Differentiation between cholesteatoma and inflammatory process of the middle ear, based on contrast-enhanced computed tomography imaging (original) (raw)
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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.
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.
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...
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..
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.
Imaging of non-operated cholesteatoma: clinical practice guidelines
European annals of otorhinolaryngology, head and neck diseases, 2012
Middle ear cholesteatoma is an aggressive form of chronic otitis media requiring surgical therapy. The surgical strategy depends on the location of the lesion, its extensions to the middle ear and mastoid, the anatomical conformation of the tympanomastoid cavities and the health status of the patient (as well as his or her interest in aquatic leisure activities). For several years, imaging of the ear has been a routine test in the preoperative work-up of the disease. National guidelines for the topic "Imaging of non-operated middle ear cholesteatoma" were prepared in October 2010, for the annual congress of the French Society of Otolaryngology Head and Neck Surgery (SFORL), by a panel of experts from the SFORL, represented by the French Association of Otology and Neuro-otology (AFON), and the French Radiological Society (SFR), represented by the French Society of Head and Neck Imaging (CIREOL). These guidelines are presented in the present article.
Canal wall reconstruction in cholesteatoma surgeries: rate of residual
European Archives of Oto-Rhino-Laryngology, 2014
To evaluate the rates of residual and recurrent cholesteatoma following canal wall reconstruction (CWR) tympano-mastoidectomy with mastoid obliteration, for the treatment of chronic otitis with cholesteatoma. Consecutive cohort study. We included patients following surgical cholesteatoma removal by CWR tympano-mastoidectomy with hydroxyapatite mastoid obliteration from 2008 to 2012. We analyzed audiometric and postoperative radiologic data. We determined the rates of residual disease and recurrence, and evaluated postoperative complications. Thirty-six ears were included in this study. The mean follow-up after surgery was 24 months (range 12.3-51.4 months). The recurrence rate was 3.1% (one case) and the rate of residual disease was 6.2% (two cases including one of iatrogenic cholesteatoma). No canal-wall-down tympanoplasty was required. Local infection was detected in 33% of cases and was successfully treated with appropriate antibiotics. Postoperative audiometry showed no impairment of the cochlear reserve. No postoperative facial palsy or deafness was observed. CWR permits well exposure of the lesion, making complete excision of the cholesteatoma possible. This study showed a decreasing of the rate of residual cholesteatoma and must be confirmed with further studies. CWR makes it possible to use hearing aids for auditory rehabilitation.
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.
2004
Aim of the study was to evaluate the functional results, in two homogeneous groups, for severity of the disease, submitted to canal-wall-down tympanoplasty (TPL CWD), with and without ossiculoplasty. A total of 60 patients who underwent canal-wall-down tympanoplasty for cholesteatoma were evaluated: 31 underwent ossiculoplasty (group A) and 29 classic Wullstein type III and IV operation (group B). Hearing results were evaluated 2 years after surgery according to the AAO-HHS guidelines. Pre-operative audiometrics revealed an air conduction PTA (AC-PTA) of 45.12 dB in group A, and 56.25 dB in group B. Bone conduction PTA (BC-PTA) was 16.86 dB in group A and 26.06 in group B. Two years after surgery, AC-PTA was 42.98 dB in group A and 58.65 dB in group B; BCPTA was 18.79 dB in group A and 25.13 dB in group B. The mean pre-operative ABG was 28.44 dB in group A and 30.14 dB in group B. Two years after surgery, group A showed a mean ABG of 24.06 and group B of 35.54 dB, the difference bet...