Comparison of preoperative high resolution computerized tomography of temporal bone with intra-operative findings in patients with cholesteatoma
Keywords:Cholesteatoma, Computed tomography scan, Correlation, Sensitivity, Specificity
Background: Aim was to study the correlation between high resolution computed tomography (HRCT) scan and intraoperative findings during surgery in cases of chronic otitis media with cholesteatoma.
Methods: This was a descriptive study conducted on 72 patients with acquired cholesteatoma at Govt TD Medical College, Alappuzha for a period of 18 months. All the patients were subjected to HRCT of the temporal bone. Radiological correlation was done with the intra-operative findings. Sensitivity, specificity, positive and negative predictive values were calculated.
Results: Total 24 (33.3%) patients had holotympanic cholesteatoma, 21 (29.2%) had involvement of the attic alone and 16 (22.2%) had attic and antrum involved. 100% correlation was found with bony wall erosions, whereas 96.9% and 75% sensitivity were noted in incus and stapes erosions respectively. 100% specificity was obtained in facial canal and sinus plate erosion, while a specificity of 96.9% in tegmen erosion and 98% in were seen in malleus erosion. By chi square test the difference in correlation was not significant (p value>0.01). Good correlation was seen for lateral semicircular canal fistula. Contrast CT is more specific, but MRI with diffusion weighted sequences is the best in imaging cholesteatoma, especially residual lesions.
Conclusions: Good correlation was found between HRCT scan and intra-operative findings in cases of cholesteatoma in relation to bony wall erosion of the surrounding structures. CT scan alone cannot differentiate soft tissue masses.
Nevoux J, Lenoir M, Roger G, Denoyelle F, Le Pointe HD, Garabédian EN. Childhood cholesteatoma. Euro Ann Otorhinolaryngol Head Neck Dis. 2010;127(4):143-50.
Dornelles C, Costa SS, Meurer L, Schweiger C. Some considerations about acquired adult and pediatric cholesteatomas. Revista Brasileira de Otorrinolaringol. 2005;71(4):536-46.
Aquino JE, Cruz Filho NA, de Aquino JN. Epidemiology of middle ear and mastoid cholesteatomas: study of 1146 cases. Braz J Otorhinolaryngol. 2011;77(3):341-347.
Rosito LS, Netto LF, Teixeira AR, da Costa SS. Classification of cholesteatoma according to growth patterns. J Am Med Assoc Otolaryngol Head Neck Surg. 2016;142(2):168-72.
Rogha M, Hashemi SM, Mokhtarinejad F, Eshaghian A, Dadgostar A. Comparison of Preoperative Temporal Bone CT with Intraoperative Findings in Patients with Cholesteatoma. Iran J Otorhinolaryngol. 2014;26(74):7-12.
Rosito LS, Netto LF, Teixeira AR, da Costa SS. Classification of cholesteatoma according to growth patterns. J Am Med Asoc Otolaryngol Head Neck Surg. 2016;142(2):168-72.
Aljehani M, Alhussini R. The Correlation Between Preoperative Findings of High-Resolution Computed Tomography (HRCT) and Intraoperative Findings of Chronic Otitis Media (COM). Clin Med Insights Ear Nose Throat. 2019;12:1179550619870471.
Baráth K, Huber AM, Stämpfli P, Varga Z, Kollias S. Neuroradiology of cholesteatomas. AJNR Am J Neuroradiol. 2011;32(2):221-9.
Gulati M, Gupta S, Prakash A, Garg A, Dixit R. HRCT imaging of acquired cholesteatoma: a pictorial review. Insights into imaging. 2019;10(1):1-8.
Gaurano JL, Joharjy IA. Middle ear cholesteatoma: characteristic CT findings in 64 patients. Annm Saudi Med. 2004;24(6):442-7.
Anbarasu A, Chandrasekaran K, Balakrishnan S. Soft tissue attenuation in middle ear on HRCT: Pictorial review. Ind J Radiol Imag. 2012;22(4):298.
Bhalla AS, Singh A, Jana M. Chronically discharging ears: evalution with high resolution computed tomography. Polish J Radiol. 2017;82:478.
Kemppainen HO, Puhakka HJ, Laippala PJ, Sipilä MM, Manninen MP, Karma PH. Epidemiology and aetiology of middle ear cholesteatoma. Acta oto-Laryngologica. 1999;119(5):568-72.
Trojanowska A, Drop A, Trojanowski P, Rosińska-Bogusiewicz K, Klatka J, Bobek-Billewicz B. External and middle ear diseases: radiological diagnosis based on clinical signs and symptoms. Insights Imaging. 2012;3(1):33-48.
Kanotra S, Gupta R, Gupta N, Sharma R, Gupta S, Kotwal S. Correlation of high-resolution computed tomography temporal bone findings with intra-operative findings in patients with cholesteatoma. Indian J Otol 2015;21:280-5
Jackler RK, Dillon WP, Schindler RA. Computed tomography in suppurative ear disease: A correlation of surgical and radiographic findings. Laryngoscope 1984;94:746-52.
Walshe P, McConn Walsh R, Brennan P, Walsh M. The role of computerized tomography in the preoperative assessment of chronic suppurative otitis media. Clin Otolaryngol Allied Sci 2002;27:95-7.
Sirigiri RR, Dwaraknath K. Correlative study of HRCT in attico-antral disease. Indian J Otolaryngol Head Neck Surg. 2011;63:155-8.
Gerami H, Naghavi E, Wahabi-Moghadam M, Forghanparast K, Akbar MH. Comparison of preoperative computerized tomography scan imaging of temporal bone with the intra-operative findings in patients undergoing mastoidectomy. Saudi Med J. 2009;30:104-8.
Datta G, Mohan C, Mahajan M, Mendiratta V. Correlation of preoperative HRCT findings with surgical findings in Unsafe CSOM. J Dent Med Sci 2014;13:120-5.
Rai T. Radiological study of the temporal bone in chronic otitis media: Prospective study of 50 cases. Ind J Otol. 2014;20(2):48.
Chee NW, Tan TY. The value of pre-operative high resolution CT scans in cholesteatoma surgery. Singapore Med J. 2001;42:155-9.
Zhang X, Chen Y, Liu Q, Han Z, Li X. The role of high-resolution CT in the preoperative assessment of chronic otitis media. Lin Chuang Er Bi Yan Hou Ke Za Zhi 2004;18:396-8.
Mafee MF, Levin BC, Applebaum EL, Campos M, James CF. Cholesteatoma of the middle ear and mastoid. A comparison of CT scan and operative findings. Otolaryngol Clin North Am 1988;21:265-93.
Prashanth V, Pandya VK. Role of CT scan in diagnosis and management of otogenic intracranial abscess. Ind J Otolaryngol Head Neck Surg. 2011;63(3):274-8.
El-Anwar MW, Eldib DB, Elmalt A, Khazbak AO. Supratubal recess and sinus tympani: CT analysis of middle ear hidden areas. Egypt J Radiol Nuclear Med. 2019;50(1):1-7.
Gomaa MA, Karim AR, Ghany HS, Elhiny AA, Sadek AA. Evaluation of temporal bone cholesteatoma and the correlation between high resolution computed tomography and surgical finding. Clinic Med Insight Ear Nose Throat. 2013;6:CMENT-S10681.
Aziz A, Md Daud MK. Primary middle ear tuberculosis mimicking cholesteatoma. Malays Fam Physic. 2020;15(1):44-6.
Yildirim-Baylan M, Ozmen CA, Yorgancilar RGE, Akkuş Z, Topcu I. An Evaluation of Preoperative Computed Tomography on Patients with Chronic Otitis Media Ind J Otolaryngol Head Neck Surg. 2012;64(1):67-70.