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

Abstract

INTRODUCTIONConventional radiography of the temporal bone (X-Ray mastoid bone) has not kept pace with the progress of modern otology and for this reason many otologists have felt that radiography of the temporal bone is of little value in CSOM. The diagnosis may be made entirely on clinical grounds and many surgeons feel that with experience and careful techniques the extent and nature of the pathology can be determined during the course of surgical exploration without prior information being required.The advent of HRCT has made a significant impact on the surgical management of individuals with middle ear disease. It confirms and expands upon the otoscopic findings, resolves clinical doubts, and in many circumstances plays a significant role in determining surgical technique when surgery is necessary. The surgical approach can be planned on the basis of HRCT findings.1 However, routine HRCT scanning prior to ABSTRACT Background: High Resolution Computed Tomography (HRCT) has widely replaced conventional techniques (X-Ray Mastoid bone) for temporal bone imaging. The most significant use of computed tomography lies in evaluation of cases of Chronic Suppurative Otitis Media (CSOM). The objective of the study was to evaluate the usefulness of HRCT scanning of temporal bone in defining the extent and severity of disease in patients with CSOM, thereby altering the surgical plan and outcome. Methods: This prospective study was conducted at a tertiary care hospital in Ahmedabad. After obtaining approval from IEC (Institutional Ethical Committee), study was carried out on 50 patients diagnosed with CSOM of atticoantral type. Written informed consent of all patients was taken before enrollment in the study. HRCT scan findings were reviewed and correlated with per-operative findings. Results: Out of total 50 patients of CSOM, 26 (52%) were males. Majority of the patients (70%) were in the age group of 11 to 30 years. Left ear was involved in 40% of the patients. Majority of the patients (80%) presented with chief complaint of otorrhoea. In the present study, External Auditory Canal (EAC) was seen normal in majority of patients (82%) both radio logically and per operatively. HRCT scan was found to be very sensitive (96%) in diagnosing cholesteatoma. The sensitivity of HRCT for diagnosing disease in epitympanum, antrum and aditus was found to be 100%, 97% and 88% respectively. CT scans diagnosed erosion of malleus with 100% sensitivity and specificity and erosion of incus with 91% sensitivity and 100% specificity. Conclusions: HRCT was helpful in determining the anatomy of the middle ear and mastoid, and accurately predicted the extent of the disease process of CSOM.

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

“…Similar results were also noted in study by Niveditha et al and Rai et al 2,17 The dural plate is best observed in the coronal plane and as a thin bone plaque covering the epitympanum and the mastoid (Figure 3). 11 In our study, HRCT temporal bone was found to be 100% sensitive and specific in identifying tegmen tympani erosion which is in consonance with studies by Tak et al and Chatterjee et al 9,16 Sinus plate erosion was seen in 20% of cases with 85.7% sensitivity and 100% specificity (Figure 4). Chatterjee et al have reported almost similar findings in their study of 167 patients showing 88.89% sensitivity and a specificity of 100%.…”

“…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 almost similar to findings by Tak et al who found 91% sensitivity and 100% specificity. 9 Malleus was second most common seen in 60% with 89.4% sensitivity and 90.9% specificity. Garg et al have reported almost similar findings in their study of 60 patients showing 90.9% sensitivity and a specificity of 89.4%.…”

Role of High-Resolution Computed Tomography Temporal Bone in the Evaluation of Unsafe Chronic Suppurative Otitis Media

“…Incus was the most common ossicle eroded (68%) with sensitivity of 91.8% and specificity of 100%. This is in accordance with the findings by Tak and Khilnani who found 91% sensitivity and 100% specificity [19]. Malleus was the next most commonly eroded ossicle after incus, seen in 48% of cases with sensitivity of 88.8% and specificity of 92.8% which is correlating to the study by Prakash and Tarannum who found 89.4% sensitivity and 90.9% specificity [5].…”

Clinicoradiological correlation between preoperative high-resolution computed tomography findings and intraoperative findings in chronic otitis media (squamous type)

“…2 the facial nerve, tegmen and sinus plate and determining dural sigmoid sinus and jugular bulb status. 3 Accurate identification of the nature, site, size, extension and invasion into adjacent structures and tissue plane including the intracranial extension has been made possible by HRCT thereby affecting the course of the management. 4 The use of HRCT in the preoperative evaluation of the patient with chronic otitis media is still controversial.…”