Otologic Surgery Preoperative Imaging: Mandatory or Recommended? Useful or Defensive?

Abstract

Objectives: Look for and implement guidelines for preoperative imaging requests to facilitate clinical practice and avoid medico-legal problems. Methods: A review of contemporary English medical literature via Medline using the terms imaging, preoperative imaging, computed tomography (CT) scan/CT, magnetic resonance imaging (MRI)/magnetic resonance plus otosclerosis, chronic otitis media, cholesteatoma, simple chronic otitis, tympanoplasty/myringoplasty, and middle ear was performed. Abstracts were reviewed independently by two authors and relevant articles were then evaluated. Indications for preoperative imaging study for each pathology considered, benefits, main findings and the cost-beneficial relationship were investigated. Results: Few articles address this issue. Otosclerosis: 152 articles, with some of the studies referring to the assessment of activity and extension of the disease, but only 3 were related to the demand for imaging. Myringoplasty/tympanoplasty: a total of 87 items were found but only 4 address the issue of preoperative imaging evaluation. Chronic otitis media/cholesteatoma: 467 articles, with 32 approaching this subject. For each abstract evaluated, conditions were considered: the indications and relevant findings versus the diagnosis controversial aspects and the real need of the request (findings that can be easily diagnosed intraoperatively). Conclusions: There is a growing number of otolaryngologists who routinely request preoperative imaging before middle ear surgery based on ambiguous criteria. The proposal for the creation of guidelines will help clinicians in their diagnostic decisions and to avoid medico-legal problems.