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ORIGINAL RESEARCH

High Resolution Computed Tomography Imaging Findings in Chronic Otitis Media with and Without Cholesteatoma
Kolesteatomlu ve Kolesteatomsuz Kronik Otitis Mediada Yüksek Rezolüsyonlu Bilgisayarlı Tomografi Bulguları
Received Date : 20 Mar 2023
Accepted Date : 24 Apr 2023
Available Online : 03 May 2023
Doi: 10.24179/kbbbbc.2023-96825 - Makale Dili: EN
KBB ve BBC Dergisi. 2023;31(3):162-9
Copyright © 2020 by Turkey Association of Society of Ear Nose Throat and Head Neck Surgery. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/)
ABSTRACT
Objective: To correlate high-resolution computed tomography (HRCT) imaging findings of chronic otitis media (COM) with and without cholesteatoma regarding the presence, site, and severity of bone defects. Material and Methods: Temporal bone HRCT images of patients with COM, obtained between 2011 and 2022, were retrospectively reviewed. Patients with a soft tissue mass in the tympanic cavity were allocated into either COM with cholesteatoma (CH+COM) or without cholesteatoma group (CH-COM) based on pathology results and-/or magnetic resonance imaging findings. Computed tomography images were analyzed with regard to the presence, site and severity of middle ear bone erosions/defects and group comparisons were made. Results: A total of 60 patients (CH+COM: 23 patients, CH-COM: 37 patients) were included. Blunting of the scutum, defect of the tegmen tympani, absence/incompleteness of the Körner's septum, erosion of the ossicular chain, and destruction of the medial and lateral tympanic walls were significantly more frequent in the CH+COM group (p<0.05). While small bone discontinuities (≤2 mm) of the tegmen tympani or blunting of the scutum were present in both groups, a greater defect of these structures was observed only in the CH+COM group. No significant difference was detected neither regarding the location of the soft tissue masses nor the presence of posterior wall defects (p>0.05). Conclusion: Radiologists should be aware of bone erosions when evaluating temporal bone HRCT images of patients with COM, even if cholesteatoma is not suspected. Furthermore, reporting the severity of bone destruction could be a helpful hint regarding the presence of cholesteatoma and might impact surgical planning.
ÖZET
Amaç: Çalışmada kolesteatomlu ve kolestatomsuz kronik otitis media (KOM) tanılı olguların yüksek çözünürlüklü bilgisayarlı tomografi (YÇBT) görüntüleme bulgularının kemik defektlerinin varlığı, yeri ve şiddeti açısından karşılaştırılması amaçlanmıştır. Gereç ve Yöntemler: 2011-2022 yılları arasında temporal kemik YÇBT ile tetkik edilen KOM hastaların YÇBT görüntüleri retrospektif olarak incelendi. Timpanik boşlukta yumuşak doku kitlesi olan hastalar, patoloji sonuçları ve-/veya manyetik rezonans görüntüleme bulgularına göre kolesteatomlu (K+KOM) veya kolestatomsuz KOM (K-KOM) grubuna ayrıldı. Bilgisayarlı tomografi görüntüleri orta kulak kemik erozyonlarının/ defektlerinin varlığı, yeri ve şiddeti açısından değerlendirildi ve grup karşılaştırmaları yapıldı. Bulgular: Bu çalışmaya toplam 60 hasta (K+KOM: 23 hasta, K-KOM: 37 hasta) dâhil edildi. Skutumda küntleşme, tegmen timpani defekti, Körner septum yokluğu/devamsızlığı, kemikçik zincirinde erozyon ve medial ve lateral timpanik duvarlarda harabiyet C+COM grubunda anlamlı olarak daha sıktı (p<0,05). Tegmen timpanide küçük kemik devamsızlıkları (≤2 mm) veya skutumda küntleşme her iki grupta mevcutken, bu yapılarda sadece K+COM grubunda daha şiddetli defektler gözlendi. Yumuşak doku kitlelerinin yerleşimi ile arka duvar defekti varlığı açısından 2 grup arası anlamlı fark saptanmadı (p>0,05). Sonuç: KOM’lu olguların temporal kemik YÇBT görüntülerinin değerlendirmesinde radyologların kolesteatom şüphesinden bağımsız olarak olası kemik erozyonları açısından dikkatli olması gerekmektedir. Ayrıca kemik yıkımının şiddetinin bildirilmesi, kolesteatomun varlığına ilişkin ipucu sağlayarak cerrahi planlamada önemli olabilir.
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