Estudo Comparativo entre Achados Radiológicos e Cirúrgicos na Otite Média Crônica Comparative Study Between Radiological and Surgical Findings of … (original) (raw)
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Indian Journal of Otolaryngology and Head & Neck Surgery, 2015
Chronic suppurative otitis media (CSOM) presents with a typical history of recurrent otorrhoea with tympanic membrane perforation. The diagnosis of cholesteatoma is usually made on otologic examination. High resolution computed tomography (HRCT) is indicated to evaluate the extension and the complications of cholesteatoma. The aim of the work was to study the role of HRCT in detecting, evaluating diagnosing and managing CSOM. All patients presenting with CSOM who were planned for mastoid exploration surgery in department of ENT, Gauhati Medical College and Hospital within a period of 2 years-from 1st January, 2013 to 31th December, 2014, were taken up for the study. HRCT mastoids done routinely before cholesteatoma surgery, but with improved resolution, to characterize all middle ear structures and complications of the disease prior to surgery, might guide as road map during mastoid explorations for unsafe CSOM. The important role of HRCT lies on the early detection of cholesteatoma, and more conservative surgical procedures can be used to eradicate the disease.
Journal of Evolution of Medical and Dental Sciences
High Resolution Computed Tomography (HRCT), a modification of routine CT, provides a direct visual window in the temporal bone providing minute structural details. Purpose of the present study was to evaluate the suppurative diseases of middle ear and mastoid with their complications on HRCT and to correlate these imaging findings surgically. Our study shows good correlation of various HRCT findings in suppurative diseases of middle ear & mastoids with intra-operative findings. MATERIALS AND METHODS This retrospective study included 60 patients who were referred to the Department of Radiodiagnosis, Assam Medical College with clinically suspected temporal bone or ear pathologies. After detailed clinical examination, the patients were subjected to HRCT examination. The imaging findings of all cases were correlated with the surgical findings. RESULTS Out of 60 patients, 63.3% had unsafe CSOM with cholesteatoma. The HRCT findings with surgical correlation showed a high 91.89% sensitivity for identifying cholesteatoma. HRCT also provided good sensitivity for detecting erosion of scutum (90.32%), erosion of ossicular chain (86.96%) and erosion of lateral semi-circular canal (80%). HRCT had lower sensitivity (66.67%) for identifying facial canal dehiscence. CONCLUSION The HRCT findings showed a good sensitivity with intraoperative findings in identification of cholesteatoma, erosion of scutum, ossicular chain and semi-circular canal.
Advanced medical journal
Background and objectives:To compare the findings of high resolution computed tomography of temporal bone with intraoperative findings of patients suffering from chronic suppurative otitis media. Methods:This is a prospective randomize case study which was conducted on 100 patients complaining from chronic ear discharge and hearing impairment. The study was conducted at otolaryngology department, Rizgary Teaching hospital, Erbil City-Iraq from January 2016 to December 2018. The surgical procedures were the same for all patients as mastoid exploration. Based on the intraoperative finding it was decided either to choose canal wall up mastoidectomy or canal wall down mastoidectomy procedure that to be appropriate for particular case with studying and comparing the radiological finding accordingly. Results:Of the 100 patients,47% were males and 53% females. Eighteen cases were diagnosed with cholesteatoma and 82 cases were without. The high resolution computed tomography of temporal bon...
Saudi medical journal, 2009
To compare the consistency rates of pre- and intra-operative radiological findings in patients with chronic suppurative otitis media (CSOM). In a cross-sectional study, 80 patients with CSOM underwent pre-operative CT scanning and we compared the results with intra-operative clinical findings during mastoidectomy from 2000-2004 in the Otology Department, Amiralmomenin Hospital of Guilan Medical University, Rasht, Iran. Sensitivity, specificity, positive and negative predictive value of CT scan in tympanic and mastoid cholesteatoma, ossicular chain erosion, tegmen tympani erosion, dehiscence of facial canal, lateral semicircular canal (LSCC) fistula were assessed. Then, correlation between radiological findings and intra-operative findings were calculated. The mean age of the patients was 27.9 +/- 16.3 years. Mostly were males (n=57 [71.3%]). Correlation of preoperative radiological images with intra-operative clinical findings were moderate to good on tympanic cholesteatoma, mastoid...
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
Correlation of HRCT mastoid with clinical presentation and operative findings in ear diseases
International Journal of Otorhinolaryngology and Head and Neck Surgery
The human temporal bone has an extremely complex structure. Direct axial and coronal CT sections are quite satisfactory for imaging the anatomy of the temporal bone but most of the normal and pathological details of the temporal bone are better visualized with direct sagittal CT sections. The sagittal projection is of interest for surgeons, as it has the advantage of following the plane of surgical approach. HRCT is found to be extremely useful for evaluating the diseases involving the external auditory canal, middle ear cavity, vertical segment of facial nerve canal, vestibular aqueduct, tegmen tympani, sigmoid sinus plate, sinodural angle, carotid canal, jugular fossa, infra and supralabrynthine air cells and temporomandibular joint. HRCT has contributed greatly to an understanding of the complex anatomy and spatial relationship of the minute structures of hearing and balance organs, which are packed into a small pyramidshaped petrous temporal bone. HRCT shows not only soft tissue extension but also gives a more sensitive demonstration of calcification. It has also become useful ABSTRACT Background: HRCT is found to be extremely useful for evaluating the ear diseases involving the external auditory canal, middle ear cavity, vertical segment of facial nerve canal, vestibular aqueduct, tegmen tympani, sigmoid sinus plate, sinodural angle, carotid canal, jugular fossa, infra and supralabrynthine air cells and temporomandibular joint. Our main objective was to correlate the clinical presentation and operative findings of ear diseases with HRCT mastoid. Methods: This study is done in our institute otorhinolaryngology dept. from April 2014 to April 2016. This is prospective study involves 36 patient belonging to different age and sex groups with high suspicious of ear diseases. We have taken detail history of each patient with complete ear nose throat examination done and after that all patient were investigated with routine blood investigation, X-ray and HRCT mastoid to correlate clinical finding and subjected for operation to compare operative findings with HRCT finding. Results: Determined using Pearson chi square test indicated a statistically significant correlation between HRCT temporal bone with clinical presentation and operative findings of ear diseases (p<0.05). Conclusions: With the advent of modern high-resolution CT scanners, detailed demonstration of temporal bone anatomy is practically possible now. We have been able to identify many significant structures not demonstrated by any of the known imaging modalities. The improved contrast and soft tissue a definition possible with HRCT has resulted in production of excellent images of soft tissue lesions in air spaces. Hence HRCT appears to be the diagnostic modality of choice for cholesteatomas and other soft tissue lesions in middle ear.
International Journal of Otorhinolaryngology and Head and Neck Surgery
Background: High Resolution Computed Tomography (HRCT) has widely replaced conventional techniques (X-Ray Mastoid bone) for temporal bone imaging. The most significant use of computed tomography lies in evaluation of cases of Chronic Suppurative Otitis Media (CSOM). The objective of the study was to evaluate the usefulness of HRCT scanning of temporal bone in defining the extent and severity of disease in patients with CSOM, thereby altering the surgical plan and outcome. Methods: This prospective study was conducted at a tertiary care hospital in Ahmedabad. After obtaining approval from IEC (Institutional Ethical Committee), study was carried out on 50 patients diagnosed with CSOM of atticoantral type. Written informed consent of all patients was taken before enrollment in the study. HRCT scan findings were reviewed and correlated with per-operative findings. Results: Out of total 50 patients of CSOM, 26 (52%) were males. Majority of the patients (70%) were in the age group of 11 to 30 years. Left ear was involved in 40% of the patients. Majority of the patients (80%) presented with chief complaint of otorrhoea. In the present study, External Auditory Canal (EAC) was seen normal in majority of patients (82%) both radio logically and per operatively. HRCT scan was found to be very sensitive (96%) in diagnosing cholesteatoma. The sensitivity of HRCT for diagnosing disease in epitympanum, antrum and aditus was found to be 100%, 97% and 88% respectively. CT scans diagnosed erosion of malleus with 100% sensitivity and specificity and erosion of incus with 91% sensitivity and 100% specificity. Conclusions: HRCT was helpful in determining the anatomy of the middle ear and mastoid, and accurately predicted the extent of the disease process of CSOM.
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.
International Journal of Otorhinolaryngology and Head and Neck Surgery, 2020
Background: Chronic otitis media (COM) is characterized by ear discharge and hearing loss. There are two types of COM depending on the presence or absence of cholesteatoma. COM with cholesteatoma is termed as COM squamosal type and COM without cholesteatoma is termed COM mucosal type. COM squamosal type is associated with potential complications. If cholesteatoma is detected early, less invasive surgical methods can be used for hearing preservation and make ear safe from recurrent infections. A proper clinical examination can most often diagnose a cholesteatoma but require a high resolution computed tomography (HRCT) scan to assess the extent of the disease and potential complications. But most often the intra operative findings may not correlate with the HRCT findings. The aim of the study was to evaluate the clinical presentation of COM squamosal disease, preoperative HRCT and intra-operative findings and formulate a proper surgical intervention to avoid complications. Methods: T...
Role of Computed Tomography in diagnosis of complications in chronic suppurative otitis media
Annals of Tropical Medicine and Public Health, 2019
Chronic otitis media is chronic inflammation of middle ear cavity, it present with longstanding discharging ear and perforated tympanic membrane with or without cholesteatoma and other complications. Cross sectional study was performed to identify the role of computed tomography in diagnosis of complications in chronic suppurative otitis media among 40 patients between June 2018 and June 2019. Aim: To identify role of CT scan in diagnosis of anatomical and pathological effects of chronic suppurative otitis media as: pneumatisation of mastoid, soft tissue mass in middle ear cleft and mastoid, cholesteatoma, bones erosions, facial nerve canal dehiscence, labyrinthine and semicircular canal fistula.Patient and Methods: 40 patients included in our study between period June 2018 to June 2019, they are referred from otology department to radiology department in AL Hillah General Teaching Hospital that thin slices CT temporal bone was taken for all these patients. Results: Age incidence: between 15-20 years was 3 of 40 patients (7.5%), 20-40 was 25 (62.5%), 40-50 was 12 0f 40 patients (30%). Mean age is 32.77 years. 16 of 40 patients were female (40%), 24 of 40 patients were male (60%).Male to female ratio 1.5:1. Incidence of symptoms and signs was: headache & pain in 6 patients (15%), vertigo in 5 (12.5%), hearing loss in 30 (75%), discharging ear in 40 (100%), and facial palsy in 2 (5%). Pathology in middle ear: Granulation in 20 cases (50%), cholesteatoma in 15 (37.5%), and polyp in 5 (12.5%). Pneumatisation of mastoid bone: well in 25 cases (62.5%), sclerotic in 13 (32.5%), and poor in 2 (5%). Middle ear and mastoid mass: in CT scan 25 cases (62.5%) and in surgery 24 (60%). Cholesteatoma incidence: in CT scan 15 cases (37.5%) and in surgery 15 (37.5%). Incidence of complications: scutum erosion in CT 14 (35%) in surgery 15 (37.5%), ossicular erosion in CT 11 (27.5%), in surgery 8 (20%), facial canal dehiscence in CT 2 (5%), in surgery 3 (7.5%), labyrinthine fistula in CT 2 (5%), in surgery 1 (2.5%), semicircular canal fistula in CT 3 (7.5%), in surgery 2 (5%), tegument erosion in CT 1 (2.5%), in surgery 2 (5%), and tegument tympani erosion in CT 1 (2.5%) in surgery 1 (2.5%).