Role of High Resolution Computed Tomography of Mastoids in Planning Surgery for Chronic Suppurative Otitis Media

Background: Chronic suppurative otitis media (CSOM) is a common condition seen in patients attending ENT department. The diagnosis of cholesteatoma is usually made on otologic examination. The necessity for HRCT imaging in an uncomplicated case is controversial. The objective was to evaluate preoperative HRCT temporal bone and to determine its’ usefulness in patients with Chronic suppurative otitis media (CSOM) undergoing surgery.Methods: This study was a prospective study involving 30 cases of CSOM with cholestaetoma. All the patients underwent pre-operative HRCT screening followed by surgical exploration of middle ear cleft. Pre-operative CT scan and intra-operative findings recorded and compared. Results: Out of total 30 patients of CSOM, 16 (53%) were males and (90%) presented with chief complaints of otorrhoea. HRCT scan was found to be very sensitive (100%) in detecting cholesteatoma in middle ear cleft but differentiation between granulations or cholesteatoma wasn’t possible. HRCT satisfactorily delineated ossicular erosion except stapes suprastructure erosion which had 81.8% sensitivity and specificity 88.88%. For bony boundaries of middle ear, HRCT showed very high sensitivity and specificity for detecting scutum erosion, tegmen erosion, mastoid cortex erosion, jugular bulb dehiscence and bony external auditory canal erosion. It was moderately sensitive for LSCC Erosion (75%), Facial canal erosion (80%) and Sinus plate erosion (85.7%).Conclusions: These results indicate that preoperative CT temporal bone scan of patients with CSOM serves as an important guide in surgical approach for otolaryngologists, although there are limitations in evaluation of the CT results.

Section: Discussionsupporting

confidence: 88%

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

Prakash

Tarannum

2018

“…Chatterjee et al and Sreedhar et al were able to obtain 100% accuracy for localization of disease on HRCT; however, our study could not achieve such high accuracy for most of the locations except for mesotympanum involvement (where 100% accuracy was achieved). 13,14 Our study depicted EBC involvement on HRCT in 8% cases; however, Sarin et al didn"t detect EBC involvement in any case on HRCT, but intra-operatively, EBC involvement was detected in 12.5% cases. 15 Similar to our study, they reported tegmen erosion and LSCC erosion as less common findings (15% and 10% cases respectively).…”

Section: Figure 6: Axial Hrct Rt Temporal Bone Showing Soft Tissue Chcontrasting

confidence: 49%

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

Dashottar

Bucha²,

Sinha

et al. 2018

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.

“…3 Despite some concerns that CT cannot reliably distinguish cholesteatoma from mucosal disease and regarding its limitation in sensitively recognizing erosive complications, imaging of ear has been a routine test in preoperative evaluation of the disease and many studies support the value of CT-scan in preoperative evaluation of cholesteatoma. [4][5][6] The hallmarks of cholesteatoma on CT scans are a soft tissue mass in attic and mastoid antrum associated with smooth bony expansion, scalloping of the mastoid, erosion of lateral wall of attic and erosion of ossicles. 3 While a definitive diagnosis of cholesteatoma can only be made at the time of surgery, the CT scan evaluation may at times influence the decision and timing of surgical exploration with evidence of bony erosion, complications like acute mastoiditis, brain abscess prompting earlier surgical intervention.…”

Section: Discussionmentioning

confidence: 99%

“…3 While a definitive diagnosis of cholesteatoma can only be made at the time of surgery, the CT scan evaluation may at times influence the decision and timing of surgical exploration with evidence of bony erosion, complications like acute mastoiditis, brain abscess prompting earlier surgical intervention. 5 CT scan may also assist in pre-operative detection of varied pneumatisation of the mastoid temporal bone and the presence of anatomical variations like dehiscence of semicircular canal while showing lower specificity in detecting facial canal dehiscence, dural plate erosion, and sigmoid plate erosion. 5 In the current study evaluating HRCT temporal bone, infections of middle ear cleft (with cholesteatoma) was the most common pathology observed and this is in line with studies by Jyothi et al and Seema et al 2,3 Also, the CT scan accurately delineated ossicular erosion, scutum erosion, fallopian canal, tegmen tympani and lateral semicircular canal erosions in the cases with cholesteatoma.…”

Section: Discussionmentioning

confidence: 99%

High resolution computed tomography of temporal bone in the evaluation of otologic diseases

Handi¹,

Patil

Nisha

2017

INTRODUCTIONDue to the complex anatomy of the temporal bone, conventional radiological methods like X-ray mastoid have limited ability to delineate the details of the temporal bone and cochlea-vestibular anatomy and disease pathology. The availability of modern highresolution computerized tomography (HRCT) scanners has resulted in ability to demonstrate the detailed temporal bone anatomy and identify significant structures and has revolutionalized the role of radiology in diagnosis and management of temporal bone diseases. 1 HRCT is particularly helpful in evaluating the anatomy and pathology of external auditory canal, middle ear cavity, vestibular aqueduct, tegmen tympani, sigmoid sinus plate, vertical segment of facial nerve canal, sinodural angle, carotid canal, jugular fossa, infra and supralabrynthine air cells and temporomandibular joint; both soft tissue extension and significantly sensitive ABSTRACT Background: Conventional radiological methods like X-ray mastoid have limited ability to delineate the details of the complex temporal bone and cochlea-vestibular anatomy and disease pathology. This can be overcome by the use of High resolution computed tomography (HRCT) evaluation of the temporal bone. HRCT is helpful in evaluating the anatomy and pathology type and extent of disease, thereby helps in preoperative planning. Methods: The CT scan of forty five patients attending the outpatient department of otorhinolaryngology in a tertiary care centre between August 2014 to August 2017 was evaluated in this study. Each CT scan was interpreted by an otolaryngologist and a radiologist and interpretation was by consensus. The data collected was evaluated and results are reported as rates and proportions (%). Results:The study evaluated CT scan of 45 patients of which 35 were male patients and 10 were female patients with age ranging from 5 years to 75 years. Most of these patients belonged to the 21-30, 31-40 age groups [9 (20%) in each group]. Infections of middle ear cleft (all with cholesteatoma), fractures of the temporal bone, anomalies and tumors of the external auditory canal and middle ear were the pathologies observed in these CT scans with infection (otomastoiditis) [23 (51.1%)] being the most common pathology observed. Conclusions: Pre-operative CT scan may not only help in identifying the nature, extent of infectious disease including ossicular, bony erosions; it may also identify anomalies in the temporal bone and surrounding structures. Thus, HRCT temporal bone will help the surgeon in planning effective surgical strategy, reducing morbidity during the surgery.