Preoperative temporal bone HRCT and intra-operative findings in middle ear cholesteatoma: a comparative study

Abstract

Background: Middle ear cholesteatoma is a potentially dangerous condition owing to the varied extra-cranial as well as intra-cranial complications, it can be associated with. Clinical suspicion and otologic examination sufficiently identifies the pathology but its entire extent and spread is delineated by HRCT examination only, which is presently the "Gold Standard". In this study we tried to evaluate the efficacy of HRCT temporal bone in depiction of extent of pathology in cases of cholesteatoma of middle ear and we tried to verify the findings of HRCT imaging with intra-op findings.Methods: A prospective observational study comprising of 50 patients suspected of middle ear cholesteatoma was carried out at a tertiary care hospital in Lucknow, India. Pre-op evaluation with bilateral temporal bone HRCT imaging followed by suitable surgery was performed. Important pre-operative HRCT and intra-operative surgical findings were correlated for statistical significance. Results: Mesotympanum involvement (96%) was the most common HRCT finding as far as location and extent were concerned and incus erosion (70%) was the most common bony complication. A high sensitivity and specificity (82% -100%) of HRCT was found in detection of Erosion of scutum, tegmen tympani and incus. For findings such as stapes erosion and facial canal erosion on HRCT, a sensitivity of 68.4% and 50% respectively was found when compared to intra-op findings. Conclusions: HRCT temporal bone is a useful tool in pre-operative delineation of the extent of cholesteatoma and the recognition of its manifestations and complications. It can help the operating surgeon in appropriate surgical planning.

Correlation of Preoperative High-resolution Computed Tomography Temporal Bone Findings with Intra-operative Findings in Various Ear Pathologies

“…Our study showed male dominance which was similar to studies of Dashottar et al [4] and Kanotra et al [5]. To the best of our knowledge no previous literatures showed variety of ear diseases in such type of study in a single setting.…”

Temporal Bone Cholesteatoma: Typical Findings and Evaluation of Diagnostic Utility on High Resolution Computed Tomography

“…Our study noted lateral semicircular canal fistula in three (4.7%) diseased temporal bones. This observation was seen to concur with an HRCT study done by Dashottar et al in 50 symptomatic patients, which reported lateral semicircular canal fistula in two (4%) patients [15].…”

Diagnostic efficacy of high-resolution computed tomography findings in patients of chronic suppurative otitis media atticoantral type

“…9 Mesotympanum involvement by disease was seen in all the patients compared to other study done by Dashottar et al where there was 96% involvement and 89% in study done by Ganotra. 2,4 Ossicular erosion was observed in 90% of patients in the study while it was found to be 89% in study done by Chavda et al 11 Similarly, lateral semi-circular canal involvement was observed in 6% patients while other study had 23% involvement. HRCT proved highly effective in showing ossicular erosion which correlated well intra-operatively, specifically for malleus and incus, similar to a study conducted by Rogha et al which showed good radio surgical correlation for malleus.…”

“…A high sensitivity and specificity (82-100%) of HRCT was found in detection of erosion of scutum, tegmen tympani and ossicles by Dashottar and higher sensitivity rates were found in my study for the same ranging from 90-100%. For facial canal erosion on HRCT, a sensitivity of 66% was found when compared to intra-op findings as compared to 50% in study done by Dashottar et al 2 HRCT temporal bone before surgery helped in carrying out pre-operative planning and evaluation and helped the surgeons in being more vigilant during the surgery. Also, it helped in planning for ossicular reconstruction.…”

“…But its extent cannot be determined clinically. 2,6 pre-operative planning of surgery and complete removal of the disease. 3 Aim of the study was to correlate the CT scan findings with intra-operative findings and determine the diagnostic efficacy of CT scan.…”