinuses, when a foreign body is suspected in the sinuses, the doctor will assign an additional cranial position to determine the location of the specific foreign body. In case of suspected tumor or polyp in the maxillary sinus, it is necessary to perform contrast injection into the sinus to evaluate and give an accurate diagnosis.

3. When to take X-ray of the pharynx and larynx?

The doctor may appoint the patient to perform X-ray of the pharynx and larynx in the following cases:
Straight neck position: Helps the doctor evaluate whether there is a submediastinal abscess; Tilt neck position: Can see pus pocket in front of the spine, behind the trachea, water level, gas level, foreign body in food,... X-ray techniques of otolaryngology help the doctor to assess the main identify the patient's health problems. When prescribed, the patient should follow all instructions given by the doctor. Accordingly, to ensure accurate results, patients should choose reputable medical facilities to perform.
Currently, Vinmec International General Hospital has brought a modern X-ray machine system with international standards to examine and diagnose many diseases, including ENT diseases. Accordingly, the entire procedure of ENT examination and X-ray at Vinmec is carried out methodically and in accordance with the process standards by a team of highly skilled medical professionals, and a system of standard examination rooms. Therefore, the results of X-ray at the nose and throat are obtained very clearly and accurately, contributing significantly to the identification of the disease and the stage of the disease. Therefore, customers who want to learn about ENT X-ray techniques at Vinmec International General Hospital can contact the call center or directly go to Vinmec to use the utility service.

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