A cross sectional study to assess the role of preoperative HRCT temporal bone in CSOM: a comparison between middle ear surgeries with and without pre-op HRCT

Madhuri S. More, Rahul B. Patel, Jaymin A. Contractor, Alpa P. Pipaliya, Esha J. Desai, Bhavik M. Patel


Background: Importance of HRCT before middle ear surgery is proved by many published articles but most of the studies were done without evaluating the accuracy of clinical judgment at the same time.

Methods: All the patients of CSOM in whom the middle ear surgery was planned were included in the study. Total number of sample size was 80 patients. Group A: 20 patients in which HRCT temporal bone was indicated as a routine evaluation before middle ear surgeries. Group B: 60 patients in which HRCT temporal bone was not indicated.  

Results: Maximum 43.75% (35) patients belong to 21 to 30 yrs. F: M is 1.5:1. Unilateral ear disease is more common (62.5%). 41.8% had mucosal type while 16.25% had squamosal type of COM. 77.5% ears found to have hearing loss. Conductive hearing loss was the most common (43.13%). HRCT in comparison with Intra-op had Kapa value of 1 (Aditus blockage & Tegmen erosion), 0.6 (sinus plate erosions), 0.5 (malleus, Incus, stapes erosions), 0.48 (Ossicular chain status), 0.46 (Scutum erosion), 0.4 (LSC fistula) and 0.3 (fallopian canal erosions. Clinical judgment in comparison with intra-op had kapa value of 1 (stapes erosion), 0.96 (aditus blockage), 0.79 (Incus erosion), 0.78 (malleus erosion) and 0.76 (ossicular chain status).

Conclusions: Clinical judgment is as good as or even better than CT in presuming/detecting at least individual ossicular erosions, ossicular chain status, aditus blockage and HRCT temporal bone should be reserved for high risk and complicated cases.


CSOM, Middle ear surgery, HRCT temporal bone

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