HRCT Temporal Bone- A Mandatory Preoperative Investigation for Improving Surgical Outcome in Unsafe Csom

Abstract

BACKGROUND Chronic Suppurative Otitis Media (CSOM) is considered to be a slowly progressive destructive disease of the middle ear. It is the most commonly encountered middle ear pathology, which disrupts the normal anatomy and physiological functioning of the ear. Otoscopic evaluation is sufficient to establish the diagnosis of the disease; however, its extent can be determined only on the basis of a High Resolution Computed Tomography (HRCT) of the temporal bone. While the most common presentation of CSOM is a discharging ear. Its complications may be masked by the disease itself, thereby giving a false presentation of a limited extent. HRCT temporal bone can help quantify the extent of the disease and hence prioritise the patients who warrant an urgent management.The aim of this study is to establish the importance of HRCT temporal bone in a patient with unsafe CSOM, even in absence of clinical suspicion of ongoing complication to improve the surgical outcome. MATERIALS AND METHODSThis study has been conducted on 50 patients who have presented to the ENT OPD at RGMC, Kalwa. RESULTSOut of 50 patients who presented with complications, 20 patients (40%) did not have any history suggestive of impending complications. The HRCT temporal bone helped in establishing the presence of these complications and allowing for prompt treatment. CONCLUSIONIt was found that presence of HRCT helps in determining lurking complications and thus helps in deciding the urgency with which tympanomastoidectomy surgery needs to be performed. KEY WORDSHRCT, Temporal Bone, Mastoid, Cholesteatoma. HOW TO CITE THIS ARTICLE: Baviskar S, Mehta L, Gori T, et al. HRCT temporal bone-a mandatory preoperative investigation for improving surgical outcome in unsafe CSOM.

Role of High-Resolution Computed Tomography Temporal Bone in the Evaluation of Unsafe Chronic Suppurative Otitis Media

“…This is comparable to the study by Sirigiri and Dwaraknath who found sensitivity of 100% and specificity of 94% [16]. The positive predictive value is low 66.6% which correlates with the study by Baviskar et al which was 66.7% [22].…”

“…HCRT is 100% sensitive and specific to detect scutum erosion which is in accordance with the study by Juveria and Sudarshan and Rocher et al [20,21]. The tegmen was found to be eroded in 12% of cases with sensitivity of 100% which is in accordance with Baviskar et al [22] and Jackler et al [15]. However, few studies have shown lower sensitivity values between 45 and 50% [9][10][11].…”

High Resolution Computed Tomography Findings of Temporal Bone in Patients With Unsafe Chronic Suppurative Otitis Media.

“…Erosion of the facial nerve canal was found in 32% cases in our study with the tympanic part being more commonly affected which is more than as observed by Baviskar S et [14] al in his descriptive study of 50 patients of unsafe CSOM.The variable results can be explained by the small number of cases of facial [10] nerve canal dehiscence and statement made by Mafee et al .They had stated that visualisation of thin bony structures like facial nerve canal may be misleading due to error in computer reconstruction of their images. The fact that computer averages their density with adjacent soft tissue and air makes these structures appear eroded.…”

“…Tegmen tympani erosion was seen in 38% cases in our study. In the study conducted by Baviskar [14] et al showed erosion of tegmen tympani only in 20% cases.…”