Pre-Operative Temporal Bone CT Scan Readings and Intraoperative Findings During Mastoidectomy (original) (raw)
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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...
Indian Journal of Otolaryngology and Head & Neck Surgery, 2020
High resolution computed tomography (HRCT) of temporal bone helps in understanding the complex anatomy of temporal bone and in identifying disease in temporal bone. However, its role in diagnosing cholesteatoma and analyzing its extent and complications is not established unequivocally. Present study was undertaken to check sensitivity and specificity of HRCT in diagnosing cholesteatoma and assessing its extent and in identifying ossicular destruction and other complications. In this prospective study in 50 patients with clinical diagnosis of cholesteatoma, preoperative high-resolution temporal bone CT scans axial and coronal view were carried out and compared with intra-operative findings. Kappa statistics was used for radio-surgical correlation. Comparison of CT scan findings with intraoperative findings revealed perfect correlation for sigmoid plate erosion, mastoid cortex dehiscence and scutum erosion, strong correlation for erosion of malleus, posterior superior wall and peri labyrinthine cells, good for erosion of incus and stapes, labyrinthine fistula, tegmen erosion and extent of disease and moderate correlation for facial canal dehiscence. HRCT scan of the temporal bone is useful preoperative investigation for cholesteatoma surgery for identification and documentation of ossicular status, location and extent of disease, erosion of tegmen or sinus or labyrinthine dehiscence, with the exception of facial canal dehiscence. Although it serves as road map for surgery, it still has some false positives and false negatives and the importance of a skilful, aware and alert surgeon cannot be overemphasized.Electronic supplementary materialThe online version of this article (10.1007/s12070-020-01892-z) contains supplementary material, which is available to authorized users.
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.
Indian Journal of Otolaryngology and Head & Neck Surgery, 2020
The primary objective is to classify acquired cholesteatoma according to the ChOLE classification system based on the preoperative and intraoperative findings, and to describe prevalence of each stage. The secondary objective is to correlate the extent of inside out approach mastoidectomy required with the staged extent of cholesteatoma. A non-randomized Prospective Observational study conducted in 67 patients in a tertiary care hospital. Each case was categorized according to the ChOLE classification system including cholesteatoma extension, ossicular chain status, life threatening complications and eustachian tube dysfunction. Based on the extent of disease, inside out approach mastoidectomy was done and results analysed. Most patients presented with stage 2 disease [67%]. Canal wall was preserved for all stage I, and in stage II cholesteatoma canal wall was either kept intact, reconstructed or lowered based on the extent of erosion of posterior meatal wall and cholesteatoma extension. All stage III underwent canal wall down mastoidectomy. Staging of cholesteatoma by ChOLE classification allows standardization in reporting gravity of disease and surgical outcomes. Inside out approach mastoidectomy contributes to the successful surgical management of cholesteatoma by eradicating the disease with the creation of a smaller cavity.
Cross-institutional evaluation of a mastoidectomy assessment instrument
2017
The objective of this work is to obtain validity evidence for an evaluation instrument used to assess the performance level of a mastoidectomy. The instrument has been previously described and had been formulated by a multi-institutional consortium. Design Mastoidectomies were performed on a virtual temporal bone system and then rated by experts using a previously described 15 element task-based checklist. Based on the results, a second, similar checklist was created and a second round of rating was performed. Setting Twelve otolaryngological surgical training programs in the United States. Participants 65 mastoidectomy performances were evaluated coming from 37 individuals with a variety of temporal bone dissection experience, from medical students to attending physicians. Raters were attending surgeons from 12 different institutions. Results Intraclass correlation (ICC) scores varied greatly between items in the checklist with some being low and some being high. Percentage agreement scores were similar to previous rating instruments. There is strong evidence that a high score on the task-based checklist is necessary for a rater to consider a mastoidectomy to be performed at the level of an expert but a high score is not a sufficient condition. Conclusions
Journal of evolution of medical and dental sciences, 2016
BACKGROUND Patients with chronic suppurative otitis media are very common in Barpeta district of Assam. It is also common and frequent OPD visitors in medical colleges and other hospitals across India. HRCT mastoids play an important role in diagnoses of CSOM, selection of surgical procedures and to know the anatomic details of temporal bone in revision cases. METHOD AND MATERIALS The aim of the study is to evaluate the findings of preoperative HRCT mastoids and to determine the accuracy and the usefulness of these imaging methods in patients with CSOM undergoing surgery by comparing with intraoperative findings. The study was carried out at Department of ENT and Department of Radiology of Fakhruddin Ali Ahmed Medical College and hospital from January 2012 to january2015. A total no of 50 patients with atticoantral variety of CSOM are included in the study. Preoperative HRCT mastoid done in all cases were planned for mastoid exploration. RESULT The study shows a sensitivity and specificity of 100% with regards to soft tissue masses in mastoids and middle ears. The sensitivity and specificity in respect to ossicular erosion, sinus plate erosion, LSCC, facial canal and tegmen plate dehiscence ranges from 70 to100%. CONCLUSION The study shows HRCT is a good preoperative tool which can determine disease extension in middle ear, attic and mastoid region.
Mastoid Obliteration in Cholesteatoma Surgery, Different Materials
Zagazig University Medical Journal
Background: The principal advantages of mastoid cavity obliteration are 1) reduced nitrogen-absorbing mucosa in the mastoid cavity preventing recurrence of retraction cholesteatoma in patients with eustachian tube dysfunction, 2) elimination of mastoid cavity preventing accumulation of squamous epithelium and bowel infection. The size of the surgical cavity can be diminished using obliteration to create a small cavity that is self cleaning and easily maintained. Both autologous and synthetic materials have been used for obliteration. Materials such as free graft, fat, cartilage, bone chips, bone pâté, hydroxyapatite, and periostio-muscular flaps are used. Aim of work: To evaluate the benefit from mastoid obliteration in cholesteatoma surgery. Patients and methods: This study was applied on 12 patients that have middle ear cholesteatoma.mastoidectomy had been done then obliteration either by natural or synthetic fillers had been done and followed up by DW-MRI Results: The patients consisted of 6 females (50%) and 6 males (50%). Their ages ranged from 14 to 52 years old. Conclusion: Mastoid obliteration can be used in combination with either the ICW or CWD techniques. It gives favourable long-term results. It is certainly the treatment of choice for persistent dischargeingmastoid cavities.
The Laryngoscope
Objective: Our study aims to evaluate the effectiveness of mastoid obliteration compared to the canal wall up (CWU) technique in cholesteatoma surgery based on the systematic review of the literature and the meta-analysis of the data. Methods: The systematic search was performed in four major databases (MEDLINE, Web of Science, Embase, and CENTRAL) on October 14, 2021. Studies comparing the CWU technique and mastoid obliteration were included. The exclusion criteria were less than 12 months follow-up, congenital cholesteatoma, indefinite description of the surgical method, and animal studies. The protocol was registered on Prospero (registration number: CRD42021282485). The risk of bias was evaluated with the ROBINS-I tool. Residual and recurrent disease proportions as primary outcomes, quality of life, ear discharge, infection rates, hearing results, and operation time as secondary outcomes were analyzed. In the quantitative synthesis, the random effect model was used, and heterogeneity was identified. Results: A total of 11 articles with 2077 operations' data were found eligible. All the identified studies were retrospective cohorts. The odds of pooled residual and recurrent disease proportion were significantly lower in the obliteration group compared to CWU (OR = 0.45, CI:0.28;0.80, p = 0.014). However, when separated, the proportion of ears with recurrent (OR = 0.41, CI:0.11;1.57, p = 0.140) or residual (OR = 0.59, CI:0.23, 1.50, p = 0.207) disease did not show a significant difference, even though the odds were quite similar. The qualitative synthesis identified no significant difference in the secondary outcomes, but obliteration elongated the operation time. Conclusion: Mastoid obliteration significantly decreased the proportion of residual and recurrent cholesteatoma in pooled analyses compared to the CWU technique with low-quality of data.