"Is Cone Beam Computed Tomography (CBCT) a Potential Imaging Tool in ENT Practice?: A Cross-Sectional Survey Among ENT Surgeons in the State of Odisha, India

Diagnostic Value of Cone-Beam Computed Tomography in Conductive or Mixed Hearing Loss with Intact Tympanic Membrane

BACKGROUND

Conductive or mixed hearing loss with an intact tympanic membrane is a group of diseases characterized by similar clinical symptoms. Definitive diagnosis depends on the findings of exploratory tympanic surgery. Cone-beam computed tomography (CBCT) has great potential for middle ear imaging. This study evaluated the diagnostic value of CBCT for conductive or mixed hearing loss with an intact tympanic membrane.

METHODS

CBCT and high-resolution computed tomography (HRCT) imaging data were collected from patients with an intact eardrum who received medical treatment in our hospital for conductive or mixed hearing loss from October 2020 to May 2023. The imaging characteristics and diagnostic values of CBCT and HRCT were analyzed.

RESULTS

A total of 137 patients who met the inclusion criteria and underwent CBCT were enrolled, including 89 with otosclerosis, 41 with ossicular chain interruption, and 7 with tympanosclerosis. CBCT clearly displayed a middle ear focus, such as low-density lesions located in the fissula ante fenestram, ossicular chain malformation or dislocation, and tympanic calcification foci. The area under the curve values for otosclerosis, ossicular chain interruption, and tympanic sclerosis were 0.934, 0.967, and 0.850, respectively. CBCT was more effective than HRCT for visualizing the lenticular process, incudostapedial joint, and stapes footplate.

CONCLUSIONS

CBCT of the middle ear demonstrated higher-quality imaging to improve the diagnosis of conductive or mixed hearing loss with an intact tympanic membrane. Therefore, CBCT is recommended for further investigation of noninflammatory diseases of the middle ear with no special findings on HRCT.

Ostiomeatal complex inflammation with a rare ethmoid sinolith utilizing cone-beam computed tomography: A clinical and radiological approach to diagnosis

A 28-year-old female patient was referred for panoramic radiography during a regular dental check-up. The dentist pointed out an additional suspicion of odontogenic maxillary sinusitis as she had complained of nasal obstruction, nasal discharge, postnasal drip, and frontal headache at the time. In this present case, cone-beam computed tomography (CBCT) imaging modality was utilized to evaluate the paranasal sinuses and detect any pathologic signs. This study aims to highlight the potential value of the modality for the identification of paranasal sinus diseases by presenting a rare finding of an ethmoid sinolith associated with a persistent ostiomeatal complex inflammation. The insufficient data currently available on the incidence of ethmoid sinoliths emphasize the significance of reports intended to inform practitioners about the imaging properties of these calcifications. To the author's knowledge, this is the first case report that demonstrated the primary utilization of dental CBCT in detecting ethmoid sinolith in a straightforward manner.

Insight in to the Awareness of CBCT as an Imaging Modality in the Diagnosis and Management of ENT Disorders: A Cross Sectional Study

The advent of Cone-beam computed tomography (CBCT), has revolutionized 3D imaging in dentistry. CBCT has enormous potential to be used as an alternative imaging modality by Otolaryngologists. But their knowledge regarding CBCT is limited. The study aims to evaluate the awareness of CBCT as an imaging modality among Ear, nose and Throat (ENT) practitioners. The validated questionnaire was sent by email and the participants were asked to fill the google form through the link provided to record the responses. The participants were asked to answer 25 multiple choice questions regarding the general information and practice related to CBCT imaging. Data was evaluated according to the descriptive statistics and the Chi-square test was used to determine the test of significance. The response rate for this study was 84.4%. The mean age of the participants was 44.9 ± 11.3. 69% of the respondents were academicians,14.2% had exclusive clinical practice, and 16.8% had both clinical and academic exposure. Among the study population, 76.8% had never advised CBCT in their practice. Only 10.3% of the study participants were aware of the potential of CBCT in ENT disorders. The mean knowledge, attitude and practice scores were very low regarding the applications of CBCT. Most of the study participants advised CBCT for maxillofacial fractures (78.1%) and was statistically significant p < 0.05. The knowledge about various advantages and clinical applications of CBCT among Otolaryngologists is limited. However, continuing medical education and inclusion in the medical curriculum will increase the scope and awareness about CBCT among ENT fraternity.

Anatomical Variations of the Maxillary Sinus – A Cone Beam Computed Tomography Study

Objectives: The knowledge of the normal morphology of the maxillary sinuses and their variations is important for maxillofacial radiologists to achieve a better evaluation and delineation of pathologies and for pre-implant evaluation of the maxilla.

The aim of our study was to evaluate anatomical variations of maxillary sinuses using Cone Beam Computed Tomography (CBCT).

Materials and methods: 150 CBCT images where bilateral maxillary sinuses were scanned were included in the study following the inclusion and exclusion criteria. 75 CBCT scans each of males and females were studied using the Planmeca Romexis software (Version 4.6.2). Multiplanar images were searched for the presence of anatomical variations such as septae, haller cells and ethmomaxillary sinus. The data were subjected to Chi square test using SPSS software to compare and relate gender and site based differences in the occurrence of the anatomical variations.

Results: Sinus septa was the predominant variation in both males and females with significantly higher prevalence in females and on the right side. An ethmomaxillary sinus was seen significantly more often in males, while Haller cells did not show any gender based differences in their occurrence. Ethmomaxillary sinus and Haller cells showed no difference in occurrence on the right and left side.

Conclusions: Anatomic variations of the maxillary sinuses are a common finding. It necessary for the clinicians to be familiar with these variations to avoid clinical complications especially in cases of implant placements.

Comparison of the Type and Severity of Nasal Septal Deviation between Chronic Rhinosinusitis Patients Undergoing Functional Endoscopic Sinus Surgery and Controls

Objectives

Some correlations have been proposed between chronic rhinosinusitis (CRS) and type and severity of nasal septal deviation. This study sought to compare the type and severity of nasal septal deviation between CRS patients undergoing functional endoscopic sinus surgery (FESS) and asymptomatic controls using cone-beam computed tomography (CBCT).

Materials and Methods

This prospective case-control study evaluated 49 CRS patients who did not respond to pharmaceutical therapy and were candidates for FESS and 49 asymptomatic controls. All participants underwent CBCT and were inspected for septal deviation type and severity. Data were analyzed by the independent t-test and chi-square test.

Results

The study population comprised of 58.25% males and 41.8% females, with a mean age of 33.74 ± 11.78 years. Significant correlations were noted between the presence of CRS and severity of septal deviation (P=0.007). Type of septal deviation had no significant correlation with the presence of CRS (P=0.443).

Conclusion

Patients with CRS have significantly more severe nasal septal deviation. However, type of septal deviation is not correlated with CRS.

[Value of cone-beam computer tomography in the middle and inner ear observation]

Objective:To identified the feasibility and normal range of cone beam computer tomography（CBCT） in the measurement of temporal bone. Methods:15 formalin fixed human cadaver head specimens were scanned by CBCT, high resolution CT, and Micro CT, respectively. Morphological parameter measurements of the middle and inner ear structures including ossicular chain, cochlea, semicircular canal and facial nerve were performed, and the results measured by the three scanning methods were compared. Results:None of the parameters measured by the three scanning methods were statistically significant except the thickness of stapes footplate（P<0.01） and the diameter of cochlear basal turn（P<0.01）. CBCT was superior in detecting facial nerve bony canal dehiscence. Conclusion:CBCT has the advantages of short scanning time, low radiation dose and high resolution. It can accurately display the morphological characteristics of the temporal bone structures, and is a reliable evaluation method for otological surgery.

Analysis of inferior nasal turbinate width and concha bullosa in subjects with nasal septum deviation: a cone beam tomography study

Background

In individuals with nasal septal deviation (NSD), compensatory hypertrophy of the nasal turbinates occurs as a protective mechanism of the nasal passage from dry and cold air. NSD associated nasal turbinate hypertrophy is usually recurrent, requiring repetitive imaging. Therefore, a multiplanar imaging modality with a low radiation dose is best suited for long-term follow-up of this condition. This study aimed to evaluate the association of width of inferior turbinates and presence of concha bullosa with the degree of NSD using Cone beam computed tomography (CT).

Methods

The CBCT scans of 100 patients with NSD were selected as per convenience sampling and were evaluated by two maxillofacial radiologists. The width of the non-hypertrophied inferior turbinate (NHT) on the convex side of the NSD, and hypertrophic inferior turbinates (HT) on the concave side of the NSD were measured at three locations. The septal deviation angle (SDA) and the presence of concha bullosa (CB) were determined.

Results

A significant difference was observed in the anterior, middle, posterior, and mean widths between HT and NHT (p < 0.001). There was a significant difference in the widths of the HT and NHT among different types of NSD. A strong positive correlation (r = 0.71, p < 0.001) was found between SDA and the mean width of the HT. Age (P = 0.71) and gender (P = 0.65) had no significant difference among different types of NSD. Regression analysis revealed that the presence of CB (p = 0.01) and middle width of the HT (p < 0.001) are significant predictors of SDA and type of NSD.

Conclusion

The results of the present study reveal that the middle width of the HT and the presence of CB influence the degree of NSD. The present study results recommend the use of CBCT as a substitutive low radiation dose imaging modality for evaluation of NSD, CB, and associated inferior turbinate hypertrophy.

Cone-Beam Computed Tomography: A User-Friendly, Practical Roadmap to the Planning and Execution of Every Rhinoplasty-A 5-Year Review

BACKGROUND

Cone-beam computed tomography has recently rapidly developed worldwide as a versatile and convenient alternative to traditional computed tomography for imaging of the maxillofacial region. However, most surgeons performing rhinoplasty are surprisingly unfamiliar with it, in both the plastic surgery and ear, nose, and throat communities.

METHODS

The broad clinical experience of a single center over the past 5 years is reviewed. The many applications of cone-beam computed tomography to primary and secondary rhinoplasty are analyzed regarding septum, turbinates, nasal bones, skin thickness, and other issues. The importance of a paradigm shift from a two-dimensional to a three-dimensional approach in image reconstruction is demonstrated, together with the value of surface contour enhancement.

RESULTS

Cone-beam computed tomography has a multitude of practical applications highly relevant to rhinoplasty. The surface image will strengthen aesthetic analysis, and the detailed preview of bony and functional anatomy will facilitate surgical planning. Cone-beam computed tomography serves as a roadmap to plan and execute rhinoplasties more predictably and efficiently. The availability of spatial views and accurate detail, together with the possibility of easy, accurate measuring, offers a plenitude of potential applications.

CONCLUSIONS

Cone-beam computed tomography is a user-friendly, quick technique with abundant advantages in planning any rhinoplasty. It causes the patient no inconvenience and has very few, if any, drawbacks, with these being limited to radiation exposure and limited cost.

New evolution of cone-beam computed tomography in dentistry: Combining digital technologies

Panoramic radiographs and computed tomography (CT) play a paramount role in the accurate diagnosis, treatment planning, and prognostic evaluation of various complex dental pathologies. The advent of cone-beam computed tomography (CBCT) has revolutionized the practice of dentistry, and this technique is now considered the gold standard for imaging the oral and maxillofacial area due to its numerous advantages, including reductions in exposure time, radiation dose, and cost in comparison to other imaging modalities. This review highlights the broad use of CBCT in the dentomaxillofacial region, and also focuses on future software advancements that can further optimize CBCT imaging.