Is Routine Use of High Resolution Computerized Tomography of Temporal Bone in Patients of Atticoantral Chronic Suppurative Otitis Media without Intracranial Complications Justified?

Abstract

Role of high resolution computerized tomography (HRCT) of temporal bone is established in cases of atticoantral chronic suppurative otitis media (CSOM) with intracranial complications. Routine use of HRCT in management of patients of atticoantral CSOM without intracranial complications has been an issue of debate. The aim of this study was to evaluate the routine use of HRCT of temporal bone in such cases. This study was a prospective study done at LG hospital, AMC MET Medical College, Ahmedabad to evaluate and compare the temporal bone findings in HRCT and intraoperative findings in 100 patients with atticoantral CSOM. All patients underwent HRCT screening followed by surgical exploration of middle ear cleft. In extent of disease HRCT showed very high sensitivity and specificity for epitympanum (100, 94%) and mesotympanum (98, 98%) areas. It gave valuable information of disease extent in hidden areas like sinus tympani and facial recess of mesotympanum. HRCT satisfactorily delineated malleus and incus erosion but had 75% sensitivity for detecting erosion of stapes suprastructure, though specificity was of 97%. For bony anatomical landmarks HRCT showed very high sensitivity and specificity for detecting erosion of lateral semicircular canal, tegmen tympani and sinus plate. Detection of facial canal erosion on HRCT had moderate sensitivity of 75%. We concluded that routine use of HRCT is justified as a reliable preoperative tool in patients with atticoantral CSOM without intracranial complications and it helps to plan type of surgical intervention. HRCT has limited role to distinguish between granulations and cholesteatoma and also to delineate stapes supra structure and facial nerve canal.

Role of high resolution computed tomography of temporal bone in preoperative evaluation of chronic suppurative otitis media

“…In this study, male: female ratio was 1.14:1 which is in accordance with the study by Kemppainen et al 5 The most common presenting symptom was otorrhoea followed by hearing loss which is in accordance with a study by Yorgancilar et al 6 In our study, CT was 100% sensitive for diagnosing cholesteatoma by HRCT images which is in correlation with the studies by Sirigiri et al and Bathla et al 7,8 It was 100% specific for diagnosing cholesteatoma in epitympanum, mesotympanum and hypotympanum but was less specific for cholesteatoma in antrum and aditus. In our study, HRCT was found to have less sensitivity in differentiating cholesteatoma from granulations which is in consonance with other studies.…”

“…In our study, HRCT was found to have less sensitivity in differentiating cholesteatoma from granulations which is in consonance with other studies. [8][9][10][11] HRCT was found to be helpful in correctly picking out extent of the disease which is in agreement with studies by Donoghue et al and Mafee et al 12,13 Early radiological sign of cholesteatoma is bone erosion. In our study, all cases (90%) reported in CT were confirmed at surgery.…”

“…This is in consonance with other studies. 7,8,[18][19][20][21][22] The reason of low to moderate sensitivity is that, in the area of tympanic portion of the facial nerve canal, the bony floor is very thin and may not be visualized on coronal and axial CT images. 23 In our study, Erosion of the lateral semicircular canal was seen in 10% cases with sensitivity 75% ( Figure 5) which is similar to study by Rogha et al and specificity 100% which is in correlation with the study by Gul et al 24,25 HRCT had 100% sensitivity and 100% specificity for erosion of bony EAC which isn't in correlation with study by Vanita et al who reported 0% sensitivity and 100% specificity.…”

High-resolution computed tomography (HRCT) in pediatric and adult patients with unsafe chronic suppurative otitis media (CSOM) and its surgical correlation

“…[ 15 ] Even one of the studies has revealed a specific sign (mass effect sign) for diagnosing cholesteatoma on HRCT. [ 16 ] Thus, similar to our study many papers have documented that HRCT scan findings correlate well with surgical findings for cholesteatoma and bony erosions,[ 14 15 16 17 18 19 20 21 22 23 ] however, few studies have disputed the above findings. [ 24 25 ] This may be due to the difference in the technical parameters used for the HRCT acquisition in different studies as well as the varying expertise of the radiologists involved in these studies.…”

“…In a recent study, the routine use of HRCT temporal bone has been justified even in patients without intracranial complications. [ 14 ] In another study done on the pediatric population, the authors have revealed that the preoperative HRCT temporal bone scan is a useful technique for the evaluation of the cholesteatoma surgery owing to a very good correlation between imaging and intraoperative findings. [ 15 ] Even one of the studies has revealed a specific sign (mass effect sign) for diagnosing cholesteatoma on HRCT.…”