title: CT scan versus surgery: how reliable is the preoperative radiological assessment in patients with chronic otitis media?
abstract: The objective of the study was to evaluate the accuracy of the preoperative radiological assessment regarding 10 different middle ear structures in patients with chronic otitis media (COM). The setting of the prospective study was in a Tertiary university hospital. Fifty patients scheduled for a primary operation for COM. All patients underwent preoperative temporal bone high-resolution CT-scan (HRCT). AC(1)-statistics between the radiological report and the intra-operative findings were calculated. There was no correlation between the radiological assessment and the surgical findings in the scutum, attic area, and oval window. There was a poor or fair agreement on the condition of the malleus-incus complex, the status of the tympanic cavity, and the round window. There was a moderately strong agreement regarding the status of the lateral semicircular canal (LSCC) and tegmen tympani. This agreement was primarily observed, when no erosion/exposure was present in the LSCC or the dura. There was a very strong agreement in the mastoid air-cell complex and the sigmoid sinus, especially when the former was abnormal and the latter had no pathology. There are significant difficulties in radiological imaging for reliably assessing the middle ear in patients with chronic otitis media, using HRCT. The preoperative CT scan generally underestimates the actual pathology found by the surgeon in certain middle ear areas. The decision for surgical intervention should not be based on the radiological interpretation of certain middle ear structures, and ENT surgeons should be prepared to encounter conditions which are not reported by the radiologist preoperatively, and modify the operating strategy accordingly. EBM level: 2c.
authors.affiliation: ENT Department, Lister Hospital, Coreys Mill Lane, Stevenage, Hertfordshire SG1 4AB, UK. pevlast@hotmail.com
authors.forename: Petros V
authors.initials: PV
authors.lastname: Vlastarakos
authors.forename: Catherine
authors.initials: C
authors.lastname: Kiprouli
authors.forename: Sotirios
authors.initials: S
authors.lastname: Pappas
authors.forename: John
authors.initials: J
authors.lastname: Xenelis
authors.forename: Paul
authors.initials: P
authors.lastname: Maragoudakis
authors.forename: George
authors.initials: G
authors.lastname: Troupis
authors.forename: Thomas P
authors.initials: TP
authors.lastname: Nikolopoulos
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002908:Chronic Disease; D004432:Ear, Middle / Q000000981:diagnostic imaging / Q000473:pathology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010033:Otitis Media / Q000000981:diagnostic imaging* / Q000473:pathology / Q000601:surgery; D012680:Sensitivity and Specificity; D014057:Tomography, X-Ray Computed; D055815:Young Adult