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

Abstract

BackgroundPre-operative assessment of middle ear cholesteatoma is a must for assessing the disease's location, extent, and complication, and high-resolution computed tomography (HRCT) is the modality of choice. Therefore, this study aims to assess the common signs of cholesteatoma on HRCT and its diagnostic ability. MethodsFifty patients with suspected cholesteatoma were considered for the study, which was carried out on an Ingenuity Core 128 slice CT scanner (Philips, Amsterdam, Netherlands). The bilateral temporal bones of 50 patients were assessed for soft tissue density and associated findings. The number of temporal bones with soft tissue density was then correlated with intra-operative and histopathological examinations (HPE). ResultsOut of 100 temporal bones, 63 were diseased, and 37 were normal temporal bones. Epitympanum/Prussak's space was the most involved site with soft tissue density seen in 60/63 (95.2%) diseased temporal bones, followed by aditus ad antrum and mesotympanum, which was seen in 51/63 (80.9%) diseased temporal bones. The majority of the soft tissue lesions were non-dependent, accounting for 43/63 (68.2%) of the diseased temporal bones. Bony erosions were seen in 54/63 (85.7%) and bony expansion in 35/63 (55.5%) of the diseased temporal bones. HRCT showed a sensitivity of 100%, specificity of 88.1%, a positive predictive value (PPV) of 92.1%, a negative predictive value (NPV) of 100%, and accuracy of 95% for detection of cholesteatoma. ConclusionHRCT of the temporal bone precisely demonstrates cholesteatoma's location, extent, and bony changes. Therefore, it has exceptional sensitivity, high specificity, and accuracy in diagnosing cholesteatoma.

High-Resolution Computed Tomography in Middle Ear Cholesteatoma: How Much Do We Need It?

“…In our study, we found four cases (9%) of an LSC fistula. Other studies noted an LSC fistula in just 4.7% of the cases and even lower (4% of the patients) [16,28]. In our study, HRCT scans assessed the LSC fistula cases with a sensitivity of 75% and specificity of 97.6%.…”

“…Also commonly detected was the pars flaccida type [12]. In other studies, the most frequently encountered type was pars flaccida cholesteatoma: a study on 30 cholesteatoma cases showed lesions in the epitympanum in 73.3% of patients, followed by mesotympanum [15], and in another one pars flaccida cholesteatoma was described in 50.7% of cases, followed by extensive cholesteatoma in 30.1% of patients [16]. Pars tensa cholesteatoma was the least encountered type in most of the studies.…”

“…The correlation was still very good but borderline (kappa = 0.76). In another study, the scutum was eroded in 55.5% of the cholesteatoma cases [16]. Rai et al reported scutum erosion in 65% of the patients [18].…”

“…HRCT finding shows eroded/thinned tegmen tympani in 13 cases, but intraoperatively, it was present in 9 cases out of the total of 46 (19%) with a sensitivity of 90% and specificity of 88.8%. Another study identified tegmen tympani erosion in 38% of the cases [16]. In a study performed by Jamal et al, tegmen tympani erosion was seen in 30% of the patients [24].…”

A 3D and Explainable Artificial Intelligence Model for Evaluation of Chronic Otitis Media Based on Temporal Bone Computed Tomography: Model Development, Validation, and Clinical Application

“…Offering a cost-effective alternative to magnetic resonance imaging (MRI), CT is instrumental in distinguishing cholesteatoma from CSOM by detecting osseous erosion in the tympanum. Although studies have shown that clinicians are capable of diagnosing COM based on CT alone [11][12][13][14][15][16][17], distinguishing between COM subtypes poses greater challenges to the human eye.…”