Computed-Tomography-Structured Reporting in Middle Ear Opacification: Surgical Results and Clinical Considerations From a Large Retrospective Analysis

Abstract

Purpose: The aim of the study is to compare the accuracy of unstructured preoperative Computed Tomography (CT) reports from non-tertiary diagnostic centers with intraoperative findings in a large cohort of patients with Chronic Otitis Media (COM) undergone surgery.Methods: From 2012 to 2019, a total number of 301 patients were considered for our purposes. All patients with clinical evidence of COM had preoperative non-contrast high resolution CT scan of the temporal bone in non-tertiary diagnostic centers, performed within 3 months before surgery.Results: The accuracy of CT reports was analyzed in terms of nature, anatomical site, disease extension, bony erosion, vascular structures abnormalities relevant to surgical planning, and Eustachian tube patency. Compared to post-surgical findings, CT reporting critical analysis revealed a tendency to overestimation of bony erosion, coupled to underestimated description of facial canal/lateral semi-circular canal, vascular structures, and Eustachian tube.Conclusion: Discrepancies between CT reports and surgical findings in middle ear opacification can be at least in part due to limited expertise of general radiologists in ENT neuroimaging. To limit this lack of information and the limited accuracy of middle ear structures depiction, here we propose a structured checklist to adopt in the case of a temporal bone CT scan for COM, in order to optimize the communication with surgeons and provide all the crucial information for an accurate surgical planning.

Comparison of the Utility of High-Resolution CT-DWI and T2WI-DWI Fusion Images for the Localization of Cholesteatoma

“…TSE-DWI and its corresponding T2WI fusion images can clearly show important anatomic landmarks, such as the lateral semicircular canal and the cochlea. Although T2WI is not sufficient to match the CT display of fine anatomy and cholesteatoma bone erosion, 16 the horizontal semicircular canal display and the relationship between the lesion and the horizontal semicircular canal are the otologist's main concern because they influence the choice of the surgical approach. When the cholesteatoma lesion is confined to the attic or tympanic cavity and does not extend to the posterior limb of the lateral semicircular canal, it is resected using only the transcanal endoscopic approach; involvement of the mastoid antrum or mastoid process requires conversion to mastoidectomy (microscopic ear surgery) or the combined microscopic and endoscopic approach to resect the lesion.…”

Quality of Life Assessment of Chronic Otitis Media Patients Following Surgery

“…So far, medical therapy is generally prescribed preoperatively or when surgery is contraindicated [ 17 , 18 , 19 , 20 ]. Although surgery is a common event in the life of a patient with COM, it is very interesting to investigate all benefits that it will bring to patients’ QoL even if the improvement of QoL after cholesteatoma surgery is important, but it should not be a factor that limits the decision about performing surgery.…”

“…Most of the previous publications have focused on QoL based on surgical techniques and/or on the severity of COM (presence or absence of cholesteatoma, extension of the inflammatory process, ossicular chain status, etc.) [ 18 , 19 , 20 ]. These variables have linked each other.…”

“…On the other hand, it can be hypothesized that less invasive surgery, such as closed ones, ensures higher patient satisfaction due to better functional results [ 18 , 19 , 20 ].…”

Classification of mastoid air cells by CT scan images using deep learning method

“…Clinical intervention for opacification in the mastoid process is very crucial after a diagnosis [16]. In some cases, we witness the discrepancies between CT reports and surgical findings regarding middle ear opacification which is mostly caused by misdetection of radiologists in imaging [17].…”