Computed Tomography in Chronic Suppurative Otitis Media: Value in Surgical Planning

Abstract

The present study was conducted prospectively to evaluate how accurately high resolution computed tomography scanning could define the extent and severity of the underlying disease in patients with chronic suppurative ear disease, thus, helping convert a surgical exploration into a planned procedure. Sixty adult consecutive cases of chronic suppurative otitis media underwent a detailed high resolution computed tomography by a single radiologist. The recorded radiological findings in various heads were then compared to the surgical findings during mastoid exploration of these patients by a single otologist and the two statistically compared. The presence and distribution of soft tissue in the middle ear cleft and mastoid could confidently be predicted using this modality. The malleus, body and short process of incus were well visualized, but not the long process of incus and the stapes suprastructure. Lateral semicircular canal fistulae could be demonstrated with an acceptable degree of accuracy. It was possible to detect facial nerve dehiscence and defects in tegmen tympani in significant number of cases although, statistical values were low for these structures. High resolution scanning is a modality which can accurately image the pathological anatomy in unsafe chronic suppurative otitis media. Otologists should use it more often, especially in complicated cases as an adjunct to better preoperative assessment, and thus, the surgical outcome. Its accuracy is likely to improve with larger studies and better experience, wherein its routine use may become justifiable.

A study of the correlation between the pre-operative high resolution computed tomography findings and intra-operative findings in chronic otitis media-squamosal type

“…Sensitivity of detecting facial canal erosion was only 60%. These results were comparable to studies by Yildirim et al, Rogha et al and Payal et al [15][16][17]…”

Relation between Ossicular Erosion and Destruction of Facial and Lateral Semicircular Canals in Chronic Otitis Media

“…Preoperative diagnosis with CT is useful, but the verification of a labyrinthine dehiscence can only be definitely established at the time of surgery. 5,6 In this study, we investigated the difference of rates between ossicular erosion in cases of patients with and without FNCD/LSCC who had undergone mastoidectomy due to chronic otitis media with or without cholesteatoma.…”

Use of Non-Echo-Planar Diffusion-Weighted MR Imaging for the Detection of Cholesteatomas in High-Risk Tympanic Retraction Pockets

“…6 However, it is nonspecific for cholesteatoma and relies on indirect signs for its diagnosis. 7,8 More recently, MR imaging techniques have been used to differentiate cholesteatoma from other middle ear masses, especially T1-weighted delayed postcontrast imaging and DWI. 9,10 DWI techniques are based on the restriction of movement of water molecules, such as that caused by keratin-filled cholesteatomas, producing a hyperintense signal.…”