Is Routine Use of High Resolution Computerized Tomography of Temporal Bone in Patients of Atticoantral Chronic Suppurative Otitis Media without Intracranial Complications Justified?

  • Meeta Bathla
  • Hiren Doshi
  • Atul Kansara
Original Article


Role of high resolution computerized tomography (HRCT) of temporal bone is established in cases of atticoantral chronic suppurative otitis media (CSOM) with intracranial complications. Routine use of HRCT in management of patients of atticoantral CSOM without intracranial complications has been an issue of debate. The aim of this study was to evaluate the routine use of HRCT of temporal bone in such cases. This study was a prospective study done at LG hospital, AMC MET Medical College, Ahmedabad to evaluate and compare the temporal bone findings in HRCT and intraoperative findings in 100 patients with atticoantral CSOM. All patients underwent HRCT screening followed by surgical exploration of middle ear cleft. In extent of disease HRCT showed very high sensitivity and specificity for epitympanum (100, 94%) and mesotympanum (98, 98%) areas. It gave valuable information of disease extent in hidden areas like sinus tympani and facial recess of mesotympanum. HRCT satisfactorily delineated malleus and incus erosion but had 75% sensitivity for detecting erosion of stapes suprastructure, though specificity was of 97%. For bony anatomical landmarks HRCT showed very high sensitivity and specificity for detecting erosion of lateral semicircular canal, tegmen tympani and sinus plate. Detection of facial canal erosion on HRCT had moderate sensitivity of 75%. We concluded that routine use of HRCT is justified as a reliable preoperative tool in patients with atticoantral CSOM without intracranial complications and it helps to plan type of surgical intervention. HRCT has limited role to distinguish between granulations and cholesteatoma and also to delineate stapes supra structure and facial nerve canal.


CSOM HRCT Atticoantral Cholesteatoma 


Compliance with Ethical Standards

Conflict of interest

The authors of this article declare that he/she has no conflict of interest.

Human and Animal Rights

Animals were not involved in this study.

Informed Consent

Informed consent was obtained from all individual participants included in the study.

Ethical Approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and with the 1964 Helenski declaration and its later amendments or comparable ethical standards.


  1. 1.
    Shah C, Shah P, Shah S (2014) Role of HRCT temporal bone in pre-operative evaluation of cholesteatoma. Int J Med Sci Public Health 3(1):69–72. doi: 10.5455/ijmsph.2013.031020131 CrossRefGoogle Scholar
  2. 2.
    Sreedhar S, Pujary K, Agarwal AC, Balakrishnan R (2015) Role of high resolution computed tomography scan in the evaluation of cholesteatoma: a correlation of high-resolution computed tomography with intra-operative findings. Indian J Otol 21:103–106. doi: 10.4103/0971-7749.155294 CrossRefGoogle Scholar
  3. 3.
    Youngs R (1998) Chronic suppurative otitis media-cholesteatoma. In: Ludman H, Wright T (eds) Diseases of the ear, 6th edn. Arnold, London, pp 387, 388, 395Google Scholar
  4. 4.
    Semaan MT, Megerian CA (2006) The pathophysiology of cholesteatoma. Otolaryngol Clin N Am 39(6):1155. doi: 10.1016/j.otc.2006.08.003 CrossRefGoogle Scholar
  5. 5.
    Kakkar V, Gulia JS et al (2005) Role of pre-operative CT Scan in unsafe chronic otitis media. Indian J Otol 11:14–17Google Scholar
  6. 6.
    Kveton JF (2010) Open cavity mastoid operations. In: Gulya AJ, Minor LB, Poe DS (eds) Glasscock—Shambaugh surgery of the ear, 6th edn. PMPH—USA CBS, Shelton, pp 516–517Google Scholar
  7. 7.
    Mills RP (1997) Management of chronic suppurative otitis media. In: Booth JB (ed) Otology, scott brown’s otolaryngology, vol 3, 6th edn. Butterworth Heinemann, Oxford, pp 5–6Google Scholar
  8. 8.
    Phelps PD (2002) The petrous temporal bone. In: Daniel S (ed) Radiology and imaging, vol 2, 7th edn. Elsevier, Amsterdam, p 1597Google Scholar
  9. 9.
    Browning GG, Merchant SN et al (2008) Chronic otitis media. In: Gleeson M et al (eds) Scott-Browns otorhinolaryngology, head and neck surgery, vol 3, 7th edn. Hodder Arnold, London, pp 3419, 3431–3432Google Scholar
  10. 10.
    Rai T (2016) Radiological study of the temporal bone in chronic otitis media: prospective study of 50 cases. Indian J Otol 20(2):48–55. doi: 10.4103/0971-7749.131865 CrossRefGoogle Scholar
  11. 11.
    Valvassori GE, Hemmati M (2010) Imaging of the temporal bone. In: Gulya AJ, Minor LB, Poe DS (eds) Glasscock-Shambaugh surgery of the ear, 6th edn. PMPH—USA CBS, Shelton, p 267Google Scholar
  12. 12.
    Phelps PD (1997) Radiology of ear. In: John B, Booth JB (eds) Otology, scott-brown’s otolaryngology, vol 3, 6th edn. Butterworth-Heinemann, Oxford, p 3Google Scholar
  13. 13.
    Watts S, Flood LM, Clifford K (2000) A systematic approach to interpretation of computed tomography scans prior to surgery of middle ear cholesteatoma. J Laryngol Otol 114(4):248–253CrossRefPubMedGoogle Scholar
  14. 14.
    Bansal M (2016) Chronic suppurative otitis media and cholesteatoma. Essentials of ear, nose and throat, 1st edn. Jaypee Brothers Medical Publishers, New Delhi, pp 112–113Google Scholar
  15. 15.
    Browning GG (1997) Aetiopathology of inflammatory conditions of the external and middle ear. In: Booth JB (ed) Otology, scott brown’s otolaryngology, vol 3, 6th edn. Butterworth Heinemann, Oxford, pp 26, 30Google Scholar
  16. 16.
    Kumar A, Wiet R (2010) Aural complications of otitis media. In: Gulya AJ, Minor LB, Poe DS (ed) Glasscock-Shambaugh surgery of the ear, 6th edn. PMPH-USA CBS, Shelton, pp 444, 445Google Scholar
  17. 17.
    Biswas A (2009) Pure tone audiometry. In: Biswas A (ed) Clinical audio-vestibulometry, 4th edn. Bhalani publishing house, Mumbai, pp 5, 16Google Scholar
  18. 18.
    Sirigiri RR, Dwaraknath K (2011) Correlative study of HRCT in attico-antral disease. Indian J Otolaryngol Head Neck Surg 63(2):155–158. doi: 10.1007/s12070-011-0162-5 CrossRefPubMedPubMedCentralGoogle Scholar
  19. 19.
    Yildirim-Baylan Muzeyyen, Ozmen Cihan Akgul, Gun Ramazan, Yorgancilar Ediz, Akkus Zeki, Topcu Ismail (2012) An evaluation of preoperative computed tomography on patients with chronic otitis media. Indian J Otolaryngol Head Neck Surg. 64(1):67–70. doi: 10.1007/s12070-011-0271-1 CrossRefPubMedGoogle Scholar
  20. 20.
    Vallabhaneni R, Srinivasa Babu CR (2016) HRCT temporal bone findings in CSOM: our experience in rural population of South India. IOSR J Dent Med Sci 15:49–53Google Scholar
  21. 21.
    Ahuja AT, Yuen HY, Wong KT, Yue V, Van Hasselt AC (2003) Computed tomography imaging of the temporal bone-normal anatomy. Clin Radiol 58:681–686. doi: 10.1016/S0009-9260(03)00209-5 CrossRefPubMedGoogle Scholar
  22. 22.
    Garber LZ, Dort JC (1994) Cholesteatoma: diagnosis and staging by CT scan. J Otolaryngol 23(2):121–124PubMedGoogle Scholar
  23. 23.
    Jackler RK, Dillon WP, Schindler RA (1984) Computed tomography in suppurative ear disease: a correlation of surgical and radiographic findings. Laryngoscope 94:746–752PubMedGoogle Scholar
  24. 24.
    O’Reilly BJ, Chevratton EB, Wylie I, Thakkar C, Butler P, Sathanathan N, Morrison G, Kenyon GS (1991) The value of CT scanning in chronic suppurative otitis media. J Laryngol Otol 105:990–994CrossRefPubMedGoogle Scholar
  25. 25.
    Chatterjee P, Khanna S, Talukdar R (2015) Role of high resolution computed tomography of mastoids in planning surgery for chronic suppurative otitis media. Indian J otololaryngol Head Neck Surg 67(3):275–280. doi: 10.1007/s12070-015-0873-0 CrossRefGoogle Scholar
  26. 26.
    Sunita M, Sambandan AP (2015) Importance of Pre- Operative HRCT Temporal Bone in chronic suppurative otitis media. Odisha J Otorhinolaryngol Head Neck Surg 9(1):10–13Google Scholar
  27. 27.
    Abele TA, Wiggins RH III (2015) Imaging of the temporal bone. Head Radiol Clin N Am 53:15–36. doi: 10.1016/j.rel.2014.09.010 CrossRefPubMedGoogle Scholar
  28. 28.
    Baneerjee A, Flood LM, Yates P, Clifford K (2003) Computed tomography in suppurative ear disease: does it influence management. J Larngol Otol 117(6):454–458Google Scholar

Copyright information

© Association of Otolaryngologists of India 2017

Authors and Affiliations

  1. 1.Department of ENT, AMC MET Medical CollegeLG HospitalManinagar, AhmedabadIndia

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