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DOI : 10.21176/ ojolhns.0974-5262.2015.09.

IMPORTANCE OF PRE-OPERATIVE HRCT TEMPORAL BONE

IN CHRONIC SUPPURATIVE OTITIS MEDIA


* Sunita M, **A.P. Sambandan

ABSTRACT

INTRODUCTION

Aim: The role of pre-operative HRCT temporal


bone in evaluating the extent and severity of disease
in patients with chronic suppurative otitis media.

of chronic suppurative otitis media with pre-operative

Diagnostic imaging to know the extent of


disease in chronic suppurative otitis media whether
it is tubotympanic type or atticoantral type was only
x-ray of the mastoids, routinely. After the advent of
CT scan, high resolution computed tomography of
the temporal bone has become very valuable in
identifying the extent of the disease. HRCT temporal
bone is not regularly recommended for routine

HRCT temporal bone and the results analyzed.

CSOM patients.

Setting and design: A prospective study in a


tertiary care centre
Materials and methods: Study done on 50 patients

Results: HRCT is useful in detecting the extent of

1,2

However they are recommended

in those patients with cholesteatoma.

3-5

This study

ossicular chain involvement, tegmen, scutum and lateral

highlights the importance of HRCT in


tubotympanic and atticoantral type of CSOM.

semicircular canal erosion, and facial canal dehiscence.

MATERIALS AND METHODS:

Conclusion: HRCT is useful prior to surgical


approach in patients with actively discharging
tubotympanic and atticoantral type of CSOM.

This is a prospective study in which preoperative HRCT temporal bone with 0.6mm cuts
was done on 50 patients with chronic suppurative
otitis media both tubotympanic and atticoantral type.

soft tissue involvement in the middle ear and mastoid,

Keywords: HRCT temporal bone, CSOM


tubotympanic type, CSOM atticoantral type, Surgery.

The parameters studied are:


1.

Presence of mastoid pneumatisation

Dr. Sunitha. M

2.

Soft tissue density

Assistant Professor,

3.

Erosion of scutum, tegmen, lateral semicircular


canal, sinus plate, mastoid cortex

Sri Muthukumaran Medical College

4.

Facial canal dehiscence

Hospital & Research Institute,

5.

Ossicular chain status

Address for correspondence:

Vol.-9, Issue-I, Jan-June - 2015

both

Department of ENT,

Chennai-600069.
Mobile: 09488037684
E-mail: drsunithavasu@gmail.com

The patients were evaluated with clinical history


and

thorough

otoendoscopy or

examination
examination

including
under

otoscopy,
microscope,

diagnostic nasal endoscopy and pure tone audiometry.

10

*Assistant Professor, Department of ENT, **Professor & HOD, Department of ENT, Sri Muthukumaran Medical College Hospital & Research Institute,
Chennai.

DOI No.: 10.21176/ ojolhns.0974-5262.2015.09.1

The patients were subjected for x-ray both


mastoids and HRCT temporal bone. These
patients underwent surgery accordingly.
OBSERVATIONS:
In this study 31 patients(62%) were in the age group
20-30years and the mean age group was 27 years. The
youngest was 11 years and the oldest was 59 years.

Male:female ratio was 0.9:1.


Based on clinical diagnosis, tubotympanic
type of CSOM was seen in 31 cases, of which 25
cases were inactive type and 6 were active type.
Atticoantral type of CSOM was seen in 19 cases.
On x-ray mastoids, pneumatisation was seen in
30%, diploeic in 8%, sclerosed mastoid in 54% and
cavity in 8% of the cases. On HRCT temporal bone,
pneumatisation was seen in 38%, diploeic in 4%,
sclerosed in 50% and cavity in 8% of the cases.

Whereas in atticoantral type of CSOM, the extent


of involvement was more in the epitympanum,
followed by antrum, aditus, posterior tympanum,
rest of middle ear and mastoid air cells.
The ossicular destruction was more common
with incus, followed by stapes in actively discharging
tubotympanic type of CSOM. In atticoantral type of
CSOM, incus was most commonly eroded, followed
by stapes and malleus.
In inactive tubotympanic type of CSOM, there was
no soft tissue opacity in the middle ear and mastoid,
and the ossicular chain was intact in all the 25 cases.

Table II: Other HRCT findings in TT type and AA type.

Soft tissue density was seen in 6 cases in actively


discharging tubotympanic type of CSOM and in all the
19 cases of atticoantral type of CSOM. The extent of
involvement of the disease in this tubotympanic type of
CSOM

was

more

in

the

antrum

followed

by

epitympanum, aditus, mastoid air cells and middle ear.

DISCUSSION:
The pneumatisation and the status of the mastoid
was better appreciated on HRCT temporal bone. These
findings were similar to study by Vlastarakos et al.
11

Issue- JanJune
I,

Facial canal dehiscence was seen in 1 case in


tubotympanic type and in 4 cases in atticoantral type of
CSOM.

Vol.9,

Scutum, tegmen, lateral semicircular canal,


mastoid cortex and sinus plate erosion was seen in
atticoantral type of CSOM, but not in tubotympanic type
of CSOM.

- 2015

Table I. HRCT findings of site and extent of


soft tissue density in the middle ear and mastoid
in TT type and AA type.

DOI No.: 10.21176/ ojolhns.0974-5262.2015.09.1

(2010), who found strong agreement for mastoid


6
cell aeration.
On HRCT, soft tissue opacity was noted in 6
cases out of the 31 cases of tubotympanic type of
CSOM. Intra-operatively there were granulations
in 3 cases and edematous mucosa in 3 cases of
tubotympanic type of CSOM.

When comparing the HRCT findings with surgical


correlation in CSOM, HRCT could detect soft tissue
density and extent of spread with 98% sensitivity and
89% specificity. These findings were similar to OReilly
8,9

et al and Tripti.

HRCT could detect ossicular

destruction with sensitivity of 100% in malleus erosion,


86% in incus erosion and 82% in stapes suprastructure
erosion. However the specificity was 100%. These

On HRCT, soft tissue opacity was noted in all


19 cases in atticoantral type of CSOM. Mafee et al,
OReilly et al and Tripti had similar results.

7-9

Intra-

operatively there was cholesteatoma in 10 cases


and granulations in 9 cases of atticoantral type of
CSOM. HRCT could not differentiate the soft tissue
density. Mafee, OReilly, Jackler and Garber et al
7,8,10,11

are in agreement with this finding.

18

findings were similar to Alzoubi et al.

HRCT was 100% sensitive and specific to detect


lateral semicircular canal erosion and tegmen erosion,
but 83% sensitive to detect facial canal dehiscence
with 100% specificity. CT failed to identify facial canal
dehiscence in one case. These findings were similar to
Alzoubi et al.

18

HRCT was found to be 100% sensitive

and specific to detect mastoid cortex erosion and sinus

Erosion of scutum was seen in 42.1%, tegmen


erosion in 31.6% of cases with atticoantral type of

plate dehiscence. These findings were similar to Sirigiri


16

and Dwarkanath.

CSOM. This finding was similar to Gaurano and


12

Joharjy.

HRCT could detect erosion of ossicular


13

chain which were similar to study by Tatlipinar et al.

Table III: Correlation between HRCT and


surgical findings.

Lateral semicircular canal erosion was noted in


15.8% of the cases of atticoantral type of CSOM on
14

HRCT. These findings were similar to Chee and Tan.

Mastoid cortex erosion was seen in 5.3% of the


cases with atticoantral type. These findings were
similar to Suat Keskin et al.

15

Sinus plate erosion

was seen in 5.3% the cases with atticoantral type of


CSOM. These findings were similar to a study by
9

Tripti. Facial canal dehiscence was seen in 4 cases

Vol.-9, Issue-I, Jan-June - 2015

of atticoantral type of CSOM which was similar to a


study by Sirigiri and Dwarkanath.

16

6 patients of tubotympanic type of CSOM


underwent cortical mastoidectomy and 25 patients

CONCLUSION:

underwent tympanoplasty. In atticoantral type of

HRCT temporal bone could detect bony erosion


accurately and also the extent of soft tissue involvement
with ossciular chain status. This was very much useful in
planning the surgical approach not only in atticoantral but
also in tubotympanic type of CSOM. We emphasize the
need for HRCT temporal bone study pre-operatively not

CSOM, 2 cases underwent atticotomy, 2 cases


underwent atticoantrostomy, 3 cases underwent
canal up mastoidectomy and the remaining canal
wall down mastoidectomy depending on the HRCT
findings. These findings were similar to Payal et al.

17

only in atticoantral but also in tubotympanic of


CSOM with actively discharging ears.

DOI No.: 10.21176/ ojolhns.0974-5262.2015.09.1

DISCLOSURES

scanning in chronic suppurative otitis media. J


Laryngol Otol 1991;105:990 4.

(a) Competing interests/Interests of Conflict- None

(b) Sponsorships - None


(c) Funding - None

9.

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