The mastoid and middle opacification may suggest increased mass effect on the adjacent Eustachian tube. There is some bony remodeling at the tegmen tympani and osseous integrity cannot be assured by MRI. However, it is noted that the bony septa of the right mastoid air cells appear grossly intact. Temporal bone CT may be considered for further evaluation as clinically indicated. The left petrous apex region of bright T1/T2 signal and mild magnetic susceptibility has also enlarged to 22 x 20 mm compared to 18 x 13 mm previously.