Pre-operative prediction of cholesteatomas from radiology: retrospective cohort study of 106 cases

Abstract

ObjectivePre-operative imaging is often used to predict the extent of a cholesteatoma and anatomical variation to plan for surgery. This study aimed to measure the predictive accuracy of computed tomography findings.MethodsA retrospective cohort study was conducted of all patients in a district general hospital undergoing mastoid surgery within a consecutive 12-month period, in whom computed tomography had been performed prior to operative intervention. The study measured the key findings of pre-operative computed tomography imaging and compared them to the intra-operative findings.ResultsA total of 106 patients were included. The sensitivity and specificity for predicting cholesteatoma were 79 per cent and 81 per cent respectively. The positive predictive value was 90 per cent and the negative predictive value was 65 per cent. In predicting complications of cholesteatomas, the sensitivity was 70 per cent, whereas the specificity was 91 per cent. The positive predictive value was 88 per cent and the negative predictive value was 76 per cent.ConclusionPre-operative computed tomography conducted prior to mastoid surgery has high positive predictive values for both predicting cholesteatomas and complications (90 per cent and 88 per cent respectively).

Accuracy of High‐Resolution Computed Tomography Compared to High‐Definition Ear Endoscopy to Assess Cholesteatoma Extension

“…14,17 Several studies have correlated radiologic findings with intraoperative findings, resulting in good positive predictive values for the prediction of cholesteatoma and its complications in preoperative CT imaging. 18 Nevertheless, the correlation of radiological findings with intraoperative findings on the extension of the cholesteatoma into various retrotympanic subspaces has been investigated only sparsely in the literature. Walshe et al found the accurate radiologic prediction of disease extension with a sensitivity and specificity of 100% each into the sinus tympani in 75% and facial recess in 65% of the total of 20 patients.…”

“…However, the typical localization in the tympanic or mastoid cavity, associated bony erosions, and possible complications such as labyrinthine fistula, facial nerve canal dehiscence, or tegmen erosion indicate a cholesteatoma in native HRCT 14,17 . Several studies have correlated radiologic findings with intraoperative findings, resulting in good positive predictive values for the prediction of cholesteatoma and its complications in preoperative CT imaging 18 . Nevertheless, the correlation of radiological findings with intraoperative findings on the extension of the cholesteatoma into various retrotympanic subspaces has been investigated only sparsely in the literature.…”

Correlation of pre-operative computed tomography, intra-operative findings and surgical outcomes in revision tympanomastoidectomy

“…Similar findings have been reported previously, with intra-operative findings identifying posterior external auditory canal wall erosion, mastoid erosion and residual cells along the facial ridge as reliable predictors of cholesteatoma recurrence, and associated with canal wall down procedures, but they have not been linked with pre-operative CT findings. 11–13,22…”

“…Similar findings have been reported previously, with intra-operative findings identifying posterior external auditory canal wall erosion, mastoid erosion and residual cells along the facial ridge as reliable predictors of cholesteatoma recurrence, and associated with canal wall down procedures, but they have not been linked with pre-operative CT findings. [11][12][13]22 Conclusion Utilising readily available pre-operative CT imaging alongside a detailed assessment of possible cholesteatoma recurrence patterns by a radiologist may improve outcomes of revision surgery. Performing pre-operative CT scans increases the rate of accurate diagnosis of recurrent cholesteatoma, reduces the time required to diagnose recurrent disease, and lowers the average age at diagnosis and corresponding revision surgery.…”

A 3D and Explainable Artificial Intelligence Model for Evaluation of Chronic Otitis Media Based on Temporal Bone Computed Tomography: Model Development, Validation, and Clinical Application

“…Offering a cost-effective alternative to magnetic resonance imaging (MRI), CT is instrumental in distinguishing cholesteatoma from CSOM by detecting osseous erosion in the tympanum. Although studies have shown that clinicians are capable of diagnosing COM based on CT alone [11][12][13][14][15][16][17], distinguishing between COM subtypes poses greater challenges to the human eye.…”