Sensitivity and Specificity of High-Resolution Computed Tomography (HRCT) of Temporal Bone in Diagnosing Cholesteatoma and Its Correlation with Intraoperative Findings (original) (raw)
Related papers
Cureus, 2023
Introduction: Cholesteatoma, a hazardous non-neoplastic lesion of the temporal bone, is prevalent in socioeconomically disadvantaged groups in developing nations like India. Timely detection and surgical intervention are essential for effective management. High-resolution computed tomography (HRCT) has revolutionized the assessment of temporal bone pathology, though its role in preoperative evaluation remains debated. This study aimed to validate HRCT's utility in diagnosing cholesteatoma, compare its findings with intraoperative observations, and assess sensitivity and specificity. Methods: This diagnostic accuracy study was conducted at a tertiary care center in Western India, from March 2021 to November 2022. HRCT findings of 54 cholesteatoma patients were evaluated and compared with intraoperative findings. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), accuracy, and Cohen's kappa coefficient were calculated. Results: HRCT demonstrated a sensitivity exceeding 90% in identifying scutum erosion, mastoid sclerosis, and abnormalities in the tympanic membrane, along with a specificity surpassing 90% in detecting various conditions, including facial canal erosion, sinus plate erosion, lateral semicircular canal erosion, erosion of the posterior wall of the external auditory canal, and abnormalities in the tympanic membrane. Furthermore, HRCT exhibited an accuracy of over 90% in detecting most pathologies. There was a perfect or near-perfect agreement observed for abnormal tympanic membrane, sinus plate erosion, mastoid sclerosis, and erosion of the posterior wall of the external auditory canal (with kappa values > 0.8). Moderate to fair agreement was noted for other pathologies. Conclusion: HRCT offered precise detection of the majority of pathologies, thereby facilitating surgical planning. However, the presence of limitations in distinguishing specific abnormalities highlights the significance of utilizing HRCT in tandem with other diagnostic modalities to ensure meticulous diagnosis and effective treatment planning.
Is Computed Tomographic Scanning Alters the Management of Patients with Suspected Cholesteatoma?
Asian Journal of Medical Radiological Research
Background: Cholesteatoma is an abnormal skin growth that can develop in middle section of your ear behind the eardrum; a cholesteatoma may also be caused by a poorly functioning eustachian tube, which is the tube that leads from the back of the nose to the middle of the ear. It causes mainly chorionic ear infection, sinus infection, cold and allergies. This may cause a section of eardrum to be pulled into middle ear, creating a cyst than can turn into cholesteatoma. Subjects and Methods: A prospective, analytical study was conducted among 90 patients with complaint of unsafe chronic suppurative otitis media which were randomly selected from outpatient Department of ENT at Shridev Suman Subharti Medical College, Dehradun, Uttarakhand. The patients comprised of both males as well as females and also of different age groups. Results: Out of 90 patients, 61(67.22%) were males followed by 29 (32.22%) females. The minimum age of patient in the study was of 8years and the maximum age of patient in study of 50 years. Maximum number of patients belonged to the age group of 11-20 (50%). The mean age in this study was 23 years. Among study subjects, 32 (35.55%) cases had conductive hearing loss, 11(12.22%) cases had sensorineural type, 40(44.44%) had mixed type and 7(7.77%) had no response. Out of 90 study subjects, 46 (51.11%) had cholesteatoma. Conclusion: The clinical and radiological findings showed a high level sensitivity with intra operative findings as regards to the presence of cholesteatoma, changes of the ossicular chain and erosion of the lateral semicircular canal. HRCT findings, in the treatment of any congenital abnormality of the ear were a good guide to the surgeon for planning and management.
International Journal of Otorhinolaryngology and Head and Neck Surgery
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.
Innovative Publication, 2017
Among patients attending to ENT OPD, chronic suppurative otitis media (CSOM) is one of the common conditions. Mastoid, middle ear surgeries are difficult at times because, the CSOM can be associated with complications; the temporal bone accommodates vital structures (internal carotid artery, facial nerve, jugular bulb etc.) and its anatomical variations. In this study, we planned to investigate the use of preoperative HRCT scan to assess the pathology, extent of the disease, middle ear structures, and presence of cholesteatoma and also to compare with intra operative findings. Materials and Methods: The HRCT findings of 40 patients with CSOM with cholesteatoma were compared with operative findings. CT scan was performed with Seimens Somatom emotion 6 scanner. With the help of HRCT status of the middle ear structures (ossicles, scutum, facial nerve canal and tegmen tympani), semicircular canals and sigmoid plate were assessed and compared with operative findings. Correlation between radiological and intra-operative findings was calculated. Results: A good radio surgical correlation is seen in CSOM with cholesteatoma for status of most middle and inner ear structures except for the integrity of the facial canal. A poor radiosurgical correlation was observed for differentiating cholesteatoma from chronic mucosal thickening as the underlying pathology in cases with CSOM. HRCT was found to be sensitive in detecting erosions of incus(85%), stapes(82.3%), scutum(91.67%), sigmoid plate(100%) and mastoid cortex(100%) whereas less sensitive in erosions of malleus (68.75%), tegmen(32.6%), semicircular canal(71.4%) and facial canal(53.3%). 100% specificity was obtained for erosions of malleus, incus, scutum, sinus plate and mastoid cortex whereas it is relatively less specific for erosions of facial canal(84%) and tegmen(81%). Interpretation and Conclusion: HRCT of temporal bone has a definitive role in pre-operative assessment of CSOM with cholesteatoma as it helps in assessing the extent of the disease and integrity of most of the middle ear structures.
Utility of high resolution computed tomography in pre-operative evaluation of cholesteatoma
International Journal of Otorhinolaryngology and Head and Neck Surgery, 2020
The diagnosis of aural cholesteatoma is made by otoscopic examination, in microscopic evaluations or ABSTRACT Background: Prior knowledge about temporal bone anatomy and extent of cholesteatoma may help the ENT surgeon to plan the surgery and avoid impending complications. This study aims to evaluate the role of pre-operative high resolution computed tomography (HRCT) in cholesteatoma and to compare HRCT findings with intra-operative findings. Methods: A diagnostic evaluation study was performed among 30 atticoantral cholesteatoma cases presenting in the ENT outpatient department of MES Medical College in Malappuram, Kerala over a period of one and half years. The intraoperative findings were considered as the gold standard to which the radiological features were compared and the sensitivity, specificity and predictive value of HRCT were determined. Results: High sensitivity of HRCT was noted in detecting soft tissue in mesotympanum 94.4% and aditus ad antrum 94.1%. Low sensitivity 59% was noted in detecting stapes erosion when compared to malleus and incus erosions. Except in conditions of soft tissue in epitympanum, dural plate dehiscence and sclerotic mastoid, a high specificity of 100% was noted in all other findings. Conclusions: This study reaffirms the usefulness of HRCT in pre-operative evaluation of cholesteatoma-atticoantral type.
e-CliniC
This study was aimed to determine the accuracy of preoperative temporal bone CTscan ini assessing cholesteatoma in chronic suppurative otitis media (CSOM) patients. This was a diagnostic test study conducted by comparing the findings of the preoperative temporal bone CTscan with the intraoperative findings of 54 CSOM patients who had a temporal bone CT-scan followed by surgery at the Hasanuddin University Hospital and the Jaury Academic Hospital. Assessment of cholesteatoma on a preoperative temporal bone CT-scan was performed when soft tissue density was found in the middle ear accompanied by bone erosion. In addition, an assessment was also carried out for the presence of ossicular, scutum, tympanic tegmen, facial nerve canal and mastoid tegmen erosions. The results indicated that the accuracy of preoperative temporal bone CT-scan in assessing cholesteatoma in CSOM patients was 87.04% with a sensitivity of 85%, specificity of 88.23%, a positive predictive value of 80.95%, and a negative predictive value of 90.91%. The sensitivity of the preoperative temporal bone CT-scan in assessing the highest erosion of cholesteatoma in the erosion of the scutum and tympanic tegmen (100%) with the specificity and accuracy of the preoperative temporal bone CT scan of the in assessing erosions in cholesteatoma highest on mastoid tegman erosion (100% and 96.29%). In conclusion, preoperative CT scan of temporal bone has high accuracy, sensitivity, and specifity values in assessing cholesteatoma and erosions of surrounding structures. Keywords: cholesteatoma, chronic suppurative otitis media (CSOM), temporal bone CT-Scan Abstrak: Penelitian ini bertujuan untuk mengetahui akurasi gambaran CT-scan tulang temporal preoperatif dalam menilai kolesteatoma pada penderita otitis media supuratif kronis (OMSK). Jenis penelitian ialah uji diagnostik yang membandingkan temuan pada CT scan tulang temporal preoperatif dengan hasil temuan intraoperatif pada 54 penderita OMSK yang menjalani pemeriksaan CT scan tulang temporal dilanjutkan dengan tindakan operasi di Rumah Sakit Universitas Hasanuddin dan Rumah Sakit Akademis Jaury. Penilaian kolesteatoma pada CT Scan tulang temporal preoperatif ketika ditemukan densitas jaringan lunak di telinga tengah yang disertai dengan erosi tulang. Selain itu, dilakukan penilaian adanya erosi osikula, skutum, tegmen timpani, kanalis nervus fasialis, dan tegmen mastoid. Hasil penelitian mendapatkan akurasi CT scan tulang temporal preoperatif dalam menilai kolesteatoma pada penderita OMSK sebesar 87,04% dengan sensitivitas 85%, spesifisitas 88,23%, nilai prediksi positif 80,95%, dan nilai prediksi negatif 90,91%. Sensitivitas CT scan tulang temporal preoperatif dalam menilai erosi pada kolesteatoma tertinggi pada erosi skutum dan tegmen timpani (100%) dengan spesifisitas dan akurasi CT scan tulang temporal preoperatif dalam menilai erosi pada kolesteatoma tertinggi pada erosi tegmen mastoid (100% dan 96.29%). Simpulan penelitian ini ialah CT scan tulang temporal preoperatif memiliki nilai akurasi, sensitivitas, serta spesifisitas yang cukup tinggi dalam menilai kolesteatoma serta erosi pada struktur di sekitarnya. Kata kunci: kolesteatoma, otitis media supuratif kronis (OMSK), CT scan tulang temporal
Post-operative Temporal Bone Imaging
Medical Radiology, 2014
Three categories of patients are referred for follow-up imaging after temporal bone surgery. The first group consists of patients with (complicated) chronic middle ear disease, including cholesteatoma. For this group, the imaging algorithm has changed enormously for the last 10 years. Multidetector computed tomography (MDCT) and more recently cone beam CT (CBCT) are ideally suited to demonstrate the bony details after mastoidectomy and to assess the integrity of the ossicular chain reconstruction when prosthetic failure is suspected. To evaluate the middle ear and/or mastoid cavity for the presence of residual cholesteatoma, MR imaging (MRI) has become the first choice diagnostic modality. Non-EPI diffusion-weighted imaging (DWI) has proven to be the most sensitive and specific technique and has higher diagnostic performance than delayed contrast-enhanced MR-imaging. After stapes surgery in patients with otosclerosis, imaging studies are rarely required. When prosthetic failure is suspected, MDCT and CBCT can be performed. In patients with postoperative vertigo and sensorineural hearing loss (SNHL), MR imaging may be needed to look for labyrinthine abnormalities (hemorrhage, infection, …) if CT is not contributive. In the follow-up of patients with vestibular schwannoma, MR imaging is the modality of choice, whether a conservative ('wait and scan') management, radiosurgery or surgey has been chosen.