Role of CT Mastoids in the Diagnosis and Surgical Management of Chronic Inflammatory Ear Diseases

Abstract

Chronic Suppurative Otitis Media (CSOM) is a chronic inflammation of middle ear cleft. It presents with discharging ear and decreased hearing. The diagnosis is mostly on clinical examination with otoscope or oto endoscope. Computerised Tomography (CT) of mastoids is done to evaluate the extent of the disease and its complication. High resolution CT is now the investigation of choice for temporal bone disease. This study emphasizes on the importance of CT scan in diagnosis of inflammatory ear diseases and most importantly identifying pitfalls or complications which a surgeon can come across during surgery. The aims and objectives of this study is (1) to establish the efficacy of CT in the diagnosis of the complications and surgical management of chronic inflammatory pathologies of middle ear. (2) To find subgroups of CSOM where CT is particularly useful. In this series, a total of 25 cases presenting to our OPD at Govt. ENT Hospital between 2013 and 2014 have been diagnosed and findings of surgery correlated with HRCT scan of temporal bones done preoperatively. In this study, 64 % of the patients were male and incidence of CSOM with patients undergoing surgery belonged to the age group 21-30 years (32 %). The most common presenting symptom was ear discharge (92 %) and decreased hearing (96 %). The most common type of pathology in this study was attic perforation (36 %) and granulations (40 %) followed by cholesteatoma (36 %) and mucosal edema (16 %). Not all cases presented with complications, facial palsy (12 %) and mastoid abscess (8 %) were among few complications seen. 14 patients (56 %) of 25 cases underwent simple cortical mastoidectomy followed by 9 cases (36 %) for modified radical mastoidectomy and atticotomy for 2 cases (8 %). CT scan findings correlated well with surgical findings for cholesteatoma, middle ear mass and bone erosions. Where as for ossicular integrity and facial canal dehiscence, there was a discrepancy.

Radio-surgical correlation of chronic suppurative otitis media

“…This is similar to the ratio described in the literature. Majeed et al, reported a ratio of 1.77:1, which was comparable to the study done by Vlastarakos et al 2,5 In our study, the youngest patient was 6 years old and the eldest was 58 years old with the mean age of the patients being 27.17 years. The mean age in similar studies done in other countries is found to be higher than this.…”

“…By virtue of its projection advantage and superior contrast resolution compared to conventional tomography, HRCT imaging can accurately detail the anatomy as well as demonstrate the pathology in the middle ear cleft. 2 In the present study all the cases of chronic suppurative otitis media who underwent HRCT temporal bone imaging were retrospectively analysed. We found 92 such cases.…”

“…6 The lower mean age in our study can be explained by the higher incidence of CSOM cases in our country which is corroborated by Majeed et al in their study. 2 If we analyses the patients according to the disease category among the 92 patients, 82 had chronic suppurative otitis media attico-antral disease, 9 were diagnosed to have aural polyp and 1 had chronic suppurative otitis media, tubo-tympanic disease ( Figure 1). As explained, HRCT has a crucial role in describing the anatomy and evaluating the pathology in chronic suppurative otitis media attico-antral disease cases.…”

“…This is comparable to the findings noted in the study by Majeed et al, and Sirigiri et al, who demonstrated 100% sensitivity and 90% specificity in detecting cholesteatoma through computerized tomography. 2,7 Blunting of scutum is the first sign of attic cholesteatoma on HRCT and as such can detect the early stages of cholesteatoma, which can be beneficial to the patients as a limited surgery like atticotomy will clear the disease and preserve hearing. Rocher and colleagues proved this point by demonstrating excellent correlation for the scutum erosion on HRCT with a κ>0.…”

“…With the advances in the field of radiology the role of modern multi-detector, multi-row computerized tomography scanning systems in evaluating cholesteatoma and its complications is indispensible. 2 High resolution computerized tomography (HRCT) of temporal bone also gives an idea about the anatomical variations helping the surgeon prepare for the surgery. But it cannot differentiate between cholesteatoma, granulation tissue, scar tissue or secretions in the middle ear.…”