Is there a role for virtual otoscopy in the preoperative assessment of the ossicular chain in chronic suppurative otitis media? Comparison of HRCT and virtual otoscopy with surgical findings

Abstract

The aim of this study was to assess the role of virtual otoscopy and 3D ossicular reconstruction in the preoperative assessment of the ossicles in chronic suppurative otitis media. Thirty three patients of chronic suppurative otitis media with conductive deafness (air-bone gap > 35 dB) were included in this prospective study. All patients underwent axial multidetector CT. The axial CT data set was utilized for multiplanar 2D reformations as well as virtual otoscopy (VO) and 3D reconstructions. The imaging findings on these two techniques were read independently by two radiologists with respect to different parts of the ossicular chain by using a three-point scoring system and were compared with surgical findings. Both imaging techniques had comparable accuracy for evaluation of larger ossicular parts. However, for evaluation of stapes superstructure, VO/3D images were more accurate (85.29%) than 2D images (76.97%). Assessment of the lenticular process and incudostapedial joint by HRCT and 2D reformatted images was not reliable (P > 0.1); however, significant correlation (P < 0.001) was present between VO/3D and the operative findings. Virtual otoscopy improves evaluation of the ossicular chain particularly that of smaller structures such as the lenticular process, incudostapedial joint and stapes superstructure which may influence decisions regarding planning of ossiculoplasty.

Reconstruction and exploration of virtual middle-ear models derived from micro-CT datasets

“…However, their protocol limited the radiologist to two standardized views with surface rendering only. Similarly, Pandey et al (2009) reported that 3D reconstructions were superior to standard 2D views for evaluation of the stapes superstructure, and results correlated strongly with intraoperative findings (Pandey et al, 2009). The radiologist in this study was limited to six standardized views.…”

Quality assessment of 3D-CTVR, MPR and section plane techniques in ossicular chain reconstruction in middle ear cholesteatoma

“…In his pre-operative imaging assessment of ossicles in 30 chronic suppurative otitis media with cholesteatoma patients, Pandey described that their assessments were satisfactory in larger ossicular parts. However, in the evaluation of stapes superstructure, their accuracy of MPR (in multiplanar 2D reformation) was only 76.97% [12]. In our study, it was 75% for MPR but 40% for section plane.…”

Value of section plane, MPR, and 3D-CTVR techniques in the fine differential diagnosis of ossicular chain in the case of conductive hearing loss with intact tympanic membrane

“…Pandey A.K. reported that the assessments of the larger ossicular structure tend to be satisfactory and that the accuracy of assessments of the superstructure of the stapes were 76.97% for MPR but only 40% for section plane imaging ( Pandey et al., 2009 ). This means that MPR can indicate anatomical features and pathologic conditions more precisely than section plane and can distinguish otosclerosis from absence of the ossicular chain more readily than other methods.…”