The role of high resolution CT Scan in cholesteatoma surgery

Original article


Khaled Mesalaty * , Reda Darwish **

*Otorhinolaryngology Department, Tripoli Central Hospital, Faculty of Medicine, El-Fatteh University, Tripoli, Libya.
**Diagnostic Radiology Department, Faculty of Medicine, University of Alexandria, Alexandria, Egypt.

JMJ Vol. 4, No. 1 (Summer 2005): 57-62


The use of routine imaging for chronic otitis media remains more controversial, with experienced otologic surgeons expressing varied opinions as to its utility. The aim of this work was to define the role of high resolution computed tomography (HRCT) in preoperative and postoperative stages of cholesteatomatous ear. Methods: Prospective study correlates the CT and surgical findings in 112 patients operated on for cholesteatoma between April 1994 and December 2003. All patients were subjected to axial and coronal planes utilizing 1 mm slices with viewing sets in high resolution bone reconstruction algorithm before primary surgery. Special emphasis was given to potential and possible sites of disease involvement. Twenty patients were reexamined by postoperative CT scan one year after the primary surgery. Twelve of them were underwent second-look operation. In reoperated cases again imaging results were compared with operative findings. Results: The all over sensitivity of CT scan in diagnosing cholesteatoma in the present study was 81% while specificity was 88%. The sensitivity of postoperative CT scan in diagnosis of residual cholesteatoma was 66% and positive predictive value was only 50%. False positive and false negative results is discussed. Conclusion: Although HRCT could indeed imaging many of the minute structures of interest to the surgeon yet it was not of great importance in deciding whether to do open or closed technique. Preoperative CT scan should be used selectively in high risk of complications, only one hearing ear and in paediatric cholesteatoma.

Keywords: CT scan, Cholesteatoma, Surgery, preoperative, postoperative.