Correlation of HRCT mastoid with clinical presentation and operative findings in ear diseases

Abstract

INTRODUCTIONThe human temporal bone has an extremely complex structure. Direct axial and coronal CT sections are quite satisfactory for imaging the anatomy of the temporal bone but most of the normal and pathological details of the temporal bone are better visualized with direct sagittal CT sections. The sagittal projection is of interest for surgeons, as it has the advantage of following the plane of surgical approach. HRCT is found to be extremely useful for evaluating the diseases involving the external auditory canal, middle ear cavity, vertical segment of facial nerve canal, vestibular aqueduct, tegmen tympani, sigmoid sinus plate, sinodural angle, carotid canal, jugular fossa, infra and supralabrynthine air cells and temporomandibular joint. HRCT has contributed greatly to an understanding of the complex anatomy and spatial relationship of the minute structures of hearing and balance organs, which are packed into a small pyramidshaped petrous temporal bone. HRCT shows not only soft tissue extension but also gives a more sensitive demonstration of calcification. It has also become useful ABSTRACT Background: HRCT is found to be extremely useful for evaluating the ear diseases involving the external auditory canal, middle ear cavity, vertical segment of facial nerve canal, vestibular aqueduct, tegmen tympani, sigmoid sinus plate, sinodural angle, carotid canal, jugular fossa, infra and supralabrynthine air cells and temporomandibular joint. Our main objective was to correlate the clinical presentation and operative findings of ear diseases with HRCT mastoid. Methods: This study is done in our institute otorhinolaryngology dept. from April 2014 to April 2016. This is prospective study involves 36 patient belonging to different age and sex groups with high suspicious of ear diseases. We have taken detail history of each patient with complete ear nose throat examination done and after that all patient were investigated with routine blood investigation, X-ray and HRCT mastoid to correlate clinical finding and subjected for operation to compare operative findings with HRCT finding. Results: Determined using Pearson chi square test indicated a statistically significant correlation between HRCT temporal bone with clinical presentation and operative findings of ear diseases (p<0.05). Conclusions: With the advent of modern high-resolution CT scanners, detailed demonstration of temporal bone anatomy is practically possible now. We have been able to identify many significant structures not demonstrated by any of the known imaging modalities. The improved contrast and soft tissue a definition possible with HRCT has resulted in production of excellent images of soft tissue lesions in air spaces. Hence HRCT appears to be the diagnostic modality of choice for cholesteatomas and other soft tissue lesions in middle ear.

Pre-operative prediction of cholesteatomas from radiology: retrospective cohort study of 106 cases

“…Sensitivity values ranged from 33 per cent to 100 per cent. 1–4,6,8,9,12,15,16,18 Specificities were also widely spread, ranging from 48 per cent to 100 per cent. The incidence of facial nerve dehiscence is relatively low, and therefore the sample size of patients needed to generate accurate statistical measures would generally be larger than the cohorts we have compared against.…”

“…6 reported sensitivity values of 90 per cent, 98 per cent and 100 per cent, respectively. Our cohort had a sensitivity of 75 per cent, which is more in keeping with the studies of Khavasi et al ., 4 Chintale et al ., 8 Kumaresan and Nirmala, 9 and Rogha et al . 14 (which reported sensitivity values of 66–75 per cent).…”

High resolution computed tomography of temporal bone in the evaluation of otologic diseases

“…7 HRCT is able to accurately delineate the fracture lines, ossicular disruptions and facial nerve canal injury. 1 While some authors recommend selective use of HRCT to complement decision making in cases of trauma, many studies indicate that HRCT temporal bone helps in planning the management of patients presenting with temporal bone trauma. 1,2,7,8 Appropriate and timely radiological imagining with accurate delineation of the fracture plane and assessment of associated soft-tissue injury, may help in improved management of the patients with temporal bone trauma.…”

“…The availability of modern highresolution computerized tomography (HRCT) scanners has resulted in ability to demonstrate the detailed temporal bone anatomy and identify significant structures and has revolutionalized the role of radiology in diagnosis and management of temporal bone diseases. 1 depiction of calcification of the soft tissue. In patients with temporal bone trauma, HRCT accurately evaluates the fracture lines, ossicular disruptions and facial nerve canal injury.…”

Clinicoradiological correlation between preoperative high-resolution computed tomography findings and intraoperative findings in chronic otitis media (squamous type)

“…3 Accurate identification of the nature, site, size, extension and invasion into adjacent structures and tissue plane including the intracranial extension has been made possible by HRCT thereby affecting the course of the management. 4 The use of HRCT in the preoperative evaluation of the patient with chronic otitis media is still controversial. Some autologist use it regularly aiming to evaluate the extension of the disease, which helps to plan the surgical strategies and helps to reduce the postoperative risks.…”