Middle ear cholesteatoma: A comparison of high resolution CT (HRCT) temporal bone and surgical findings

Background: HRCT is valuable in detecting the cholesteatoma and its complications. It is a useful guide to the surgeon. Aim of our study is to determine comparison between CT and surgical findings in patients with middle ear cholesteatoma. Methods: We conducted prospective study of 50 patients (males-30, females-20) age ranging from 9-70 years. Pre-operative CT scan findings were compared with operative findings in order to correlate soft tissue mass, ossicular erosion, bony erosion, extension of the disease, temporal as well as intracranial complications. Results: The study showed that a high incidence of cholesteatoma in the second decade of life. Most common presenting complaint was the ear discharge (98%). Epitympanum was involved in majority of (94%) cases, Aditus and antrum involved in 78% of the cases. The scutum was the most common (66%) bony structure to be eroded and the incus was the most eroded ossicle in the middle ear (72%). Sclerosis of mastoid air cells were encountered in 80% of patients and the lateral semicircular canal was affected in 4%, while facial canal dehiscence was found in 18%. Temporal bone complications are more common than intracranial complications.HRCT findings were compared with operative features; the comparative study included the accuracy and sensitivity of HRCT in detecting cholesteatoma (100%), incus erosion (96.4%), labyrinthine fistula (100%) and tegmen erosion (94.4%). Conclusion: The important role of HRCT scanning lies on the early detection of cholesteatoma, extension of the disease, complications and more conservative surgical procedures can be used to eradicate the disease.