Comparison of Preoperative Computerized Tomograghic Scan of Temporal Bone Findings with Intra Operative Findings in Patients with Chronic Otitis Media Undergoing Tympanomastoidectomy: A Descriptive Study
Authors: Abdulridha Mohammed Zaki Salim , Attallah Laith Mahmood , Bakir Saud Salim 
Published: September 2023

Background: Since ancient times, chronic suppurative otitis media (CSOM) has been a significant contributor to middle ear illness. Antibiotics have been extremely helpful, but (CSOM) is still a frequent condition, and its consequences present a challenge to both otologists and radiologists. Due to the intricate anatomical nature of the middle ear and inner ear, radiological assessment of the temporal bone is challenging.

Aim of the Study: To compare between preoperative CT scan findings of the temporal bone with the operative findings in patients with CSOM undergoing tympanomastoidectomy.

Methodology: A Descriptive cross-sectional prospective has been adopted and 35 patients with Chronic Suppurative Otitis Media were admitted at the Department of Otolaryngology/ Alsulaymaniyah Teaching Hospital of Otolaryngology, Head and Neck Surgery, and Zhian Hospital during the period from February to December 2015. A detailed history and careful physical examination, clinical tests revealed that all of the patients had Chronic Suppurative Otitis Media, typically with discharge from the ear and hearing loss. Each patient had their clinical history collected, and they all underwent a thorough ear, nose, and throat examination as well as an attentive otoscopic and microscopic ear examination. Additionally, all patients underwent an audiological evaluation that included pure tone audiometry, tympanometry, and HRCT.

Results: Thirty -five patients were included in this study. The mean age of the patients was 33 years; 51.4% were males and 48.6% were females. The most common presenting symptom was aural discharge in 71.4%; the second one was hearing loss in 28.6%. Mastoid pneumatization was found in 82.9% by CT while by surgery, it was found in 17.1%. CT findings showed that middle ear involvement in 11.4%, mastoid involvement in 11.4%, mastoid with middle ear involvement in 54.3%, and EAC, mastoid, and middle ear involvement in 17.1%. While the surgical findings showed middle ear disease in 20%, mastoid involvement in 11.4%, mastoid with middle ear involvement in 57.1%, and EAC, mastoid and middle ear involvement in 11.4%. The CT findings for eroded Malleus, Incus integrity, and stapes in 31.4%, 37.1%, not visualized while surgical findings showed eroded Malleus, Incus, and stapes integrity that 28.6%, 54.3%, and 28.6% respectively. The CT findings for an eroded facial canal, the lateral semicircular canal, the posterior external auditory canal wall, and sigmoid sinus plate integrity were 12.4%, 8.6%, 22.9%, and 11.4% in that order, while the surgical findings of the eroded facial canal, the lateral semicircular canal, and the posterior external auditory canal wall were found in 20.0%, 5.7%, 17.1%, and 14.2% respectively. Both CT and surgical findings of Integrity of the tegmen showed that 32 patients (91.4%) were found to have intact tegmen, and 3 patients (8.6%) had eroded tegmen and both showed that the eroded scutum found in 25.7%.

Conclusions: The current study concluded a positive correlation between CT and surgical findings that has many advantages in preoperative planning for the eradication of the disease, choosing the best approach & has a very important role in the orientation of the surgeon during the surgery to avoid any possible complications.