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

Abstract

<p class="abstract"><strong>Background:</strong> 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<strong> </strong>to evaluate preoperative HRCT temporal bone and to determine its’ usefulness in patients with Chronic suppurative otitis media (CSOM) undergoing surgery.</p><p class="abstract"><strong>Methods:</strong> 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. </p><p class="abstract"><strong>Results:</strong> 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%).</p><p class="abstract"><strong>Conclusions:</strong> 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.</p>

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

“…The sigmoid sinus plate was eroded in 16% of cases with sensitivity of 88.8% and specificity of 100%. This is in accordance with the study by Prakash and Tarannum and Chatterjee et al [5,23]. Erosion of the lateral semicircular canal with labyrinthine fistula was seen in 8% of cases with sensitivity of 100% and specificity of 95.8%.…”

“…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]. Stapes was found to be eroded in 34% of cases with lower sensitivity of 77.2% but showing specificity of 100%.…”

“…We found cholesteatoma in 87.5% of the total cases showing bony erosion which is similar to a study by Sirigiri and Dwaraknath who found cholesteatoma in 80% of patients with bony erosion [16]. In this study, ossicular erosion was the most common bony erosion seen in 80% of cases which is in accordance with the study by Prakash and Tarannum [5]. Incus was the most common ossicle eroded (68%) with sensitivity of 91.8% and specificity of 100%.…”

Intraoperative and HRCT Findings Correlation in Chronic Suppurative Otitis Media

“…One false positive was seen associated with mesotympanum soft tissue density (parstensa cholesteatoma ) which involved the tympanic segment of facial nerve. Studies 24 quoted that tympanic segment of facial nerve canal and part of vertical segment was most commonly missed due to the thin underlying bony floor. But mesotympanum soft tissue density usually makes it difficult to identify facial canal dehiscence due to the oblique orientation of scan and it is frequently difficult to locate the pathology 6,26 .…”

Role of CT in Documenting the Extent of Temporal Bone and Middle Ear Involvement among Patients with Chronic Otitis Media

“…An investigation reported 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 the evaluation of the CT results in. 21 A study conducted concluded that HRCT of the temporal bone was useful in finding the location and extent of disease in patients with chronic suppurative otitis media. 22 Another research concluded that preoperative CT of Middle ear lesions being useful for surgery planning but some lesion may not be completely diagnosed by CT scan, and intraoperative assessment of surgical field is crucial.…”