Chronic inflammatory middle ear disease: Postoperative CT and MRI findings

Khater, Nivan Hany; Fahmy, Hadeer Safwat; Shahat, Hazem Mohamed El; Khater, Ahmed

doi:10.1016/j.ejrnm.2015.05.005

Cited by 8 publications

(4 citation statements)

References 21 publications

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“…3 amongst 9 also showed cholesteatoma during surgery, who did not show cholesteatoma in MRI. In present study, sensitivity was 84%, specificity was 100%, 10 Vaid et al evaluated the role of magnetic resonance imaging (MRI) in diagnosis of cholesteatoma and correlated imaging findings with intraoperative findings, based on specific MRI findings, presence of cholesteatoma was reported in 17 out of 31 patients and all 31 patients underwent surgery and 19 patients had confirmed intraoperative cholesteatoma and similar to present study, this study also showed high sensitivity of a specific sequence based MRI examination in detection of cholesteatoma and in differentiating cholesteatoma from postoperative inflammatory/granulation tissue. 4 Martin et al studied with pre-and post-contrast magnetic resonance (MR) images to assess the role of MR imaging in the recognition of middle ear tissue abnormalities and reported that granulation tissue constantly appeared enhanced on studies done with gadolinium diethylenetriaminepentaacetic acid (DTPA), unlike cholesteatoma, cholesterol granuloma, or brain herniation into the middle ear cavities, moreover, when granulation tissue was associated with other soft-tissue masses, Gd-DTPAenhanced MR images allowed accurate definition of the site and the extension of each lesion.…”

Section: Discussionsupporting

confidence: 48%

Assessment of chronic suppurative otitis media patients with cholesteatoma on the basis of gadolinium enhanced T1-T2 weighted images of MRI

Verma¹,

Arora²,

Jain³

2019

Int J Otorhinolaryngol Head Neck Surg

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Background: The propensity for ossicular destruction is much greater in case of unsafe CSOM due to presence of cholesteatoma and/or granulations. Partial or total destruction of ossicles is seen in approximately 80% of patients with cholesteatoma, whereas in chronic otitis media without cholesteatom, ossicular chain erosion can be seen in approximately 20% cases.The present study aims to evaluate the clinical profile of patients of unsafe chronic suppurative otitis media with cholesteatoma and assesses patients on the basis of gadolinium enhanced T1-T2 weighted images of MRI.Methods: The study was conducted among patients who were fulfilling the criteria for unsafe CSOM i.e., retraction pocket in pars tensa, marginal perforation, perforation in pars flaccida, presence of granulation tissue, presence of polyp, blood stained discharge etc. were selected for the study. MRI was performed in all cases by using gadolinium enhanced T1-T2 sequences for diagnosis of cholesteatoma. Mastoidectomy was done to confirm the findings of MRI. Results: In maximum number of cases perforation was found in attic region. Most common complication of disease is the ossicular chain erosion. In present study sensitivity was 84%, specificity was 100% and positive predictive value and negative predictive value were 100% and 66% respectively.Conclusions: It can be concluded that MRI can differentiate cholesteatoma from other inflammatory etiology. By using MRI with 1.5 or 3T unit a small cholesteatoma (even 2-3 mm) can be easily detected at its early stage and further complications can be prevented.

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Section: Discussionsupporting

confidence: 48%

Assessment of chronic suppurative otitis media patients with cholesteatoma on the basis of gadolinium enhanced T1-T2 weighted images of MRI

Verma¹,

Arora²,

Jain³

2019

Int J Otorhinolaryngol Head Neck Surg

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“…Subjective tests are mainly used by otolaryngologists and have been reported to have higher sensitivity and specificity in detecting the presence or absence of middle ear disorders. 25,26 On the other hand, the objective measures such as the acoustic immittance measure are used primarily by audiologists. The latter measures are widely used because they are simple, quick to administer, cost effective, and time efficient.…”

Section: Introductionmentioning

confidence: 99%

Middle ear Pathologies in Adults Living with Human Immunodeficiency Virus: A Systematic Review

Sebothoma

Khoza-Shangase

2020

Ann Otol Rhinol Laryngol

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Introduction: Middle ear pathologies have been linked with HIV. The onset and development of these pathologies in individuals with HIV have not been categorized; and clarity has not been gained regarding whether their presentation is any different in this population when compared to HIV negative control group. Purpose: The aim of this study was to explore and document published evidence reflecting trends in middle ear pathologies in adults living with HIV. Methods: A systematic review of literature from January 1982 to December 2018 was conducted using Medline, CINAHL, PubMed, and Psych Info. Studies that reported the occurrence rate of middle ear pathologies in adults with HIV and published in English were included. Results: Twelve articles met the inclusion criteria. Evidence suggests that the reported occurrence rates of middle ear pathologies ranges from 2.5% to 58% in this population. The variability in assessment measures as well as the different cut-off criteria used in studies seem to have an influence in the findings, with pure tone audiometry identifying more middle ear pathologies in the current review than tympanometry with 226 Hz probe tone and clinical examination. Otitis media, conductive hearing loss, and type B tympanogram were common findings reported in this study. No evidence of an association between the use of antiretroviral therapy (ART) and the rates of middle ear pathologies was found. Conclusion: Although there are very few studies that have reported on middle ear pathologies in adults living with HIV, the available studies have sufficiently established a link between HIV and middle ear disease in this population, and have revealed that the rate of occurrence is influenced by a number of factors. Key amongst these is the type of assessment measure used. Careful analysis of middle ear pathologies in this population through well controlled research designs that include different assessment measures. The use of case-control and longitudinal designs to determine differences between groups and to establish the time of onset and development of middle ear pathologies is required.

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“…This also makes it difficult in postoperative cases in differentiating recurrent disease from simple granulation tissue. [9] Our study shows that HRCT had a sensitivity of 83.3% and specificity of 58.3% in detection of cholesteatomatous CSOM. This was comparable to studies by Thukral et al [10] and Gomaa et al [11] False negative cases could be attributed to presence of only soft tissue without bony destruction and inability to characterise the soft tissue at CT. False positive cases at CT can be attributed to mere bony deossification which can occur in non-cholesteatomatous CSOM being interpreted as destruction that occur in cholesteatoma.…”

Section: Discussionmentioning

confidence: 51%

Role and utility of HRCT and MRI in detection and evaluation of cholesteatoma

Jamwal¹,

Chandrashekar²,

Udayakumar³

et al. 2019

Int. J. Radiol. Diagn. Imaging

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Cholesteatoma is a common benign lesion of the middle ear characterised by accumulation of keratinous debris. It is associated with local bony erosions and hence serious intracranial and labyrinthine complications which prompts surgical intervention. Earlier, High resolution computed tomography (HRCT) was used in combination with clinical examination to arrive at a diagnosis. Computed tomography (CT) gives excellent definition of bony structures, but lacks sensitivity in differentiating between various causes of soft tissue densities. Magnetic resonance imaging (MRI) is more useful in evaluation of soft tissue details. We conducted this study with an aim of evaluating the role of diffusion weighted imaging in diagnosis of cholesteatoma and its utility to differentiate cholesteatoma from granulation/ inflammatory tissue. The study was conducted on forty patients between March 2018 and February 2019 who were clinically suspected of chronic suppurative otitis media with cholesteatoma. These patients were subjected to HRCT and Diffusion weighted MRI (DW-MRI) examination of temporal region and findings were correlated with intraoperative and histological features. Our study found that, HRCT had a sensitivity of 83.3% and specificity of 58.3% in detection of cholesteatoma, while MRI was found to accurately predict the presence of cholesteatoma in 91.6% of the cases evaluated. The sensitivity, specificity, positive predictive value and negative predictive value were 91.6%, 91.6%, 95.6% and 84.6%, respectively. Hence, we conclude that diffusion weighted magnetic resonance imaging is a useful technique for cholesteatoma imaging with high sensitivity and specificity. Combination of HRCT and MRI will be helpful to make an accurate diagnosis.

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Chronic inflammatory middle ear disease: Postoperative CT and MRI findings

Cited by 8 publications

References 21 publications

Assessment of chronic suppurative otitis media patients with cholesteatoma on the basis of gadolinium enhanced T1-T2 weighted images of MRI

Assessment of chronic suppurative otitis media patients with cholesteatoma on the basis of gadolinium enhanced T1-T2 weighted images of MRI

Middle ear Pathologies in Adults Living with Human Immunodeficiency Virus: A Systematic Review

Role and utility of HRCT and MRI in detection and evaluation of cholesteatoma

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