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

Abstract

hronic suppurative otitis media (CSOM) is a long-standing infection of a part or whole of the middle ear cleft, characterized by persistent ear discharge associated with perforation of the tympanic membrane [1]. Unsafe or atticoantral CSOM involves the posterosuperior part of the middle ear cleft characterized by scanty, purulent, and foul-smelling discharge, an attic or marginal tympanic membrane perforation. It is associated with bone eroding processes such as cholesteatoma, granulations, or osteitis, with high risk of complications. Cholesteatoma is a potentially serious condition as it can progressively enlarge and erode into neighboring structures [2]. Since temporal bone is surrounded by many vital structures such as meninges, brain, internal carotid artery, jugular bulb, and facial nerve, the associated complications are high and its gross anatomical variations make surgery difficult at times [3]. These can be avoided if recognized early and properly treated. Early surgical intervention is needed to limit the disease. The presence, location and extent of disease along with the presence of any complications determine the surgical approach to be followed and imaging plays an important role in providing these crucial information to the surgeon in this regard [4]. The advent of high-resolution computed tomography (HRCT) scanning in the 1980s has allowed superb pre-operative imaging of anatomy, some evidence of the extent of the disease, and a screen for asymptomatic complications [5]. With high contrast and good spatial resolution, computed tomography (CT) scan excels in the evaluation of bone and air space anatomy and disorders [4]. Prior knowledge of the extension and the complications of CSOM will alert the clinician and guide in surgical approach and treatment plan [5]. The present study was undertaken with an objective to study the role of HRCT as a diagnostic modality in unsafe CSOM. MATERIALS AND METHODS A hospital-based prospective study was carried out on patients with clinically diagnosed unsafe CSOM referred from the Department of ENT to the Department of Radiodiagnosis, Sriram Chandra Bhanj Medical College, Cuttack, Odisha, for HRCT temporal bone. After the ethical committee approval and obtaining and informed consent, a total of 50 subjects with clinically diagnosed unsafe CSOM of all ages and either sex (both males and females) were included in this study. Patients with post-operative ear status,