Utility of high resolution computed tomography in pre-operative evaluation of cholesteatoma


  • Amith Jacob Department of Otorhinolaryngology, MES Medical College, Malappuram, Kerala, India
  • Sandeep Sreedhar Department of Otorhinolaryngology, MES Medical College, Malappuram, Kerala, India
  • Anwar Sadath Choolakkaparambu Aboobakker Department of Otorhinolaryngology, MES Medical College, Malappuram, Kerala, India
  • Nalakath Kunjhimon Bashir Department of Otorhinolaryngology, MES Medical College, Malappuram, Kerala, India




Cholesteatoma, HRCT, Sensitivity, Specificity, Predictive value


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. 


Persaud R, Hajioff D, Trinidade A, Khemani S, Bhattacharyya MN, Papadimitriou N, et al. Evidence-based review of aetio-pathogenic theories of congenital and acquired cholesteatoma. J Laryngol Otol. 2007;121(11):1013-9.

Vikram BK, Udayashankar SG, Naseeruddin K, Venkatesha BK, Manjunath D, Savantrewwa IR. Complications in primary and secondary acquired cholesteatoma: a prospective comparative study of 62 ears. Am J Otolaryngol. 2008;29(1):1-6.

Potsic WP, Korman SB, Samadi DS, Wetmore RF. Congenital cholesteatoma: 20 years’ experience at The Children’s Hospital of Philadelphia. Otolaryngol Neck Surg. 2002;126(4):409-14.

Koltai PJ, Nelson M, Castellon RJ, Garabedian EN, Triglia JM, Roman S, et al. The natural history of congenital cholesteatoma. Arch Otolaryngol Neck Surg. 2002;128(7):804-9.

Semaan MT, Megerian CA. The pathophysiology of cholesteatoma. Otolaryngol Clin North Am. 2006;39(6):1143-59.

Gaurano JL, Joharjy IA. Middle ear cholesteatoma: characteristic CT findings in 64 patients. Ann Saudi Med. 2004;24(6):442-7.

Banerjee A, Flood LM, Yates P, Clifford K. Computed tomography in suppurative ear disease: does it influence management. J Laryngol Otol. 2003;117(6):454-8.

Mohammadi G, Naderpour M, Mousaviagdas M. Ossicular erosion in patients requiring surgery for cholesteatoma. Iran J Otorhinolaryngol. 2012;24(68):125.

Payal G, Pranjal K, Gul M, Mittal MK, Rai AK. Computed tomography in chronic suppurative otitis media: value in surgical planning. Indian J Otolaryngol Head Neck Surg. 2012;64(3):225-9.

Sirigiri RR, Dwaraknath K. Correlative study of HRCT in attico-antral disease. Indian J Otolaryngol Head Neck Surg. 2011;63(2):155-8.

Datta G, Mohan C, Mahajan M, Mendiratta V. Correlation of preoperative HRCT findings with surgical findings in Unsafe CSOM. J Dent Med Sci. 2014;13(1):120-5.

Malashetti S. An evaluation of preoperative high-resolution computed tomography of temporal bone in cholesteatoma. Int J Otorhinolaryngol Head Neck Surg. 2018;4(2):413.






Original Research Articles