Evaluation of Temporal Bone Cholesteatoma with High Resolution Computed Tomography (HRCT)

HRCT in Temporal Bone Cholesteatoma

Abstract

Background: Cholesteatoma is a potentially dangerous condition affecting middle ear cavity. As high-resolution computed tomography (HRCT) of temporal bone clearly depicts the inner anatomy, it can serve as an important imaging tool in evaluating cholesteatoma for preoperative planning. Hence, this study evaluates the efficacy of pre-operative HRCT in the evaluation of patients with middle ear cholesteatoma. Subjects and Methods: This was a prospective pilot study of 40 patients with chronic suppurative otitis media and unsafe type cholesteatoma. Each patient was subjected to full clinical evaluation, and HRCT examination prior to operative intervention. Preoperative radiological data were correlated with data related to surgical findings. Results: The study showed that a high incidence of cholesteatoma in the 2nd to 4th decade of life. The scutum and lateral attic wall were the most common bony erosions in the middle ear bony wall in nearly two-third patients. The malleus was the most eroded ossicle in the middle ear in nearly 80% cases. Facial canal erosion was found in nearly one-fifth patients. Temporal bone complications were commoner than intracranial complications. When compared with operative features, HRCT findings had an accuracy of more than 90% in detecting, localizing and determining the extent of cholesteatoma and nearly 100% accuracy in demonstrating ossicular chain erosion, labyrinthine fistula and intracranial complications. Conclusion: HRCT scan is an excellent preoperative imaging modality for the otologist to predict ossicular status and determining patient prognosis.