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. 2015 Jun 25:80:328-33.
doi: 10.12659/PJR.894155. eCollection 2015.

Computed Tomography Staging of Middle Ear Cholesteatoma

Ahmed Abdel Khalek Abdel Razek  1 , Mohamed Rashad Ghonim  2 , Bassem Ashraf  2
Affiliations

Computed Tomography Staging of Middle Ear Cholesteatoma

Ahmed Abdel Khalek Abdel Razek et al. Pol J Radiol. .

Abstract

Background: To establish computed tomography (CT) staging of middle ear cholesteatoma and assess its impact on the selection of the surgical procedure.

Material/methods: Prospective study was conducted on 61 consecutive patients (mean age 26.8 years) with middle ear cholesteatoma. CT scan of the temporal bone and surgery were performed in all patients. CT staging classified cholesteatoma according to its location in the tympanic cavity (T); extension into the mastoid (M); and associated complications (C). Cholesteatoma was staged as stage I (T1, T2), stage II (T3, M1, M2, C1), and stage III (C2).

Results: The overall sensitivity of CT staging of cholesteatoma compared to surgery was 88% with excellent agreement and correlation between CT findings and intra-operative findings (K=0.863, r=0.86, P=0.001). There was excellent agreement and correlation of CT staging with surgical findings for T location (K=0.811, r=0.89, P=0.001), good for M extension (K=0.734, r=0.88, P=0.001), and excellent for associated C complications (K=1.00, r=1.0, P=0.001). Atticotympanotomy was carried out in stage I (n=14), intact canal wall surgery was performed in stage II (n=38), and canal wall down surgery was done in stage III (n=5) and stage II (n=4).

Conclusions: We established CT staging of middle ear cholesteatoma that helps surgeons to select an appropriate surgery.

Keywords: Adenovirus Infections, Human; Anatomy, Comparative; Imaging, Three-Dimensional; Pain.

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Figures

Figure 1
Figure 1
Location of cholesteatoma within the tympanic cavity (T): (A) Axial CT scan of the petrous bone shows attic cholesteatoma located in the attic region lateral to the ossicles (T1). (B) Axial CT scan shows tympanic cholesteatoma located in the tympanic region medial to the ossicles (T2). (C) Coronal CT scan shows atticotympanic cholesteatoma filling the whole middle ear cavity (T3).
Figure 2
Figure 2
Extension of cholesteatoma into the mastoid (M): (A) Axial CT scan of the petrous bone shows cholesteatoma extending into the mastoid antrum (M1). (B) Axial CT scan shows cholesteatoma extending into the mastoid air cells and mastoid cavity (M2).
Figure 3
Figure 3
Acquired cholesteatoma of the middle ear with intracranial abscess (C2): (A) Axial CT scan of the petrous bone shows cholesteatoma of the right middle ear and right mastoid. (B) Axial contrast CT scan of the same patient shows marginally enhanced right cerebellar abscess.
See this image and copyright information in PMC

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