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Altaf J, Ashfaq AH, Arshad M, Riaz N, Shabbir Z, Mughal HH, Maqbool S, Ahmad MT, Shafiq U. Diagnostic Accuracy of Plain Computed Tomography Temporal Bone in Detection of Pre-operative Ossicular Status versus Per-operative Findings in Chronic Otitis Media. Indian J Otolaryngol Head Neck Surg 2024; 76:2601-2607. [PMID: 38883477 PMCID: PMC11169310 DOI: 10.1007/s12070-024-04561-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2024] [Accepted: 02/12/2024] [Indexed: 06/18/2024] Open
Abstract
Ossicular destruction is a common phenomenon in chronic otitis media due to an imbalance between osteoblasts and osteoclasts. Computed tomography helps us in the assessment of ossicular status, extent of pneumatization, and early identification of complications. This study aims to check the diagnostic accuracy of computed tomography temporal bone for the detection of ossicular erosion in comparison with the surgical findings taken as a gold standard. The use of this investigation as an adjunct can prove to be helpful in planning mastoid exploration as well as a primary reconstruction surgery especially in mucosal and early squamosal diseases. It's a cross-sectional validation study done on 50 patients with chronic otitis media (both mucosal and squamous type) from July 2022 to November 2023. Patients underwent CT scanning of temporal bone and ossicular status was reported by the radiologist. Later on, mastoid surgery was carried out and per operative findings were documented. 2 × 2 tables were formed and diagnostic accuracy of CT temporal bone was checked in terms of sensitivity, specificity, negative predictive value, and positive predictive value. The results revealed that CT temporal bone has a high diagnostic accuracy with a sensitivity of 92.5% and specificity of 100% for malleus (p value < 0.001). For incus and stapes, sensitivity came out to be 93.5% and 76% respectively and specificity values were 94.7% and 100% (p value < 0.001 for all) giving a verdict that the pre-operative use of this radiological investigation should be encouraged by otologists.
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Affiliation(s)
- Jawairia Altaf
- Department of ENT and Head and Neck Surgery, Benazir Bhutto Hospital, Rawalpindi, Pakistan
| | - Ahmed Hasan Ashfaq
- Department of ENT and Head and Neck Surgery, Benazir Bhutto Hospital, Rawalpindi, Pakistan
| | - Muhammad Arshad
- Department of ENT and Head and Neck Surgery, Benazir Bhutto Hospital, Rawalpindi, Pakistan
| | - Nida Riaz
- Department of ENT and Head and Neck Surgery, Benazir Bhutto Hospital, Rawalpindi, Pakistan
| | - Zuneera Shabbir
- Department of ENT and Head and Neck Surgery, Benazir Bhutto Hospital, Rawalpindi, Pakistan
| | - Hina Hanif Mughal
- Department of Radiology, Benazir Bhutto Hospital, Rawalpindi, Pakistan
| | - Shahzaib Maqbool
- Department of ENT and Head and Neck Surgery, Benazir Bhutto Hospital, Rawalpindi, Pakistan
| | - Muhammad Tehseen Ahmad
- Department of ENT and Head and Neck Surgery, Benazir Bhutto Hospital, Rawalpindi, Pakistan
| | - Usama Shafiq
- Department of Radiology, Shifa International Hospital, Islamabad, Pakistan
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Yazama H, Kunimoto Y, Hasegawa K, Watanabe T, Fujiwara K. Characteristics of repeated recidivism in surgical cases of cholesteatoma requiring canal wall reconstruction. EAR, NOSE & THROAT JOURNAL 2024; 103:234-240. [PMID: 34597528 DOI: 10.1177/01455613211048575] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE Few reports discuss the characteristics of repeated recidivism of cholesteatoma. We describe the clinical characteristics of patients with cholesteatoma who experienced at least two recidivism episodes after initial surgery for cholesteatoma requiring canal wall reconstruction. METHODS We reviewed the medical records of 11 patients who underwent surgery for cholesteatoma with canal wall reconstruction at our department between April 2008 and March 2018 and subsequently experienced two relapses that necessitated revision surgery involving tympanomastoidectomy with canal reconstruction. Patient age at the time of the first surgery ranged from 6 to 56 (mean, 25.7) years. Seven (63.6%) of the 11 patients were male. These 11 patients were classified according to the type of recidivism, and their characteristics (pathology, operation date, operation method, pattern of relapse, and position of recurrence) were investigated. RESULTS Four cases involved secondary residual cholesteatoma, with the mean interval between the first revision surgery and the second revision surgery being 23.8 (range, 11-39) months. Secondary residual sites included the anterior tympanic cavity, tympanic sinus, and anterior end of the reconstructed cartilage of the canal wall. The other seven cases involved secondary recurrence, with the mean interval between the first and the second revision surgery being 26.1 (range, 12-57) months. The sites of recurrence were at the edges of the reconstructed cartilage. One notable case involved the cartilage junction, leading us to hypothesize that retraction of the temporal muscle flap and the patulous Eustachian tube was the underlying cause. CONCLUSION For residual cholesteatoma, strict measures are necessary to maintain the operation under clear view, and more careful follow-up is necessary in patients who have had previous surgery at another hospital. For recurrent cholesteatoma, it was recognized that Eustachian tube function must be ascertained in advance, and careful observation of the reconstructed cartilage edge is necessary.
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Affiliation(s)
- Hiroaki Yazama
- Department of Otolaryngology, Head and Neck Surgery, Faculty of Medicine, Tottori University, Yonago, Japan
| | | | | | - Tasuku Watanabe
- Department of Otolaryngology, Head and Neck Surgery, Faculty of Medicine, Tottori University, Yonago, Japan
| | - Kazunori Fujiwara
- Department of Otolaryngology, Head and Neck Surgery, Faculty of Medicine, Tottori University, Yonago, Japan
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Huang Y, Feng G, Tian X, Gao Z. A Case of Giant Petrous Apex Cholesteatoma With Pseudomonas Aeruginosa Infection. EAR, NOSE & THROAT JOURNAL 2023:1455613231166578. [PMID: 37641382 DOI: 10.1177/01455613231166578] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/31/2023] Open
Abstract
Petrous apex cholesteatoma is a relatively rare and chronic aggressive disease that occurs in the petrous part of the temporal bone and can be classified as congenital or acquired. Due to the tendency of petrous cholesteatomas to cause bone destruction and invade important structures such as the facial nerve, cochlea, and semicircular canal, patients present mainly with severe hearing loss, progressive peripheral facial palsy, vertigo, etc. When the lesion invades the intracranial region or is infected, intracranial symptoms such as meningitis, lateral sinus thrombosis, and brain abscess may be present. We report a case of giant petrous cholesteatoma with Pseudomonas aeruginosa infection, with the aim of exploring the corresponding clinical treatment and surgical modalities to provide a reference for the clinical management of this type of disease.
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Affiliation(s)
- Yu Huang
- Department of Otorhinolaryngology Head and Neck Surgery, The Peking Union Medical College Hospital, Beijing, China
| | - Guodong Feng
- Department of Otorhinolaryngology Head and Neck Surgery, The Peking Union Medical College Hospital, Beijing, China
| | - Xu Tian
- Department of Otorhinolaryngology Head and Neck Surgery, The Peking Union Medical College Hospital, Beijing, China
| | - Zhiqiang Gao
- Department of Otorhinolaryngology Head and Neck Surgery, The Peking Union Medical College Hospital, Beijing, China
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Walters H, Lee-Warder L, Mentias Y, Arullendran P. Cartilage grafts mimicking cholesteatoma recurrence on diffusion-weighted magnetic resonance imaging: a case series. J Laryngol Otol 2023; 137:938-941. [PMID: 36750228 DOI: 10.1017/s0022215123000117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Abstract
BACKGROUND Cholesteatomas present a high risk for residual and recurrent disease, and the surveillance of post-operative patients can be challenging. Diffusion-weighted magnetic resonance imaging is becoming the preferred method for investigating recidivism; however, false positive imaging findings increase the risk of patients undergoing unnecessary second look surgery. CASE REPORTS This study reports two patients with false positive diffusion restriction associated with cartilage grafts that mimicked cholesteatoma and resulted in second look surgery with no disease found at operation. This study also discusses the related medical literature, including potential causes of abnormal diffusion restriction and methods to negate this. CONCLUSION Caution should be exercised when considering second look surgery in the presence of a cartilage graft and a high confidence of disease clearance. A multi-disciplinary approach is recommended for the operating surgeon to review the images with a radiologist.
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Affiliation(s)
- H Walters
- ENT Department, Sunderland Royal Hospital, Sunderland, UK
| | - L Lee-Warder
- ENT Department, Sunderland Royal Hospital, Sunderland, UK
| | - Y Mentias
- ENT Department, Sunderland Royal Hospital, Sunderland, UK
| | - P Arullendran
- ENT Department, Sunderland Royal Hospital, Sunderland, UK
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Kapoor AA, Kapoor A, Nimkar NU, Soni HD, Ojha VS, Biswas R. High-Resolution Computed Tomography and Intraoperative Correlation in Cholesteatoma: Enhancing Preoperative Evaluation and Surgical Management. Cureus 2023; 15:e44333. [PMID: 37779786 PMCID: PMC10538802 DOI: 10.7759/cureus.44333] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/29/2023] [Indexed: 10/03/2023] Open
Abstract
INTRODUCTION Cholesteatoma, a hazardous non-neoplastic lesion of the temporal bone, is prevalent in socio-economically disadvantaged groups in developing nations like India. Timely detection and surgical intervention are essential for effective management. High-resolution computed tomography (HRCT) has revolutionized the assessment of temporal bone pathology, though its role in preoperative evaluation remains debated. This study aimed to validate HRCT's utility in diagnosing cholesteatoma, compare its findings with intraoperative observations, and assess sensitivity and specificity. METHODS This diagnostic accuracy study was conducted at a tertiary care center in Western India, from March 2021 to November 2022. HRCT findings of 54 cholesteatoma patients were evaluated and compared with intraoperative findings. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), accuracy, and Cohen's kappa coefficient were calculated. RESULTS HRCT demonstrated a sensitivity exceeding 90% in identifying scutum erosion, mastoid sclerosis, and abnormalities in the tympanic membrane, along with a specificity surpassing 90% in detecting various conditions, including facial canal erosion, sinus plate erosion, lateral semicircular canal erosion, erosion of the posterior wall of the external auditory canal, and abnormalities in the tympanic membrane. Furthermore, HRCT exhibited an accuracy of over 90% in detecting most pathologies. There was a perfect or near-perfect agreement observed for abnormal tympanic membrane, sinus plate erosion, mastoid sclerosis, and erosion of the posterior wall of the external auditory canal (with kappa values > 0.8). Moderate to fair agreement was noted for other pathologies. CONCLUSION HRCT offered precise detection of the majority of pathologies, thereby facilitating surgical planning. However, the presence of limitations in distinguishing specific abnormalities highlights the significance of utilizing HRCT in tandem with other diagnostic modalities to ensure meticulous diagnosis and effective treatment planning.
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Affiliation(s)
- Abha A Kapoor
- Department of Otorhinolaryngology, Gujarat Medical Education and Research Society (GMERS) Medical College and Hospital, Gotri, Vadodara, IND
| | - Abhay Kapoor
- Department of Internal Medicine, B.J. Medical College, Ahmedabad, Ahmedabad, IND
| | - Nimisha U Nimkar
- Department of Otorhinolaryngology, Gujarat Medical Education and Research Society (GMERS) Medical College and Hospital, Gotri, Vadodara, IND
| | - Hiren D Soni
- Department of Otorhinolaryngology, Gujarat Medical Education and Research Society (GMERS) Medical College and Hospital, Gotri, Vadodara, IND
| | - Vishnu S Ojha
- Department of Internal Medicine, All India Institute of Medical Sciences, Patna, Patna, IND
| | - Ratnadeep Biswas
- Department of Internal Medicine, All India Institute of Medical Sciences, Patna, Patna, IND
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Bovi C, Luchena A, Bivona R, Borsetto D, Creber N, Danesi G. Recurrence in cholesteatoma surgery: what have we learnt and where are we going? A narrative review. ACTA OTORHINOLARYNGOLOGICA ITALICA : ORGANO UFFICIALE DELLA SOCIETA ITALIANA DI OTORINOLARINGOLOGIA E CHIRURGIA CERVICO-FACCIALE 2023; 43:S48-S55. [PMID: 37698100 PMCID: PMC10159641 DOI: 10.14639/0392-100x-suppl.1-43-2023-06] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Accepted: 01/17/2023] [Indexed: 09/13/2023]
Abstract
Treatment of cholesteatoma is surgical and has historically encompassed two main techniques: canal wall up (CWU) and canal wall down (CWD) tympanoplasty. Follow-up for cholesteatoma is still debated and can be either radiological or with second-look surgery. MRI with diffusion weighted sequences has proved to have high sensitivity and specificity in detecting recurrent or residual disease. Specifically, non-echo planar imaging DWI (non-EPI DWI) has been shown to be superior to other imaging techniques, allowing, in some cases, to avoid second-look surgery. Both residual and recurrence rates are higher in CWU compared to CWD procedures. Endoscopic ear surgery (EES) has become popular with the advantage of “looking around corners”. The endoscope is used in addition to a microscope or exclusively to reduce cholesteatoma recurrence. In addition, it has been demonstrated that mastoid obliteration and the use of potassium titanyl phosphate laser (KTP) can reduce cholesteatoma recurrence, with better functional outcomes. A synthetic sulphur compound (MESNA) may have an interesting role in the overall improvement in recurrence and residual cholesteatoma disease. This narrative review critically appraises the factors associated with the risk of recurrent cholesteatoma.
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Affiliation(s)
- Chiara Bovi
- Otolaryngology Department, Azienda Ospedaliera Universitaria Senese, Siena, Italy
| | - Alberto Luchena
- Department of Otorhinolaryngology, University of Pavia, Foundation IRCCS Policlinico “San Matteo”, Pavia, Italy
| | - Rachele Bivona
- Department of Neurosciences, Section of Otorhinolaryngology and Skull Base Microsurgery, Papa Giovanni XXIII Hospital, Bergamo, Italy
| | - Daniele Borsetto
- Department of ENT Surgery, Addenbrookes Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Nathan Creber
- Otolaryngology, Department of Surgery, The Royal Prince Alfred Hospital, Sydney, Australia
| | - Giovanni Danesi
- Department of Neurosciences, Section of Otorhinolaryngology and Skull Base Microsurgery, Papa Giovanni XXIII Hospital, Bergamo, Italy
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Hilal F, Liaw J, Cousins JP, Rivera AL, Nada A. Autoincudotomy as an uncommon etiology of conductive hearing loss: Case report and review of literature. Radiol Case Rep 2023; 18:1461-1465. [PMID: 36798057 PMCID: PMC9925837 DOI: 10.1016/j.radcr.2022.10.097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Revised: 10/27/2022] [Accepted: 10/29/2022] [Indexed: 02/04/2023] Open
Abstract
Ossicular pathology is a recognized etiology of conductive hearing loss. Ossicular pathology includes 2 main categories, that is, ossicular chain fixation and ossicular discontinuity. Ossicular discontinuity can be congenital or acquired. Auto-incudotomy is an uncommon form of acquired ossicular discontinuity that usually occurs as a sequel of spontaneous expulsion of cholesteatoma. Typically, it manifests with conductive hearing loss without evidence of cholesteatoma. In this report, we presented CT imaging finding of a 34-year-old male with tympanic membrane perforation and defective long process of the incus (auto-incudotomy) with minimal middle ear granulation tissue and adhesions, sequela of cholesteatoma. Radiologists should pay attention for evaluation of ossicles especially in patients presented with conductive hearing loss.
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Affiliation(s)
- Fathi Hilal
- Department of Radiology, University of Missouri, Columbia, MO, USA
| | - Jeffrey Liaw
- Department of Otolaryngology, University of Missouri, Columbia, MO, USA
| | | | - Arnaldo L. Rivera
- Department of Otolaryngology, University of Missouri, Columbia, MO, USA
| | - Ayman Nada
- Department of Radiology, University of Missouri, Columbia, MO, USA
- Corresponding author.
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8
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Revanth S, Nagadi AN, Murthy S, Sachidananda R, Raghu V, Chadaga H, Haldipur D. Utility of Non-EPI DWI MRI Imaging in Cholesteatoma: The Indian Perspective. Indian J Otolaryngol Head Neck Surg 2022; 74:3919-3926. [PMID: 36742588 PMCID: PMC9895567 DOI: 10.1007/s12070-021-02704-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2021] [Accepted: 06/20/2021] [Indexed: 02/07/2023] Open
Abstract
The purpose of this prospective observational study was to evaluate the diagnostic performance of non-EPI-based techniques, in detecting both primary and residual/recurrent cholesteatoma in a tertiary care center. 56 patients (25 female and 31 male) aged between 6 and 59 years were prospectively evaluated for the presence or absence of cholesteatoma. This included both primary and postoperative recurrent cholesteatoma (16). All the patients underwent sequential CT scans of temporal bones and non-EPI DWI (Non-Echo Planar Diffusion-Weighted Imaging) MRI techniques. The findings were correlated with surgical findings regarding the presence or absence of cholesteatoma. The size of cholesteatoma that was diagnosed on non-EPI DWI MRI was measured. The smallest size was 6 mm and the largest one was 21 mm. The accuracy of non-EPI DWI MRI in diagnosing cholesteatoma (primary and recurrent) was 97.5%. Whereas in diagnosing recurrent cholesteatoma accuracy was 100%. Accuracy of non-EPI DWI MRI is very high in diagnosing cholesteatoma especially in recurrent cholesteatoma and can potentially replace second look surgery when intact canal wall techniques are used. The technique is best used with a CT Scan of the temporal bone to depict bony changes, anatomical variants, or complications. The combination of HRCT and non-EPI DWI needs to be employed in diagnosing primary and recurrent cholesteatoma to maximize the diagnostic benefit as they are complimentary.
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Affiliation(s)
- S. Revanth
- Department of Radiology, Columbia Asia Hospitals, Bengaluru, India
| | - Anita N. Nagadi
- Department of Radiology, Columbia Asia Hospitals, Bengaluru, India
| | - Sreenivasa Murthy
- Department of Otolaryngology, Columbia Asia Hospitals, Bengaluru, India
| | - Ravi Sachidananda
- Department of ENT/Head and Neck Surgery, People Tree Hospitals, Bengaluru, India
| | - Vineetha Raghu
- Department of Otolaryngology, Columbia Asia Hospitals, Bengaluru, India
| | - Harsha Chadaga
- Department of Otolaryngology, Columbia Asia Hospitals, Bengaluru, India
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9
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Muacevic A, Adler JR. Diagnosis and Treatment Modalities of Cholesteatomas: A Review. Cureus 2022; 14:e31153. [PMID: 36505121 PMCID: PMC9731553 DOI: 10.7759/cureus.31153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Accepted: 11/06/2022] [Indexed: 11/08/2022] Open
Abstract
A cholesteatoma is an abnormal, noncancerous skin growth that can appear beneath the eardrum in the center of your ear. Although it might be a congenital condition, frequent middle ear infections are the main culprit. A cholesteatoma frequently appears as a cyst or sac that exfoliates the skin's outer layers. As these dead skin cells build up, the growth can enlarge and penetrate intratemporal tissues, leading to various intracranial and extracranial difficulties that can compromise facial muscles, hearing, and balance. Cholesteatomas were recognized more than three centuries ago. A cholesteatoma can develop into a serious condition if it is not treated right away. Because of its fast development and invasive nature, it can cause several consequences, some of which can be fatal for people without access to advanced medical treatment. There are no effective nonsurgical treatments available right now. It will be necessary to have a thorough awareness of both previous developments and more current ones to develop an appropriate management approach for this condition. The background information on acquired middle ear cholesteatomas is briefly reviewed in this paper. We also take into account categorization-, epidemiology-, histology-, and pathogenesis-related difficulties, and we carefully review current management and diagnosis approaches.
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Reardon T, Turnow M, Elston S, Brown NJ, Koller GM, Sharma S, Kortz MW, Mohyeldin A, Fraser JF. Surgical management of petrous apex cholesteatomas in the pediatric population: A systematic review. Surg Neurol Int 2022; 13:494. [DOI: 10.25259/sni_667_2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2022] [Accepted: 10/06/2022] [Indexed: 11/04/2022] Open
Abstract
Background:
Cholesteatomas are growths of squamous epithelium that can form inside the middle ear and mastoid cavity and damage nearby structures causing hearing loss when located at the petrous apex. The primary goal of petrous apex cholesteatoma resection is gross total removal with tympanoplasty and canal-wall up or canal-wall down tympanomastoidectomy. At present, there is no definitive surgical approach supported by greater than level 4 evidence in the literature to date.
Methods:
A systematic review was conducted utilizing PubMed, Embase, and Scopus databases. Articles were screened and selected to be reviewed in full text. The articles that met inclusion criteria were reviewed for relevant data. Data analysis, means, and standard deviations were calculated using Microsoft Excel.
Results:
After screening, five articles were included in the systematic review. There were a total of eight pediatric patients with nine total cholesteatomas removed. Conductive hearing loss was the most common (77%) presenting symptom. Perforations were noted in seven ears (86%). Recurrence was noted in 50% of patients with an average recurrence rate of 3.5 years (SD = 1.73). Average length of follow-up was 32.6 months (SD = 21.7). Canal-wall up was the most utilized technique (60%) and there were zero noted surgical complications. Five of the seven (71%) patients that experienced hearing loss from perforation noted improved hearing.
Conclusion:
Due to its rarity, diagnostic evaluation and treatment can vary. Further, multi-institutional investigation is necessary to develop population-level management protocols for pediatric patients affected by petrous apex cholesteatomas.
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Affiliation(s)
- Taylor Reardon
- Department of Neurosurgery, Kentucky College of Osteopathic Medicine, University of Pikeville, Pikeville, Kentucky, United States
| | - Morgan Turnow
- Department of Neurosurgery, Kentucky College of Osteopathic Medicine, University of Pikeville, Pikeville, Kentucky, United States
| | - Sidney Elston
- Department of Neurosurgery, Kentucky College of Osteopathic Medicine, University of Pikeville, Pikeville, Kentucky, United States
| | - Nolan J. Brown
- Department of Neurological Surgery, University of California, Irvine, California, United States
| | - Gretchen M. Koller
- Department of Neurosurgery, College of Osteopathic Medicine, Kansas City University, Kansas City, Missouri, United States
| | - Shelly Sharma
- Department of Neurosurgery, Rowan University School of Osteopathic Medicine, Stratford, New Jersey, United States
| | - Michael W. Kortz
- Department of Neurosurgery, University of Colorado School of Medicine, Aurora, Colorado, United States
| | - Ahmed Mohyeldin
- Department of Neurological Surgery, University of California, Irvine, California, United States
| | - Justin F. Fraser
- Department of Neurosurgery, Neurology, Radiology and Neuroscience, University of Kentucky, Lexington, Kentucky, United States
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Role of Diffusion-Weighted Magnetic Resonance Imaging in the Evaluation of Clinically Suspected Cholesteatoma Cases. Indian J Otolaryngol Head Neck Surg 2022; 74:719-723. [PMID: 36032877 PMCID: PMC9411291 DOI: 10.1007/s12070-021-02526-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Accepted: 03/22/2021] [Indexed: 10/21/2022] Open
Abstract
To analyze the apparent diffusion coefficient (ADC) values of middle ear and mastoid lesions in Diffusion weighted Magnetic Resonance Imaging (DW-MRI) to arrive at a probable demarcating value to differentiate cholesteatoma from non-cholesteatomatous lesions. Accurate anatomic localization of the lesion was also done using High Resolution Computed Tomography (HRCT) temporal bone. The study cohort consisted of 30 patients who had undergone HRCT, DW-MRI and surgical intervention in clinically suspected cholesteatomatous lesions during the period August 2018 to August 2020.Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy values of HRCT and MRI in relation to intraoperative findings and histopathological findings (gold standard) were calculated and compared using the 2-sided McNemar's Chi Square test. Receiver operating characteristic (ROC) curve was used to predict the cut off value of ADC to differentiate between cholesteatoma and non cholesteatomatous lesions. Total patients were 30 out of which 15 were histopathologically proven cholesteatoma. MR DWI showed 100% sensitivity, 80% specificity, and 90% accuracy in diagnosing cholesteatoma compared to HPE. The probable cut off value of ADC in differentiating cholesteatoma from non-cholesteatomatous lesions was found to be < 1.226 × 10-3 mm2/s, statistically using ROC curve. HRCT showed 96.6% accuracy in identifying the location of the lesion. MR-DWI is a useful tool both individually and in combination with HRCT in the diagnosis of cholesteatomas with high accuracy. An ADC cut-off value could also significantly help increase the accuracy of diagnosis.
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12
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Liao EN, Chan DK. Congenital aural atresia and first branchial cleft anomalies: Cholesteatoma and surgical management. Laryngoscope Investig Otolaryngol 2022; 7:863-869. [PMID: 35734058 PMCID: PMC9195010 DOI: 10.1002/lio2.793] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Revised: 02/25/2022] [Accepted: 03/23/2022] [Indexed: 11/17/2022] Open
Abstract
Objectives To describe the prevalence and significance of first branchial cleft anomalies in children with congenital aural atresia. Methods Retrospective cohort study and case series. Patients were included if they had ICD‐10 code Q16.0, Q16.1, Q16.9, Q17.2, or Q17.9 in their medical record and were seen at UCSF Benioff Children's Hospital from 2012 to 2020 for aural atresia. Children were categorized as having aural atresia and first branchial cleft anomalies if the presence of a first branchial cleft anomaly was noted in otolaryngology provider notes; otherwise, they were categorized as aural atresia alone. Patients with aural atresia and first branchial cleft anomalies were included in the case series. Results Among 125 children with congenital aural atresia, 5 (4%) were identified with first branchial cleft anomalies. In all cases, an epithelialized tract was noted to originate from the inferior aspect of the middle ear cleft, exiting the temporal bone in an inferomedial position adjacent to the stylomastoid foramen, with a cutaneous exit point inferior to the expected location of the native ear canal. There was no association with sex, microtia grade, or laterality of atresia; however, children with aural atresia and first branchial cleft anomalies were significantly more likely to have syndromes such as Goldenhar and Treacher Collins (p = .04) than those with aural atresia alone. 3/5 (60%) children with aural atresia and first branchial cleft anomalies presented with cholesteatoma compared with 1/120 (0.8%) children with aural atresia alone, a significant difference (p < .001). All four children over the age of two have undergone surgical management. In two of these, excision of the branchial cleft anomaly could be combined with atresiaplasty, with normal hearing results in both cases. Conclusions Aural atresia can be associated with comorbid anomalies of the head and neck. First branchial cleft anomalies can be suspected based on characteristic clinical appearance and confirmed with computed tomography showing a typical course through the temporal bone. When present in the context of congenital aural atresia, first branchial cleft anomalies are associated with a significantly increased risk for cholesteatoma, often necessitating surgical management with favorable hearing outcomes. Level of evidence 4.
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Affiliation(s)
- Elizabeth N. Liao
- Division of Pediatric Otolaryngology, Department of Otolaryngology–Head & Neck Surgery University of California San Francisco California USA
| | - Dylan K. Chan
- Division of Pediatric Otolaryngology, Department of Otolaryngology–Head & Neck Surgery University of California San Francisco California USA
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13
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Fischer N, Plaikner M, Schartinger VH, Kremser C, Riechelmann H, Schmutzhard J, Gottfried T, Dejaco D, Tauber H, Josip E, Henninger B. MRI of middle ear cholesteatoma: The importance of observer reliance from diffusion sequences. J Neuroimaging 2021; 32:120-126. [PMID: 34398501 DOI: 10.1111/jon.12919] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Revised: 07/30/2021] [Accepted: 08/01/2021] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND AND PURPOSE Diffusion-weighted imaging(DWI) in MRI has been developed as an important tool for the detection of cholesteatoma. Various DWI sequences are available. This study aims to evaluate the importance of the observer's reliance level for the detection of cholesteatoma. METHODS Forty patients meeting the following criteria were included in the study: (1) chronic otitis media, (2) preoperative MRI including various DWI sequences, and (3) middle-ear surgery. The MRI protocol contained the following sequences: (1) axial and (2) coronal echoplanar imaging (EPI) readout-segmented (RESOLVE) DWI with Trace acquisition and (3) coronal non-EPI half-Fourier acquired single-shot turbo spin-echo (HASTE) DWI. Cholesteatoma diagnosis was based on standard diagnostic criteria for cholesteatoma with DWI. Additionally, the radiologists were asked to grade personal reliance on their diagnosis using a Likert-type scale from 1 = very insecure to 5 = very secure. RESULTS Axial and coronal RESOLVE DWI showed a sensitivity of 77.3% and a specificity of 72.2%, respectively. The mean reliance was 3.9 for axial and 3.8 for coronal images. HASTE DWI had a sensitivity/specificity of 81.8%/66.7% with the highest reliance of all evaluated sequences (4.4). Cases with a reliance level of 5 showed a sensitivity/specificity of 100% in all sequences. A reliance level of 5 was given in the axial and coronal RESOLVE DWI in 32.5% of cases and in the HASTE DWI in 57.5%. CONCLUSION The evaluated DWI sequences showed comparable results. The reliance level significantly improved the predictor of cholesteatoma disease with MRI techniques.
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Affiliation(s)
- Natalie Fischer
- Department of Otorhinolaryngology, Medical University of Innsbruck, Innsbruck, Austria
| | - Michaela Plaikner
- Department of Radiology, Medical University of Innsbruck, Innsbruck, Austria
| | - Volker H Schartinger
- Department of Otorhinolaryngology, Medical University of Innsbruck, Innsbruck, Austria
| | - Christian Kremser
- Department of Radiology, Medical University of Innsbruck, Innsbruck, Austria
| | - Herbert Riechelmann
- Department of Otorhinolaryngology, Medical University of Innsbruck, Innsbruck, Austria
| | - Joachim Schmutzhard
- Department of Otorhinolaryngology, Medical University of Innsbruck, Innsbruck, Austria
| | - Timo Gottfried
- Department of Otorhinolaryngology, Medical University of Innsbruck, Innsbruck, Austria
| | - Daniel Dejaco
- Department of Otorhinolaryngology, Medical University of Innsbruck, Innsbruck, Austria
| | - Helmuth Tauber
- Department of Anesthesiology and Intensive Care Medicine, Medical University of Innsbruck, Innsbruck, Austria
| | - Ena Josip
- Department of Radiology, Medical University of Innsbruck, Innsbruck, Austria
| | - Benjamin Henninger
- Department of Radiology, Medical University of Innsbruck, Innsbruck, Austria
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14
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Barber SR. New Navigation Approaches for Endoscopic Lateral Skull Base Surgery. Otolaryngol Clin North Am 2021; 54:175-187. [PMID: 33243374 DOI: 10.1016/j.otc.2020.09.021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Image-guided navigation is well established for surgery of the brain and anterior skull base. Although navigation workstations have been used widely by neurosurgeons and rhinologists for decades, utilization in the lateral skull base (LSB) has been less due to stricter requirements for overall accuracy less than 1 mm in this region. Endoscopic approaches to the LSB facilitate minimally invasive surgeries with less morbidity, yet there are risks of injury to critical structures. With improvements in technology over the years, image-guided navigation for endoscopic LSB surgery can reduce operative time, optimize exposure for surgical corridors, and increase safety in difficult cases.
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Affiliation(s)
- Samuel R Barber
- Department of Otolaryngology-Head and Neck Surgery, University of Arizona College of Medicine, 1501 North Campbell Avenue, Tucson, AZ 85724, USA.
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15
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Correlation of pre-operative computed tomography, intra-operative findings and surgical outcomes in revision tympanomastoidectomy. The Journal of Laryngology & Otology 2021; 134:1096-1102. [PMID: 33407963 DOI: 10.1017/s0022215120002698] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVE To correlate pre-operative computed tomography findings, intra-operative details and surgical outcomes with cholesteatoma recurrence in revision tympanomastoidectomy. METHODS This retrospective, non-randomised, single-institution cohort study included 42 patients who underwent pre-operative computed tomography imaging and revision surgery for recurrent chronic otitis media. Twelve disease localisations noted during revision surgery were correlated with pre-operative temporal bone computed tomography scans. A matched pair analysis was performed on patients with similar intra-operative findings, but without pre-operative computed tomography scans. RESULTS Pre-operative computed tomography identified 25 out of 31 cholesteatoma recurrences. Computed tomography findings correlated with: recurrent cholesteatoma when attic opacification and ossicular chain involvement were present; and revision surgery type. Sinodural angle disease, posterior canal wall erosion and dehiscent dura were identified as predictors of canal wall down tympanomastoidectomy. Patients with pre-operative computed tomography scans had a higher rate of cholesteatoma recurrence, younger age at diagnosis of recurrent disease, more revision surgical procedures and less time between previous and revision surgical procedures (all p < 0.05). CONCLUSION Pre-operative imaging and intra-operative findings have important clinical implications in revision surgery for chronic otitis media. Performing pre-operative computed tomography increases diagnosis accuracy and reduces the time required to diagnose recurrent disease.
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16
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Kavanagh RG, Liddy S, Carroll AG, Purcell YM, Smyth AE, Khoo SG, McNeill G, Malone DE, Killeen RP. Rapid diffusion-weighted MRI for the investigation of recurrent temporal bone cholesteatoma. Neuroradiol J 2020; 33:210-215. [PMID: 32336206 DOI: 10.1177/1971400920920784] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND Suspected cholesteatoma recurrence is commonly investigated with magnetic resonance imaging (MRI) of the temporal bone. Non-echo planar diffusion-weighted imaging (non-EP DWI) has become the sequence of choice. PURPOSE To assess the agreement between an MRI protocol incorporating both non-EP DWI and contrast-enhanced sequences, and a shortened protocol without contrast-enhanced sequences in the assessment of suspected cholesteatoma recurrence. MATERIALS AND METHODS One hundred consecutive MRIs, consisting of T2-weighted, non-EP DWI and pre- and post-contrast T1-weighted sequences, were reviewed by two radiologists at a tertiary referral centre. Agreement between the two protocols was assessment by means of a weighted Cohen kappa coefficient. RESULTS We found a near perfect agreement between the two protocols (kappa coefficient with linear weighting 0.98; 95% confidence interval 0.95-1.00). There were two cases in which the two protocols were discordant. In both cases, the lesion measured <3 mm and images were degraded by artefact at the bone-air interface. The shortened protocol without post-contrast sequences yielded a 32% reduction in acquisition time. CONCLUSION When non-EP DWI is available, contrast-enhanced sequences can be omitted in the vast majority of cases without compromising diagnostic accuracy. Contrast-enhanced sequences may provide additional value in equivocal cases with small (<3 mm) lesions or in cases where images are degraded by artefact.
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Affiliation(s)
| | - Stephen Liddy
- Department of Radiology, St Vincent's University Hospital, Ireland
| | - Anne G Carroll
- Department of Radiology, St Vincent's University Hospital, Ireland
| | - Yvonne M Purcell
- Department of Radiology, St Vincent's University Hospital, Ireland
| | - Anna E Smyth
- Department of Radiology, St Vincent's University Hospital, Ireland
| | - S Guan Khoo
- Department of Otolaryngology, St Vincent's University Hospital, Ireland
| | - Graeme McNeill
- Department of Radiology, St Vincent's University Hospital, Ireland.,Department of Radiology, Royal Victoria Eye and Ear Hospital, Ireland
| | - Dermot E Malone
- Department of Radiology, St Vincent's University Hospital, Ireland.,Department of Radiology, Royal Victoria Eye and Ear Hospital, Ireland
| | - Ronan P Killeen
- Department of Radiology, St Vincent's University Hospital, Ireland.,Department of Radiology, Royal Victoria Eye and Ear Hospital, Ireland
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17
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Muhonen EG, Mahboubi H, Moshtaghi O, Sahyouni R, Ghavami Y, Maducdoc M, Lin HW, Djalilian HR. False-Positive Cholesteatomas on Non-Echoplanar Diffusion-Weighted Magnetic Resonance Imaging. Otol Neurotol 2020; 41:e588-e592. [DOI: 10.1097/mao.0000000000002606] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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18
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Burd C, Pai I, Connor S. Imaging anatomy of the retrotympanum: variants and their surgical implications. Br J Radiol 2019; 93:20190677. [PMID: 31593485 DOI: 10.1259/bjr.20190677] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
The retrotympanic anatomy is complex and variable but has received little attention in the radiological literature. With advances in CT technology and the application of cone beam CT to temporal bone imaging, there is now a detailed depiction of the retrotympanic bony structures.With the increasing use of endoscopes in middle ear surgery, it is important for the radiologist to appreciate the nomenclature of the retrotympanic compartments in order to aid communication with the surgeon. For instance, in the context of cholesteatoma, clear imaging descriptions of retrotympanic variability and pathological involvement are valuable in pre-operative planning.The endoscopic anatomy has recently been described and the variants classified. The retrotympanum is divided into medial and lateral compartments with multiple described potential sinuses separated by bony crests.This pictorial review will describe the complex anatomy and variants of the retrotympanum. We will describe optimum reformatting techniques to demonstrate the structures of the retrotympanum and illustrate the associated anatomical landmarks and variants with CT. The implications of anatomical variants with regards to otologic surgery will be discussed.
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Affiliation(s)
- Christian Burd
- Department of Radiology Guy's and St Thomas' NHS Foundation Trust, London
| | - Irumee Pai
- King's College Hospital NHS Foundation Trust, London
| | - Stephen Connor
- Department of Radiology Guy's and St Thomas' NHS Foundation Trust, London.,School of Biomedical Engineering & Imaging Sciences Clinical Academic Group, King's College London, King's Health Partners, Guy's Hospital, London.,Department of Otolaryngology, Guy's and St. Thomas' Hospital NHS Foundation Trust, London
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19
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Gulati M, Gupta S, Prakash A, Garg A, Dixit R. HRCT imaging of acquired cholesteatoma: a pictorial review. Insights Imaging 2019; 10:92. [PMID: 31578644 PMCID: PMC6775179 DOI: 10.1186/s13244-019-0782-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2019] [Accepted: 08/15/2019] [Indexed: 11/10/2022] Open
Abstract
Chronically discharging ear is a common cause of morbidity in developing countries, and it is also associated with intratemporal and intracranial complications. The surgeon is often able to detect the disease. However, cholesteatoma in the "hidden areas" like anterior epitympanic recess and sinus tympani can be missed. Facial nerve involvement and cholesteatomatous erosion of the bony labyrinth are dreaded complications, the extent of which cannot be assessed completely on clinical examination. Adding to the complexity are the various variations in anatomy like high riding jugular bulb and aberrant internal carotid artery which could lead to catastrophic complications during surgery if left undetected preoperatively. HRCT temporal bone is useful to detect the extent of the disease, various complications, and guide the surgeon for pre-operative planning. In this review, we go through the various HRCT imaging features of acquired cholesteatoma, a reporting template, and a few words about imaging of the post-operative ear.
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Affiliation(s)
- Malvika Gulati
- Department of Radiodiagnosis, Maulana Azad Medical College, Bahadur Shah Zafar Marg, New Delhi, 110002, India
| | - Swati Gupta
- Department of Radiodiagnosis, Maulana Azad Medical College, Bahadur Shah Zafar Marg, New Delhi, 110002, India.
| | - Anjali Prakash
- Department of Radiodiagnosis, Maulana Azad Medical College, Bahadur Shah Zafar Marg, New Delhi, 110002, India
| | - Anju Garg
- Department of Radiodiagnosis, Maulana Azad Medical College, Bahadur Shah Zafar Marg, New Delhi, 110002, India
| | - Rashmi Dixit
- Department of Radiodiagnosis, Maulana Azad Medical College, Bahadur Shah Zafar Marg, New Delhi, 110002, India
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20
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Fischer N, Schartinger VH, Dejaco D, Schmutzhard J, Riechelmann H, Plaikner M, Henninger B. Readout-Segmented Echo-Planar DWI for the Detection of Cholesteatomas: Correlation with Surgical Validation. AJNR Am J Neuroradiol 2019; 40:1055-1059. [PMID: 31122917 DOI: 10.3174/ajnr.a6079] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2018] [Accepted: 04/21/2019] [Indexed: 12/12/2022]
Abstract
BACKGROUND AND PURPOSE MR imaging has become an important tool for the detection of cholesteatomas of the middle ear. Various diffusion-weighted imaging sequences are available and have shown promising results. This study aimed to evaluate readout-segmented echo-planar DWI for the detection of cholesteatoma and compare the results with surgical validation. MATERIALS AND METHODS Fifty patients with chronic otitis media (24 females and 26 males; range, 12-76 years of age; mean age, 41 years) who underwent MR imaging before an operation of the middle ear (1-169 days) were included. The MR imaging protocol consisted of axial and coronal readout-segmented echo-planar DWI with b-values of 0 and 1000 s/mm2 and 3-mm slice thickness. The readout-segmented echo-planar diffusion-weighted images were fused with standard T2-weighted sequences for better anatomic assignment. The results of the MR imaging evaluation were correlated with the results from the operation. RESULTS Readout-segmented echo-planar DWI detected 22 of the 25 cases of surgically proved cholesteatoma. It has an accuracy of 92% (95% confidence interval, 80.8%-97.8%), a sensitivity of 88%, a specificity of 96%, a positive predictive value of 96%, and a negative predictive value of 89%. In 1 case, a positive finding for cholesteatoma with readout-segmented echo-planar DWI could not be proved by histology, and in 3 cases, histology yielded a cholesteatoma that was not detected with MR imaging. CONCLUSIONS Readout-segmented echo-planar DWI is a promising and reliable MR imaging sequence for the detection and exclusion of cholesteatoma.
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Affiliation(s)
- N Fischer
- From the Departments of Otorhinolaryngology (N.F., V.H.S., D.D., J.S., H.R.)
| | - V H Schartinger
- From the Departments of Otorhinolaryngology (N.F., V.H.S., D.D., J.S., H.R.)
| | - D Dejaco
- From the Departments of Otorhinolaryngology (N.F., V.H.S., D.D., J.S., H.R.)
| | - J Schmutzhard
- From the Departments of Otorhinolaryngology (N.F., V.H.S., D.D., J.S., H.R.)
| | - H Riechelmann
- From the Departments of Otorhinolaryngology (N.F., V.H.S., D.D., J.S., H.R.)
| | - M Plaikner
- Radiology (M.P., B.H.), Medical University of Innsbruck, Innsbruck, Austria
| | - B Henninger
- Radiology (M.P., B.H.), Medical University of Innsbruck, Innsbruck, Austria
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21
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Growth and Late Detection of Post-Operative Cholesteatoma on Long Term Follow-Up With Diffusion Weighted Magnetic Resonance Imaging (DWI MRI): A Retrospective Analysis From a Single UK Centre. Otol Neurotol 2019; 40:638-644. [DOI: 10.1097/mao.0000000000002188] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
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22
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23
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Abstract
The European Academy of Otology and Neurotology in collaboration with the Japanese Otological Society (EAONO/JOS) recently produced a joint consensus document outlining the definitions, classification and staging of middle ear cholesteatoma. The goals were to provide terminologies in the description of cholesteatoma, classify cholesteatoma into distinct categories to facilitate the comparison of surgical outcomes and to provide a staging system that reflects the severity, difficulty of complete removal and restoration of normal function. Cholesteatoma is considered a benign, expanding and destructive epithelial lesion of the temporal bone that is the result of a multifactorial process. If undetected and left treated, cholesteatoma may lead to significant complications including hearing loss, temporal bone destruction and cranial invasion. Recent advances in imaging modalities have allowed for high sensitivity and specificity in identifying the presence of cholesteatoma. Despite these advances, deficiencies exist around the world with access to health care facilities meaning cholesteatoma remains a serious and challenging entity to manage whether found within the pediatric or adult population. Proper diagnosis and management of each form of cholesteatoma is achieved by a thorough understanding of the etiology, classification, clinical presentation and histology, thereby facilitating prevention, early detection and appropriate treatment.
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Affiliation(s)
- James T Castle
- Department of Oral & Maxillofacial Pathology, Naval Postgraduate Dental School, Naval Medical Professional Development Center, 8955 Wood Road, Bethesda, MD, 20889-5638, USA.
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24
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Gouda M, Nasr WF, Abd Elbary MES, Razek MMA. MRI as an Alternative to Second Look Mastoid Surgery. Indian J Otolaryngol Head Neck Surg 2018; 70:410-414. [PMID: 30211099 DOI: 10.1007/s12070-018-1407-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2018] [Accepted: 05/15/2018] [Indexed: 11/30/2022] Open
Abstract
The main goal of surgery of cholesteatoma is eradication of the disease and revision surgery is indicated when a dry and safe ear has not been achieved. Residual cholesteatoma usually occurs at the sites that are difficult to reach with an operating microscope, such as posterior tympanum and anterior epitympanic recess. Computed tomography can be performed to delineate the extent of disease. High-resolution computed tomography scanning is important for planning for surgery and is indicated for all revision mastoid operations. Magnetic resonance imaging is superior to computed tomography in tissue characterization for diagnosis of recurrent cholesteatoma. To evaluate the cases of recurrent cholesteatoma comparing the intraoperative surgical findings with the preoperative MRI radiological findings and if the preoperative MRI can replace the second look surgery for cholesteatoma. This study was applied on 60 patients that have a recurrent cholesteatoma after previous mastoid surgery. A preoperative radiological evaluation was done by Magnetic resonance, surgical management was done by canal wall up or canal wall down mastoidectomy to exclude residual disease. Then, radiological, and surgical findings correlation was done. Diffusion-weighted MRI successfully detected 42 cases out of the 45 cases of surgically proved cholesteatoma, it has accuracy 95%, sensitivity 93.33%, specificity 100%, PPV 100% and NPV 83.33%. MRI is better than CT in tissue characterization for diagnosis of recurrent cholesteatoma, and can replace the unnecessary second look surgery of cholesteatoma.
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Affiliation(s)
- Magdy Gouda
- Department of Otolaryngology-Head and Neck Surgery, Faculty of Medicine, Zagazig University, Zagazig, 4419 Egypt
| | - Wail Fayez Nasr
- Department of Otolaryngology-Head and Neck Surgery, Faculty of Medicine, Zagazig University, Zagazig, 4419 Egypt
| | - Mohammad El-Sayed Abd Elbary
- Department of Otolaryngology-Head and Neck Surgery, Faculty of Medicine, Zagazig University, Zagazig, 4419 Egypt
| | - Magdy M A Razek
- Department of Otolaryngology-Head and Neck Surgery, Faculty of Medicine, Zagazig University, Zagazig, 4419 Egypt
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25
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Abdul-Aziz D, Kozin ED, Lin BM, Wong K, Shah PV, Remenschneider AK, Landegger LD, Juliano AF, Cohen MS, Lee DJ. Temporal bone computed tomography findings associated with feasibility of endoscopic ear surgery. Am J Otolaryngol 2017; 38:698-703. [PMID: 28711236 DOI: 10.1016/j.amjoto.2017.06.007] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2017] [Revised: 06/10/2017] [Accepted: 06/13/2017] [Indexed: 11/28/2022]
Abstract
PURPOSE There are no formal radiologic criteria to stratify patients for transcanal (TEES) or transmastoid endoscopic ear surgery for resection of cholesteatoma. We aim to determine 1) whether standard preoperative computed tomography (CT) findings are associated with the need for conversion to a transmastoid approach and 2) the amount of time added for conversion from TEES to transmastoid techniques. MATERIALS AND METHODS Retrospective chart review of consecutive pediatric and adult cases of TEES for primary cholesteatoma from 2013 through 2015 (n=52). TEES cases were defined as endoscope-only procedures that did not require a transmastoid approach (n=33). Conversion cases were defined as procedures that began as TEES however, required conversion to a transmastoid approach due to the inability to complete cholesteatoma removal (n=19). Preoperative CT findings and total operating room (OR) times of TEES and conversion cases were compared. RESULTS Preoperative CT scan characteristics that were associated with conversion included tegmen erosion (p=0.026), malleus erosion (p<0.001), incus erosion (p=0.009), mastoid opacification (p=0.009), soft tissue opacification extending into the aditus ad antrum (p=0.009) and into antrum (p=0.006). Total OR time for TEES cases was significantly shorter than conversion cases (median 143min versus 217min, p<0.001). CONCLUSIONS Preoperative CT findings, notably extension of soft tissue in the aditus ad antrum, antrum and mastoid, are associated with need for conversion to transmastoid technique to achieve removal of cholesteatoma. Endoscope-only cases were significantly faster than cases that required conversion to a transmastoid approach.
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Affiliation(s)
- Dunia Abdul-Aziz
- Department of Otology and Laryngology, Harvard Medical School, 243 Charles Street, Boston, MA 02114, USA.
| | - Elliott D Kozin
- Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear Infirmary, 243 Charles Street, Boston, MA 02114, USA.
| | - Brian M Lin
- Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear Infirmary, 243 Charles Street, Boston, MA 02114, USA.
| | - Kevin Wong
- Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear Infirmary, 243 Charles Street, Boston, MA 02114, USA.
| | - Parth V Shah
- Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear Infirmary, 243 Charles Street, Boston, MA 02114, USA.
| | - Aaron K Remenschneider
- Department of Otology and Laryngology, Harvard Medical School, 243 Charles Street, Boston, MA 02114, USA.
| | - Lukas D Landegger
- Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear Infirmary, 243 Charles Street, Boston, MA 02114, USA.
| | - Amy F Juliano
- Department of Radiology, Massachusetts Eye and Ear Infirmary, 243 Charles Street, Boston, MA 02114, USA.
| | - Michael S Cohen
- Department of Otology and Laryngology, Harvard Medical School, 243 Charles Street, Boston, MA 02114, USA.
| | - Daniel J Lee
- Department of Otology and Laryngology, Harvard Medical School, 243 Charles Street, Boston, MA 02114, USA.
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Monitoring Progression of 12 Cases of Non-Operated Middle Ear Cholesteatoma With Non-Echoplanar Diffusion Weighted Magnetic Resonance Imaging: Our Experience. Otol Neurotol 2017; 37:1573-1576. [PMID: 27755452 DOI: 10.1097/mao.0000000000001243] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
AIM The aim of this study is to gain insight into the disease progression and behavior of primary cholesteatoma in a cohort of patients who did not have surgery using non-echoplanar diffusion-weighted magnetic resonance imaging (DW MRI) serial monitoring. METHODS Retrospective longitudinal observational study of 12 cases of middle ear cleft cholesteatoma diagnosed between 2009 and 2014 where surgery was not performed for various reasons. All cases were monitored radiologically with non-echoplanar half-Fourier acquisition single-shot turbo spin-echo diffusion weighted imaging annually for a median period of 23 months (between 11 and 45 mo) to evaluate for changes in disease volume and direction of growth. RESULTS Of the 12 cases, there was one outlier where the cholesteatoma growth was disproportionately high compared with the rest of the cases outside the standard deviation range. A third of the cases had radiological evidence of cholesteatoma growth. The mean growth was about 11.9% of the initial disease volume per year. Seven out of the 12 cases had radiological evidence of cholesteatoma regression in terms of size, with three cases having negative follow-up DW-MRI scans as early as 17 months. The mean regression rate was much higher than the mean growth rate at 54.3% of the initial disease volume per year. The direction of greatest growth is craniocaudally. CONCLUSION Within the limits of our longitudinal study, we have shown that by monitoring with non-echoplanar diffusion weighted imaging, cholesteatoma can progress or regress when left untreated by surgery. The greatest progression was recorded in the craniocaudal direction.
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Bhalla AS, Singh A, Jana M. Chronically Discharging Ears: Evalution with High Resolution Computed Tomography. Pol J Radiol 2017; 82:478-489. [PMID: 29662576 PMCID: PMC5894029 DOI: 10.12659/pjr.901936] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2016] [Accepted: 12/07/2016] [Indexed: 12/28/2022] Open
Abstract
Chronic suppurative otitis media (CSOM) refers to the middle ear inflammation which is clinically characterized by the discharging ear, hearing deficit, fever and otalgia. Although a clinical diagnosis, imaging is imperative to rule out associated complications which apart from causing hearing deficit, may prove fatal at times. Both high resolution computed tomography (HRCT) and MRI are helpful in evaluating middle ear pathologies, usage being indication specific. Due to its excellent spatial resolution, HRCT is invaluable in assessment of chronically discharging ears, especially to look for bone erosion and the integrity of the ossicles. Due to its better spatial resolution, HRCT is preferred in suspected intra temporal complications whereas MRI is more useful in evaluating intracranial extension.
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Affiliation(s)
- Ashu Seith Bhalla
- Department of Radiodiagnosis, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India
| | - Anuradha Singh
- Department of Radiodiagnosis, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India
| | - Manisha Jana
- Department of Radiodiagnosis, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India
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28
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Trinidade A, Skingsley A, Yung MW. Mastoid obliteration surgery for cholesteatoma in 183 adult ears--a 5-year prospective cohort study: Our Experience. Clin Otolaryngol 2016; 40:721-6. [PMID: 25891851 DOI: 10.1111/coa.12444] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/05/2015] [Indexed: 11/26/2022]
Affiliation(s)
- A Trinidade
- Department of ENT, Ipswich General Hospital, Ipswich, UK
| | | | - M W Yung
- Department of ENT, Ipswich General Hospital, Ipswich, UK
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Atypical radiographic features of skull base cholesterol granuloma. Eur Arch Otorhinolaryngol 2015; 273:1425-31. [PMID: 26164292 DOI: 10.1007/s00405-015-3705-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2015] [Accepted: 06/26/2015] [Indexed: 10/23/2022]
Abstract
Cholesterol granulomas (CGs) are the most common benign lesions of the petrous apex (PA) and have distinct computed tomography (CT) and magnetic resonance imaging (MRI) characteristics. On CT, CGs of the PA (PACG) present as expansile lesions with erosion of bony trabeculae. MRI shows a hyperintense lesion on T1-and T2-weighted images and do not enhance with gadolinium. The objective is to describe the radiographic features of CGs of the skull base that do not arise from the PA. This study is a retrospective review. Three patients were operated on for suspected recurrent endolymphatic sac tumor, intracranial cholesteatoma, and recurrent sphenoid wing meningioma based on CT and MRI findings. Pathology results were consistent with CG in all three cases. All patients had bone erosion on CT. These skull base CGs did not demonstrate similar MRI features. These lesions were hyperintense, iso-to-hyperintense, and hypointense on T1-weighted MRI, respectively. These CGs were hyperintense in two cases and iso-to-hyperintense in one case on T2-weighted MRI. These lesions either demonstrated central or rim enhancement after gadolinium administration. Skull base CGs that do not arise from the PA demonstrate a broad spectrum of radiographic characteristics on MRI that are not typical of PACG.
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Lincot J, Veillon F, Riehm S, Babay N, Matern JF, Rock B, Dallaudière B, Meyer N. Middle ear cholesteatoma: Compared diagnostic performances of two incremental MRI protocols including non-echo planar diffusion-weighted imaging acquired on 3T and 1.5T scanners. J Neuroradiol 2015; 42:193-201. [DOI: 10.1016/j.neurad.2014.02.003] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2013] [Revised: 02/03/2014] [Accepted: 02/25/2014] [Indexed: 12/23/2022]
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Razek AAKA, Ghonim MR, Ashraf B. Computed Tomography Staging of Middle Ear Cholesteatoma. Pol J Radiol 2015; 80:328-33. [PMID: 26171086 PMCID: PMC4485650 DOI: 10.12659/pjr.894155] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2015] [Accepted: 04/09/2015] [Indexed: 11/24/2022] Open
Abstract
Background To establish computed tomography (CT) staging of middle ear cholesteatoma and assess its impact on the selection of the surgical procedure. Material/Methods Prospective study was conducted on 61 consecutive patients (mean age 26.8 years) with middle ear cholesteatoma. CT scan of the temporal bone and surgery were performed in all patients. CT staging classified cholesteatoma according to its location in the tympanic cavity (T); extension into the mastoid (M); and associated complications (C). Cholesteatoma was staged as stage I (T1, T2), stage II (T3, M1, M2, C1), and stage III (C2). Results The overall sensitivity of CT staging of cholesteatoma compared to surgery was 88% with excellent agreement and correlation between CT findings and intra-operative findings (K=0.863, r=0.86, P=0.001). There was excellent agreement and correlation of CT staging with surgical findings for T location (K=0.811, r=0.89, P=0.001), good for M extension (K=0.734, r=0.88, P=0.001), and excellent for associated C complications (K=1.00, r=1.0, P=0.001). Atticotympanotomy was carried out in stage I (n=14), intact canal wall surgery was performed in stage II (n=38), and canal wall down surgery was done in stage III (n=5) and stage II (n=4). Conclusions We established CT staging of middle ear cholesteatoma that helps surgeons to select an appropriate surgery.
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Affiliation(s)
| | - Mohamed Rashad Ghonim
- Department of Otolaryngology Head and Neck Surgery, Mansoura Faculty of Medicine, Mansoura, Egypt
| | - Bassem Ashraf
- Department of Otolaryngology Head and Neck Surgery, Mansoura Faculty of Medicine, Mansoura, Egypt
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Updates and knowledge gaps in cholesteatoma research. BIOMED RESEARCH INTERNATIONAL 2015; 2015:854024. [PMID: 25866816 PMCID: PMC4381684 DOI: 10.1155/2015/854024] [Citation(s) in RCA: 103] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/01/2015] [Revised: 03/04/2015] [Accepted: 03/04/2015] [Indexed: 12/15/2022]
Abstract
The existence of acquired cholesteatoma has been recognized for more than three centuries; however, the nature of the disorder has yet to be determined. Without timely detection and intervention, cholesteatomas can become dangerously large and invade intratemporal structures, resulting in numerous intra- and extracranial complications. Due to its aggressive growth, invasive nature, and the potentially fatal consequences of intracranial complications, acquired cholesteatoma remains a cause of morbidity and death for those who lack access to advanced medical care. Currently, no viable nonsurgical therapies are available. Developing an effective management strategy for this disorder will require a comprehensive understanding of past progress and recent advances. This paper presents a brief review of background issues related to acquired middle ear cholesteatoma and deals with practical considerations regarding the history and etymology of the disorder. We also consider issues related to the classification, epidemiology, histopathology, clinical presentation, and complications of acquired cholesteatoma and examine current diagnosis and management strategies in detail.
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Diffusion weighted MR imaging of primary and recurrent middle ear cholesteatoma: an assessment by readers with different expertise. BIOMED RESEARCH INTERNATIONAL 2015; 2015:597896. [PMID: 25722983 PMCID: PMC4333184 DOI: 10.1155/2015/597896] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/30/2014] [Revised: 11/11/2014] [Accepted: 11/12/2014] [Indexed: 12/14/2022]
Abstract
Introduction and Purpose. Diffusion weighted imaging (DWI) has been proven to be valuable in the diagnosis of middle ear cholesteatoma. The aims of our study were to evaluate the advantage of multi-shot turbo spin echo (MSh TSE) DWI compared to single-shot echo-planar (SSh EPI) DWI for the diagnosis of cholesteatoma. Material and Methods. Thirty-two patients with clinical suspicion of unilateral cholesteatoma underwent preoperative MRI (1.5T) with SSh EPI and MSh TSE. Images were separately analyzed by 4 readers with different expertise to confirm the presence of cholesteatoma. Sensitivity, specificity, diagnostic accuracy, and positive (PPV) and negative predictive values (NPV) were assessed for each observer and interrater agreement was assessed using kappa statistics. Diagnosis was obtained at surgery. Results. Overall MSh TSE showed higher diagnostic accuracy and lower negative predictive value (NPV) compared to conventional SSh EPI. Interreader agreement between the observers revealed the superiority of MSh TSE compared to SSh EPI. Interrater agreement among all the four observers was higher by using MSh TSE compared to SSh EPI. Conclusion. Our findings suggest that MSh TSE DWI has higher sensitivity for detection of cholesteatoma and lower probability of misdiagnosis. MSh TSE DWI is useful in guiding less experienced observers to the diagnosis.
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Radiological assessment of the sinus tympani: temporal bone HRCT analyses and surgically related findings. Surg Radiol Anat 2014; 37:385-92. [PMID: 25173355 DOI: 10.1007/s00276-014-1366-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2014] [Accepted: 08/22/2014] [Indexed: 10/24/2022]
Abstract
PURPOSE To evaluate the morphology of the sinus tympani (ST) based on computed tomography (CT) scans (axial view), describing the findings in a cohort of 148 patients (296 ears), and classifying the prevalence according to our ST classification. To evaluate the surgical prevalence based on the type of ST. To calculate the sensibility and positive predictive value (PPV) of high-resolution computed tomography (HRCT) scans for ST involvement by cholesteatoma. METHODS Retrospective review of the radiologic database and surgical reports. RESULTS In total, 98/296 (33.1%) middle ears presented a radiologic morphology Type A; 185/296 (62.5%) middle ears presented a radiologic morphology Type B; 13/296 (4.4%) middle ears presented a radiologic morphology Type C; HRCT showed a sensibility of 91%, specificity of 65%, PPV of 68% and negative predictive value (NPV) of 90%. CONCLUSIONS ST shape and depth can influence surgical preference in cholesteatoma surgery. In the case of a shallower ST, an exclusive endoscopic exploration is chosen; whereas in the case of a deeper ST, a retrofacial approach is usually preferred. HRCT scans demonstrated high sensibility and NPV for ST involvement by cholesteatoma.
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