Role of Multi-Detector Computed Tomography in Diagnosis and Staging of Cholesteatoma

Abstract
Background: Pathology of the middle ear is the third most common reason of visiting a general practitioner or a family doctor. In children and teenagers, inflammatory conditions of the middle ear are the most frequent reasons to prescribe antibiotics and perform surgery.
In the majority of these cases, proper diagnosis is made by clinical examination alone and patients will not benefit from additional diagnostic imaging studies. However, the prevalence of ear infections increased significantly and this may suggest that the current approach to preventing and treating middle ear inflammation is not adequate. Therefore, especially in complicated and recurrent conditions, imaging plays an important role; imaging findings may fundamentally influence the treatment. Also, in non-inflammatory conditions of external and middle ear Computed Tomography (CT) or Magnetic Resonance Imaging (MRI) would provide a diagnosis and/or necessary information for surgery in a significant number of cases.
Aim of Work: Evaluation the role of Multi-Detector Computed Tomography (MDCT) in diagnosis Chronic Sup-purative Otitis Media (CSOM) with or without cholesteatoma and staging of middle ear Cholesteatoma and assess its impact on the selection of the surgical procedure.
Patients and Methods: A prospective study included 30 patients with mean age 30.4 years with CSOM with or without cholesteatoma. They were evaluated regarding to their clinical symptoms, temporal multidetector computed tomography findings, and postoperative results. MDCT staging classified cholesteatoma according to its site in the tympanic cavity (S); erosion of the ossicular chain (O); and associated complications (C).
Results: MDCT imaging of these patients showed opaci-fication of middle ear cavity with integrity of the ossicular chain with 100% accuracy. Nondependent soft tissue masses in the middle ear, eroded scutum (n=20), eroded ossicles (n= 20), intact tegmen tympani (n=30), lateral mastoid fistula (n=2) and labyrinthine fistula (n=1) were observed in CSOM with cholesteatoma. All these patients underwent surgical intervention that confirmed the diagnosis of the presence of cholesteatoma in all these patients. But it also added the presence of lateral mastoid fistula and labyrinthine fistula in 1 other patient and discovered the presence of facial nerve injury in 1 patient.
Conclusion: MDCT scanning has limitations, but it is a useful in diagnosis, staging and surgic