Preoperative tomography evidence vs surgical findings; A reliable guidance for middle ear surgery?

Abstract

Our study aimed to determine the accuracy of computed tomography (CT) scan by comparing the preoperative CT findings with the perioperative findings in patients with chronic otitis media (COM). In this study, preoperative CT evidence of 208 patients, who underwent tympanomastoidectomy for COM in Afyonkarahisar Health Sciences University, Otolaryngology Clinic between September 2009 and May 2018, were compared with their surgical findings. When we compared preoperative computed tomography findings with perioperative findings of patients; CT could determine cholesteatoma in mastoid and middle ear space with 74% sensitivity, 64% specificity, 85% positive predictive value (PPV) and 24% negative predictive value (NPV), respectively. Considering ossicular defect, CT could demonstrate the destruction of malleus with 83% sensitivity, 71% specificity, 67% PPV and 66% NPV, destruction of incus with 74% sensitivity, 87% specificity, 92% PPV and 40% NPV, destruction of stapes with 69% sensitivity, 52% specificity, 59% PPV and NPV 51%, respectively. In determining ossicular chain destruction in patients with cholesteatoma, we reached the conclusion that findings of ossicular chain destruction in CT could be judged in favor of cholesteatoma with values of 81% sensitivity, 75% specificity, 93% PPD and 48% NPV. As a result, despite limitations, radiological scanning of the temporal bone with CT is a reliable guide for surgical management of COM with an expert evaluation.