Radiographic imaging of mastoid in chronic otitis media: need or tradition?


  • Sabeeh Beig Department of Otorhinolaryngology, J. N. Medical College and Hospital (A. M. U.), Aligarh, Uttar Pradesh, India
  • Saifullah Khalid Department of Radiodiagnosis, J. N. Medical College and Hospital (A. M. U.), Aligarh, Uttar Pradesh, India
  • Satish Chandra Sharma Department of Otorhinolaryngology, J. N. Medical College and Hospital (A. M. U.), Aligarh, Uttar Pradesh, India



Plain radiograph mastoids, Schuller’s view, Chronic otitis media, Attico antral, Cholesteatoma


Background: Computed tomography is the imaging of choice in chronic otitis media (COM) but it is neither available at every centre nor is affordable to masses of economically weaker countries. In this situation where only X-ray facility is available should plain radiographs of mastoid be done ?. If yes then what is the analytical evidence? This study, was conducted to find the utility of plain radiographs of mastoid by comparing radiological findings vis-a-vis operative findings.

Methods: Pre-operative radiographs of mastoids (Schuller’s view (s/v)) were taken and the radiological findings were statistically analysed with the operative findings.  

Results: Plain radiograph of mastoid (s/v) predicted some of the surgical landmarks of mastoid surgery viz tegmen and sinus plates with a fair degree of accuracy. The positive predictive value (PPV) for radiolucent shadow (assumed to indicate bone destruction and thus cholesteatoma) was also high but at the same time, a low negative predictive value and a Cohen’s kappa test showing only a fair agreement underscores the point that absence of a radiolucent shadow does not rule out the presence of cholesteatoma.

Conclusions: Radiographs of mastoid are helpful in providing a prior knowledge of the surgical landmarks in mastoid surgery. Hence with this information, if a surgeon finds himself more at ease in operating a patient then this imaging should be done when CT scan facility is unavailable. However, citing the limited information on other aspects of the disease, its use as a ‘routine’ investigation in chronic otitis media is discouraged.



World Health Organization; Chronic suppurative otitis media, Burden of illness and Management options; report of Department of Child and Adolescent Health and Development, Prevention of Blindness and Deafness, Geneva; 2004.

Beig S, Sharma SC, Khalid M. Revisiting Correlation Between Pre-Operative High-Resolution Computed Tomography and Operative Findings in Attico Antral Disease. Indian J Otolaryngol Head Neck Surg. 2018:1-6.

Gerami H, Naghavi E, Moghadam WM, Forghanparast K, Akbar MH. Comparison of preoperative computerized tomography scan imaging of temporal bone with the intraoperative findings in patients undergoing mastoidectomy. Saudi Med J. 2009;30:1048.

Leighton SEJ, Robson AK, Anslow P. The role of CT imaging in management of CSOM. Clin Otolaryngol. 1993;18:23-9.

Bates GJ, O'Donoghue GM, Anslow P, Houlding T. Can CT Detect Labyrinthine Fistulae Preoperatively. Acta Otolaryngologica. 1988;106:40-5.

Gaurano JL, Joharjy IA. Middle ear cholesteatoma: Characteristic CT findings in 64 patients. Ann Saudi Med. 2004;24:4427.

Rai T. Radiological study of the temporal bone in chronic otitis media: Prospective study of 50 cases. Indian J Otol. 2014;20:48-55.

Zhaohui L, Zhenchang W, Junfang X, Kun Z, Hong Z. HRCT study of anatomic variations of temporal bone. Chin Arc Otolaryngol Head Neck Surg. 2006;2:97-101.

Tomura N, Sashi R, Kobayashi M, Hirano H, Hashimoto M, Watarai J. Normal variations of the temporal bone on high‑resolution CT: Their incidence and clinical significance. Clin Radiol. 1995;50:144-8.

Zelikovich EI. Computed tomography of the temporal bone in diagnosis of otitis media chronicapurulenta. Vestn Otorinolaringol. 2004;4:25-9.

Keskin S, Çetin H, Tore HG. The Correlation of temporal bone CT with surgery findings in evaluation of chronic inflammatory diseases of the middle ear. Eur J Gen Med. 2011;8:24-30.

O’Reilly BJ, Chevretton EB, Wylie I, Thakkar C, Butler P, Sathanathan N, et al. The value of CT scanning in chronic suppurative otitis media. J Laryngol Otol. 1991;105:990-4.

Jackler RK, Dillon WP, Schindler RA. Computed tomography in suppurative ear disease: a correlation of surgical and radiographic findings. Laryngoscope. 1984;94:746‑52.

O’Donoghue GM. Cholesteatoma: Diagnosis and staging by CT scan. J Otolaryngol. 1987;12:157-60.

Alzoubi FQ, Odat HA, Balas AHA, Saeed SR. The role of pre-operative CT scan in patients with chronic otitis media. Eur Arch Otorhinolaryngol. 2009;266:807-9.






Original Research Articles