Limits of conventional temporal bone computed tomography in the management of cholesteatoma otitis media: Report of 96 cases

Introduction Cholesteatoma is a dangerous chronic otitis media, with keratine accumulation causing bone erosion and invasive damages. Computed tomography (CT) is commonly indicated to evaluate the extension and the complications of cholesteatoma. Materials and methods In 96 patients with cholesteatoma otitis, preoperative CT data were compared with surgical findings using the sensitivity, specificity, and the predictive value of a CT-scan for anatomical structures. Results A CT scan offers an adequate anatomical conformation of the tympanomastoid cavities. The lysis of the tegmen (Se = 61%, Sp = 79%) and the erosion of the scutum (Se = 100%, Sp = 51%) are well visualized on coronal sections. CT is very sensitive to objective ossicular chain lysis (Se = 90%) but with a low specificity (Sp = 71%). The performance of CT in the facial canal erosion (Se = 45%, Sp = 78%) and in the labyrinthine fistulae (Se = 46%, Sp = 98%) was insufficient with the conventional scanning machine used. Conclusion A CT-scan should be a routine exam before cholesteatoma surgery, but with improved resolution, and therefore sensitivity, to characterize all middle ear structures and complications of the disease.