Role of High Resolution Computed Tomography in the Evaluation of Suppurative Diseases of Middle Ear and Mastoids and Their Complications with Surgical Correlation (original) (raw)
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Arq. int. …, 2011
Introduction: The chronic otitis media (COM) is a prevalent disease and the most frequent cause of indication to mastoidectomy. Many studies have evaluated the use of tomography (CT) of temporal bones for preoperative evaluation of COM and its indication in the preoperative approach is still controversial nowadays. Objective: To evaluate the sensitivity of the clinical and radiological findings of COM according to the intraoperative surgical results and histopathological findings. Method: Transversal retrospective study through collection of record data of patients with COM submitted to mastoidectomy in the period from 2007 through 2008 in our service. Results: From a total of 82 ears, 40.24% had cholesteatoma. The CT presented 72.73% of sensitivity in the identification of cholesteatoma, 56.67% in the identification of changes to the ossicular chain and 100% in that of erosion of the lateral semicircular canal. Conclusion: The clinical and radiological findings showed a high level sensitivity with intraoperative findings as regards to the presence of cholesteatoma, large changes of the ossicular chain and erosion of the lateral semicircular canal. For minor changes to the ossicular chain, the facial nerve canal and the tympanic tegmen they described low sensitivity.
International Journal of Advances in Medicine, 2019
Background: Prior to surgery it is very important that the surgeon is fully aware, and he should have the clear picture as to the extent of the disease and the nature of the disease to give satisfactory surgical outcomes for the patient. HRCT (High resolution computed tomography) is one such guiding tool for the surgeon. The objective was to study usefulness of HRCT scan in attico-antral disease in depicting the status of the middle ear structures.Methods: A total of 30 patients were studied. HRCT temporal bone was performed by using SIEMENS EMOTION 16 slice CT machine in axial plane and coronal images were reformatted. Findings of HRCT temporal bone were recorded. Findings of mastoid exploration surgery were recorded. Report of HRCT of temporal bone was correlated with surgical findings and tabulated using percentages.Results: Surgery showed cholesteatoma in 26 (86.6%) patients. Epitympanum was involved in 29 (96.6%) patients in HRCT and 30 (100%) patients at surgery. Extension b...
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
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.
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.
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.
ROLE OF HIGH RESOLUTION COMPUTED TOMOGRAPHY IN THE EVALUATION OF TEMPORAL BONE LESIONS
Asian Journal of Pharmaceutical and Clinical Research Journal, 2022
Objectives: The study's primary goal is to assess inflammatory, traumatic, and neoplastic disorders that impact the temporal bone using high resolution computed tomography (HRCT). The other aim is to comprehend how HRCT can diagnose and detect pathologies of the temporal bone. Methods: The study was conducted at Dr. Patnam Mahender Reddy Institute of Medical Sciences from Jan 2018 to Jan 2020 with a sample size of 60. Written consent for participation in the study was taken before the scan. The study was evaluated with multidetector HRCT-HITACHI 128 SLICE machine. CT images are usually acquired or displayed in axial and coronal planes. Results: Among 60 patients, 44 patients were diagnosed with infections, 11 were diagnosed with tumors, and five patients with anatomical variants. Among 60 patients, 32 (53.3%) were male patients, and 28 (46.6%) were female patients; hence, study shows a male preponderance. Out of 60 patients, the highest number was recorded in those aged 21-30 years 16 (36%). Among 60 patients, 44 suspected of having a middle ear infection were studied. Among these 44 patients, 27 (61.3%) were diagnosed with otomastoiditis, 16 (36%) patients were diagnosed with cholesteatoma, and 1 (2.2%) patient was diagnosed with malignant otitis externa. In our study population of 60 patients, 11 were diagnosed with neoplasms. Among the 11 patients, 7 (67%) were diagnosed with acoustic neuroma in the cerebellopontine angle. Conclusion: The existence of cholesteatoma, changes to the ossicular chain, and erosion of the lateral semicircular canal were all intraoperatively detected in the present study with excellent sensitivity to the clinical and radiographic findings. For correcting any congenital ear anomalies, the HRCT results were helpful for planning and management tools for the surgeon.
High resolution computed tomography of temporal bone in the evaluation of otologic diseases
International Journal of Otorhinolaryngology and Head and Neck Surgery, 2017
HRCT is particularly helpful in evaluating the anatomy and pathology of external auditory canal, middle ear cavity, vestibular aqueduct, tegmen tympani, sigmoid sinus plate, vertical segment of facial nerve canal, sinodural angle, carotid canal, jugular fossa, infra and supralabrynthine air cells and temporomandibular joint; both soft tissue extension and significantly sensitive ABSTRACT Background: Conventional radiological methods like X-ray mastoid have limited ability to delineate the details of the complex temporal bone and cochlea-vestibular anatomy and disease pathology. This can be overcome by the use of High resolution computed tomography (HRCT) evaluation of the temporal bone. HRCT is helpful in evaluating the anatomy and pathology type and extent of disease, thereby helps in preoperative planning. Methods: The CT scan of forty five patients attending the outpatient department of otorhinolaryngology in a tertiary care centre between August 2014 to August 2017 was evaluated in this study. Each CT scan was interpreted by an otolaryngologist and a radiologist and interpretation was by consensus. The data collected was evaluated and results are reported as rates and proportions (%). Results: The study evaluated CT scan of 45 patients of which 35 were male patients and 10 were female patients with age ranging from 5 years to 75 years. Most of these patients belonged to the 21-30, 31-40 age groups [9 (20%) in each group]. Infections of middle ear cleft (all with cholesteatoma), fractures of the temporal bone, anomalies and tumors of the external auditory canal and middle ear were the pathologies observed in these CT scans with infection (otomastoiditis) [23 (51.1%)] being the most common pathology observed. Conclusions: Pre-operative CT scan may not only help in identifying the nature, extent of infectious disease including ossicular, bony erosions; it may also identify anomalies in the temporal bone and surrounding structures. Thus, HRCT temporal bone will help the surgeon in planning effective surgical strategy, reducing morbidity during the surgery.
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...
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