Correlation between HRCT Temporal Bone Findings and Surgical Findings in Patients with Chronic Suppurative Otitis Media

Sowmya Raja, (2013) Correlation between HRCT Temporal Bone Findings and Surgical Findings in Patients with Chronic Suppurative Otitis Media. Masters thesis, Madurai Medical College, Madurai.


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INTRODUCTION: Chronic otitis media [COM] is an inflammation of the middle ear cleft of long duration. It involves inflammation of the mastoid air cell system also due to its anatomical connection to the middle ear. Due to the location of the tympanomastoid compartment, separated from the middle and posterior cranial fossae by thin bony partitions, otitis media has the potential for intracranial extension. So it is very important to know the location and extent of the disease before planning surgical management. Radiological examination of the temporal bone helps us to achieve this objective. The various modalities of temporal bone imaging are conventional radiography, CT scan and MRI. The petrous temporal bone is a complex structure containing the middle and inner ear and various contained structures like the ossicles. This challenges the limits of resolution by imaging techniques. Good spatial resolution by imaging to allow adequate demonstration of these bony structures in the middle and inner ears has made management of otitis media much simpler these days. AIMS AND OBJECTIVES OF THE STUDY: 1. To study the findings of HRCT temporal bone in patients with chronic otitis media with and without cholesteatoma. 2. To evaluate the extent of pathological process and sites of involvement of the middle ear and the mastoid air cell system in these patients. 3. To study the relationship of the tympanomastoid compartment to the adjacent , critical neurovascular structures. 4. To evaluate the results of our study and compare with similarly published studies. MATERIALS AND METHODS: The present work was undertaken to study the radiological findings of temporal bone in patients diagnosed as having chronic otitis media at Government Rajaji Hospital attached to the department of ENT, Madurai Medical College, Madurai between December 2011 and November 2012. Methods of collection of data: Sample size: A minimum of 50 patients were enrolled for the study. 50 patients with Chronic otitis media presenting to ENT outpatient department at Government Rajaji Hospital attached to Madurai Medical College were taken up for study. As soon as the patient presented to the hospital, detailed clinical history and examination were carried out as per the proforma prepared. Laboratory investigations were done. All patients were subjected to HRCT temporal bones, 1mm axial and coronal slices. Once the radiological findings were noted and extent of disease established, management was done accordingly. Inclusion Criteria: 50 patients of both sexes and all age groups presenting with chronic otitis media. Exclusion criteria: 1. Patients with previous surgery for chronic otitis media were excluded. 2. Chronic otitis media requiring MRI and, 3. Patients with a history of prior temporal bone trauma were excluded. All patients entering the present study underwent certain investigations. CONCLUSION: Chronic suppurative otitis media is a disease entity that an otorhinolaryngologist encounters frequently in his day to day practice. HRCT temporal bones is emerging as an imaging tool that would guide the surgeon regarding the extent and location of the pathology in these patients such that the appropriate line of management can be chalked out in the mind of the treating surgeon. The study conducted at our centre regarding the role of CT temporal bones in patients with CSOM with respect to the variables like ossicular erosion- malleus handle, malleus head, incus; facial canal dehiscence, LSCC erosion, mastoid cortex dehiscence, cholesteatoma, and anatomical variants like Korner‟s septum, high jugular bulb and forward lying sigmoid sinus were as follows. It showed excellent correlation for anatomical variantions like Korner‟s septum, anteriorly placed sigmoid sinus; good correlation for ossicular destruction – incus being the most commonly eroded ossicle. A moderate correlation was seen in cases of diagnosis of cholesteatoma on CT and on table. CT was found to be more accurate in detection of atticoantral pathology when there were associated changes of bony destruction. CT temporal bones was not found to be so reliable for predicting facial canal dehiscence and lateral semicircular canal dehiscence due to the partial averaging effects of the imaging modality. HRCT temporal bones is a useful preoperative tool in patients who present with chronic suppurative otitis media due to - Its ability to demonstrate fine bony details, - delineation of important adjacent anatomical structures and avoid inadvertent injury, - plan the surgical approach, - detect complications, - aids in good and effective surgical clearance.

Item Type: Thesis (Masters)
Uncontrolled Keywords: HRCT Temporal Bone Findings, Surgical Findings, Chronic Suppurative Otitis Media.
Subjects: MEDICAL > Otolaryngology
Depositing User: Devi S
Date Deposited: 27 Mar 2020 06:41
Last Modified: 27 Mar 2020 06:41

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