Is Computed Tomographic Scanning Alters the Management of Patients with Suspected Cholesteatoma? (original) (raw)
Related papers
The Role of HRCT in Evaluation of Aquaired Middle Ear Cholesteatoma Otitis Prior Surgery
Zagazig University Medical Journal, 2015
Objective: Otoscopic examination is the best method for diagnosis of cholesteatoma which treated by explorative surgery. The need for pre-operative imaging studies is controversial. This study assesses the accuracy and usefulness of a pre-operative high-resolution CT scan in depicting the status of the middle ear structures in the presence of cholesteatoma. Patients and Methods: the surgical findings of 88 patients with acquired cholesteatoma were compared with the pre-operative CT findings in this prospective study. The following were analyzed: diagnostic features of cholesteatoma on CT, status of the middle ear structures (ossicles, facial nerve canal, bony labyrinth, tegmen tympani and scutum) and extension of the disease to the sinus tymapni and facial recess. Results: eighty-three (94.3%) cases had the two radiological features characteristic for cholesteatoma (a) a location typical for cholesteatoma in the epitympanum and mastoid antrum (b) bony erosion. The radio-surgical agreement was excellent for the malleus (Kappa statistics, K= 0.96), stapes (0.91), bony labyrinth (0.94), tegmen tympani (0.82) and scutum (1), good for the incus (0.75), but poor for the facial nerve canal (0.39). The scan accurately predicted the extension of the disease to the sinus tympani and facial recess. Conclusion: High-resolution CT scan is an important investigative tool prior to cholesteatoma surgery.There is good to excellent radio-surgical correlation in cholesteatoma for most middle ear structures except for the integrity of the facial canal. The scan alerts the surgeon to asymptomatic complication of the disease.
Study of the Role of Otoendoscope in Detecting Residual Disease in Cholesteatoma Surgery
Egyptian Journal of Ear, Nose, Throat and Allied Sciences
Introduction: Residual cholesteatoma occurs due to incomplete removal after primary surgery by microscope and is frequently caused by inaccessible locations such as the sinus tympani. The use of the surgical endoscope brought advances in the surgical management of cholesteatoma. Aim: This work aims to assess microscope-assisted otoendoscopy in cholesteatoma surgical management. Patients and Methods: Forty patients underwent ear surgery for a cholesteatoma using different canal wall up or canal wall down mastoidectomy techniques. Surgery was initially performed using a surgical microscope. After complete disease excision microscopically, the middle ear and mastoid cavities were examined by otovideoendoscopy, especially sinus tympani, facial recess, anterior epitympanic recess, Eustachian tube, and hypotympanum. Residual cholesteatoma was identified, and its location was reported. Results: Residual cholesteatoma was found by endoscope in 10 sites; 6, 3, and 1 in sinus tympani, anterior epitympanic recess, and facial recess, respectively. These ten sites were divided into 4 in modified radical mastoidectomy and 6 in conservative approaches. Conclusion: Endoscopic-assisted ear surgery had much-increased benefits in cholesteatoma surgery. Endoscope had become a crucial complement to the operating microscope through visualizing the middle ear cleft hidden areas and discovering any residual disease in such areas as the sinus tympani..
The Journal of Laryngology & Otology, 2006
Objective: to assess the usefulness of delayed post-contrast computed tomography (CT) examination for the detection of residual or recurrent cholesteatoma after canal wall up tympanoplasty.Study design and setting: This prospective, non-randomized study, set within an academic medical centre, included 17 consecutive patients who had undergone canal wall up tympanoplasty for cholesteatoma, with possible recurrence. Pre-contrast CT scans and delayed post-contrast images were compared with second look surgical findings.Results: A residual or recurrent cholesteatoma was found in eight of the 17 patients at revision surgery and was correctly diagnosed on post-contrast CT images in six patients (75 per cent). In the two misdiagnosed cases, cholesteatoma pearls smaller than 2.5 mm were not seen on post-contrast CT. The sensitivity of the imaging test was 75 per cent, the specificity was 60.1 per cent, the positive predictive value was 88.1 per cent and the negative predictive value was 81....
Journal of Karnali Academy of Health Scienecs, 2019
Introduction: Chronic suppurative otitis media (CSOM) is an important cause of middle ear disease and its complications challenge both otologist and radiologist. Methods: This is an observational descriptive study conducted at NAMS Bir Hospital. Total of 30 patients, referred for HRCT from the department of ENT were studied. Results: Out of 30 patients, 16 patients had CSOM with cholesteatoma and 14 patients had CSOM without cholesteatoma. HRCT presented sensitivity, specificity, positive predictive value, negative predictive value and accuracy of 87.5%, 85.7%, 87.5%, 85.7% and 86.7% respectively in diagnosing CSOM with cholesteatoma. HRCT presented sensitivity and specificity of 85.7% and 87.5% in identification of malleus erosion, sensitivity and specificity of 86.7% and 80%, in the identification of incus erosion. HRCT showed the specificity of 85% with relatively low sensitivity of 70% in identification of erosion of stapes. HRCT showed a sensitivity of 100% and specificity of 85.7%. HRCT presented sensitivity and specificity of 83.3% and 95.8% in diagnosing tegmen tympanum erosion. HRCT showed the highest sensitivity (100%) and specificity (100%) in diagnosing erosion of sigmoid sinus plate and mastoid cortex. HRCT showed relatively low sensitivity of 66.7% and 75% in diagnosing erosion of LSCC and facial canal respectively. Conclusion: The HRCT has a valuable role in preoperative evaluation of a case of CSOM. It has high sensitivity in diagnosing CSOM with cholesteatoma. However, HRCT has relatively low sensitivity for LSCC and facial nerve canal erosion.
Functional outcomes of middle ear cholesteatoma surgery
Medical review, 2018
Introduction. Chronic otitis media is defined as a persistent inflammation of the middle ear with signs of an infection lasting for three months or longer. Chronic otitis media may occur either with or without cholesteatoma. For both types of conditions, surgical treatment with closed canal wall-up or open canal wall-down techniques of tympanoplasty are considered. Our aim was to evaluate functional outcomes in two groups of patients (chronic otitis media with cholesteatoma and chronic otitis media without cholesteatoma) treated with various tympanoplasty techniques. Material and Methods. This retrospective study included 100 patients who underwent canal wall-down and canal wall-up tympanoplasty for the treatment of chronic otitis media with cholesteatoma and chronic otitis media without cholesteatoma from 2015 to 2016. All study patients underwent routine clinical and audiometric examinations. The study evaluated preoperative and postoperative functional results (evaluation of pure...
Evolving considerations in the surgical management of cholesteatoma in the only hearing ear
2014
To describe a contemporary, pragmatic approach to managing cholesteatoma in the only hearing ear. Study Design: Retrospective case series. Setting: Single tertiary referral center. Patients: All patients that underwent cholesteatoma surgery, having profound hearing loss in the contralateral ear. Intervention(s): Cholesteatoma surgery. Main Outcome Measure(s): Surgical strategy, preoperative and postoperative audiometric outcomes, short-and long-term complications, recidivism. Results: Twenty-eight patients met criteria, representing 0.25% of all chronic ear surgeries performed between 1970 and 2012. Patients undergoing surgery in the latter half of the study underwent intact canal wall procedures and ossicular chain reconstruction more frequently despite having similar severities of disease. All patients with inner ear fistula underwent an opencavity operation. In the early postoperative period, 86% of ears had stable or improved hearing levels, and all patients maintained preoperative bone conduction thresholds. At a mean follow-up of 48 months, 79% of patients maintained stable or improved pure tone thresholds, whereas 2 subjects experienced delayed sensorineural hearing loss and 2 experienced isolated declining speech discrimination. Notably, 3 of the latter 4 patients were diagnosed with labyrinthine fistula and had undergone radical mastoidectomy. None of the patients who received an intact canal wall tympanomastoidectomy experienced worsening bone conduction thresholds, whereas 1 subject demonstrated a delayed decline in speech discrimination and another recurred. Conclusion: It is commonly held that the radical or classic modified radical mastoidectomy is the procedure of choice when managing cholesteatoma in the only hearing ear while intact canal wall techniques are contraindicated. Over the last 20 years, we have adopted a less-rigid, functional approach favoring intact canal wall procedures in the absence of inner ear fistula rather than unequivocally committing to an open cavity. This strategy has been influenced by advancements in preoperative evaluation, increasing familiarity and refinement of closed-cavity techniques, postoperative imaging surveillance options, and the potential for cochlear implant ''salvage'' in the rare case of profound hearing loss. Based on the current series, this approach appears safe when performed by an experienced surgeon, and reliable long-term patient follow-up is maintained.
Philippine Journal of Otolaryngology Head and Neck Surgery, 2021
Objective: To determine the stage of middle ear cholesteatoma of patients who underwent middle ear surgery at the Southern Philippines Medical Center from January to December 2019, based on European Academy of Otology and Neurotology / Japan Otological Society (EAONO/ JOS) system. Methods: Design: Case Series Setting: Tertiary Government Training Hospital Participants: A total of 42 charts were included in the study Results: Of the 42 cases evaluated, congenital cholesteatoma was seen in 4 while acquired cholesteatoma was noted in 38, (further subdivided into 34 retraction pocket cholesteatoma and 4 non-retraction pocket/traumatic cholesteatoma). A majority (57%) had Stage II cholesteatoma (mass occupying at least two sub-sites in the middle ear) at the time of surgery. Eight (19%) had stage I cholesteatoma (confined to one sub-site), five (12%) had stage III cholesteatoma evidenced by extracranial complications such as subperiosteal abscess and erosion of the semicircular canals. S...
Evaluating the role of otoendoscope in cholesteatoma surgery
International Journal of Otorhinolaryngology and Head and Neck Surgery, 2019
The primary aim of cholesteatoma surgery is to eradicate the disease and for complete eradication, full exposure ABSTRACT Background: Endoscope assisted ear surgery (EAES) reduces the chances of residual cholesteatomas as compared to the conventional microscopic technique, primarily because of the direct visualization of sites where residual cholesteatoma is common, which is often missed out during the traditional microscopic surgical procedure. The aim of the study was to evaluate the hidden areas of middle ear using endoscopes during the conventional microscopic cholesteatoma surgery. Methods: The present prospective study was carried out in the
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.
Imaging of postoperative middle ear cholesteatoma
Clinical Radiology, 2011
Cholesteatoma is often treated surgically using canal wall-preserving techniques. Clinical and otoscopic diagnosis of residual or recurrent disease after this form of surgery is unreliable and thus radiological imaging is often used prior to mandatory "second-look" surgery. Imaging needs to be able to differentiate residual or recurrent disease from granulation tissue, inflammatory tissue or fluid within the middle ear cavity and mastoid cavity. Highresolution computed tomography (HRCT), conventional magnetic resonance imaging (MRI), and delayed contrast MRI have all been used in detecting postoperative cholesteatoma. Although delayed contrast MRI performs better than HRCT and conventional MRI, the sensitivities and specificities of these different imaging methods are relatively poor. Diffusion-weighted MRI (DWI and, in particular, non-echo planar DWI) has been shown to have a high sensitivity and specificity for detecting recurrent cholesteatoma. In this review we provide examples of postoperative imaging appearances following cholesteatoma surgery and we review the relevant literature with an emphasis on studies evaluating the diagnostic accuracy of DWI.