Assessment of Ossicular Necrosis in Tubotympanic (Mucosal) Type of Chronic Otitis Media

BACKGROUND We wanted to study the preoperative clinical, audiological, radiological findings & compare them with the perioperative findings of ossicular necrosis. METHODS 100 patients were clinically diagnosed as mucosal chronic otitis media (COM). They underwent a thorough clinical, audiological & radiological examination. X-ray mastoid Schuller's view on both sides was done in all patients & HRCT temporal bone was done in 51 patients. They were then posted for surgery & findings were compared with the perioperative ossicular necrosis. RESULTS 42 patients had ossicular defects perioperatively. Incus was found to be the most commonly necrosed ossicle & malleus was the most resistant ossicle. There was a positive association found between duration of disease, posterior perforations, large central & subtotal perforations, polypoidal middle ear mucosa, granulations over margins of perforations & audiological findings with the perioperative ossicular defects. HRCT was the most reliable investigation to predict ossicular necrosis. CONCLUSIONS From the study, it was concluded that all patients with mucosal COM can be assessed preoperatively for ossicular erosion. HRCT gives us a preoperative picture of the extent of ossicular necrosis & helps the surgeon in planning the surgical intervention. KEY WORDS COM, HRCT, Ossicular Necrosis, Mucosal, PTA

A Rural Hospital-Based Study on Temporal Bone Pathologies by High Resolution Computed Tomography from Bangalore, Karnataka

BACKGROUND The tympanic cavity is susceptible to infection by viruses and bacteria through the Eustachian tube, thereby making ear pathologies and particularly middle ear inflammatory conditions a frequent reason to consult an otorhinolaryngologist. With the advent of High-Resolution Computed Tomography, diagnosis of the middle ear anatomy, pathology and its complications if any, could be made out with better precision by providing a direct visual window by providing minute structural details. The aim of the study was to assess temporal bone pathologies that could be evaluated by HRCT study of the temporal bone in a rural hospital based setup and correlate if possible with surgical/histopathological findings. METHODS The study was a retrospective study done in M.V.J Medical College and Research Hospital, Bangalore amongst 50 patients from February 2020 to January 2021 who underwent HRCT of the temporal bone and relevant statistics were drawn from these cases. After local examination, clinical evaluation and consent, CT scan was performed. Follow-up of patients was done for confirmation with operative and/or histopathological findings whenever possible. All the data obtained were recorded in a tabulated form and analysed on MS Excel. RESULTS Amongst 50 patients, infective aetiology was found to be the most common cause, of which chronic otomastoiditis was the most common, followed by chronic Cholesteatoma, otitis media, chronic mastoiditis, and otitis externa. Amongst the congenital aetiology, we had 1 case each of osteoma, facial nerve involvement, microtia and inner ear dysplasia. Amongst the traumatic cases, longitudinal type of fracture was the most common type, followed by transverse and mixed fractures with hemotympanum being the most common HRCT finding. CONCLUSIONS HRCT of the temporal bone helps in accurate assessment of infective, congenital, traumatic and neoplastic aetiologies and helps the otologist understand the disease's extent and aid in surgery. KEYWORDS High-Resolution Computed Tomography, HRCT, Temporal bone, Radiology

Comparative Study of Preoperative Radiological Findings with Intraoperative Surgical Findings in Squamosal Type of Chronic Otitis Media

BACKGROUND Chronic otitis media (COM) of squamosal type is associated with cholestatoma with potential complications. Clinical examination and high resolution computed tomography (HRCT) scans are necessary to assess the disease site and extension. The purpose of the study was to compare the preoperative HRCT findings with the intraoperative surgical findings in squamosal type of chronic otitis media as well as various parameters in HRCT temporal bone and intraoperative findings. METHODS A prospective study was conducted on 30 patients aged between 18 and 60 years of both the genders who presented with chronic otitis media squamosal type, for a period of 22 months who attended the outpatient department of ENT. RESULTS HRCT findings and intraoperative findings were compared and results were analysed. Facial canal erosion (P - 0.0031), tegmen plate erosion (P - 0.0001), sigmoid sinus plate erosion (P - 0.002) were found to be statistically significant. Lateral semicircular canal fistula (P - 0.36) and ossicular status malleus (P - 1.000), incus (P - 0.949), stapes suprastructure (P - 0.984), and stapes footplate erosion (P - 0.977) were found to be statistically insignificant. CONCLUSIONS In our study, HRCT imaging for COM squamosal type, accurately depicted the soft tissue mass, erosion of tegmen plate, sigmoid sinus plate, scutum, lateral semicircular canal fistula, incus and suprastructure of stapes erosion and the same were found intraoperatively as well. Our study showed good comparison between the preoperative HRCT scans and the surgical findings in cholesteatoma cases. HRCT is confirmed to be valuable in the diagnosis and in guiding the surgical management of cholesteatoma. KEY WORDS Chronic Otitis Media, Cholesteatoma, HRCT Temporal Bone, Modified Radical Mastoidectomy

Clinical study of active squamosal chronic otitis media

<p class="abstract"><strong>Background:</strong> Cholesteatoma term was coined by Johannes Muller in 1838. Cholesteatomas are the last stage of squamous epithelial retraction comprising either the pars tensa or flaccida that are not self-cleansing, which retain epithelial debris and elicit a secondary, inflammatory reaction. Active squamosal epithelial disease is a retraction pocket which is filled with keratinous debris.</p><p class="abstract"><strong>Methods:</strong> 50 patients were selected presenting with active squamosal chronic otitis media (COM). For all cases a detailed history was taken, otoscopic and otomicroscopic examination along with tuning fork test were performed to know the status of tympanic membrane and status of air and bone conduction of sound waves. Audiological assessment was done by pure tone audiometry. X-ray mastoid and high-resolution computed tomography (HRCT) temporal bone was done for analysis. Pre anaesthetic fitness was taken and patients were posted for tympanomastoid exploration. </p><p class="abstract"><strong>Results:</strong> Most common presentation was of foul smelling otorrhoea in 40 patients, reduced hearing in 40 patients. 8 patients presented with vertigo and 2 presented with facial nerve paresis. Most common otoscopic finding was pf postero-superior retraction pocket in 26 patients. After clinical and radiological assessment 30 patients were posted for canal wall down mastoidectomy.</p><p class="abstract"><strong>Conclusions:</strong> Primary acquired cholesteatomacan affect all age group with significant effect on hearing and quality of life.</p>

OTO MASTOIDITIS AND SEPTIC CEREBRAL VENOUS THROMBOSIS

11 yr old female child, admitted with history of fever, left ear pain, swelling behind the left ear of 5 days duration, for which she was treated by a nearby doctor. After 1 week the child had left ear discharge, headache, neck pain, recurrent episodes of vomiting. On general examination she is thin built, febrile, toxic and dehydrated. On local examination she had ear discharge, swelling behind the left ear. On neurological examination, she had neck stifness. Routine blood investigations including, CBC, LFT, RFT were normal. On CSF examination Protein-188 mg%,Sugar- 16 mg%,Cell count-165 cells/cumm,85% were Neutrophils. Aural swab C/S showed growth of Klebsiella sensitive to Amikacin, Ciprooxacin, Piperacillin / Tazobactum and Cotrimoxazole. ENT opinion was in favour of doing Mastoidectomy. HRCT Temporal bone showed complete opacication of external auditory canal, tympanic cavity and mastoid air cells with a possibility of lling up with pus. MRI BRAIN showed Left mastoid and postauricular abscess, mastoiditis, ventriculitis, venulitis with thrombosis of left transverse and sigmoid sinuses. Patient was treated with parenteral piperacillin tazobactum, Ciprooxacin, Amikacin, Metronidazole, Mannitol, Dexamethasone and Low molecular weight heparin.Patient improved in 3 weeks.Ear discharge dried up, mastoid abscess subsided, and the child became active and ambulant

Dilemma in diagnosing a post-auricular mass-angiolymphoid hyperplasia with eosinophilia versus Kimura’s disease, an infrequent encounter

<p class="abstract">Angiolymphoid hyperplasia with eosinophilia (ALHE) and Kimura’s disease are uncommon chronic benign lesions of the skin mainly involving the head and neck regions where ALHE involves vascular and lymphocytic proliferation and Kimura’s is of inflammatory type. Dermal involvement is more in ALHE but In Kimura’s disease the lymphnodes and subcutaneous tissues are involved more. ALHE is a rare vascular tumor and Kimura’s disease is a chronic inflammatory disease. Both not only have uncertainty in etiology and pathogenesis, but also there is therapeutic dilemma in management. In this article, we describe a case of ALHE which presented to our ENT outpatient department with swelling in the left postauricular region which appeared 1.5 years back and posed a riddle in coming to correct diagnosis. On examination, a single smooth spherical swelling in upper part of post-auricular region of size 3×3 cm with well-defined edges and normal skin. Blood investigations revealed elevated absolute eosinophil count. HRCT temporal bone showed a well-defined rounded hypo-dense lesion measuring 28×23 mm with no effect of adjacent bony erosion / calcifications/ cystic changes suggestive of benign etiology. FNAC showed scantly cellular and occasionally scattered fibroblasts, pinkish stromal collagen fragments with inflammatory cells in background of haemorrhage suggestive of soft tissue neoplasm.</p>

A STUDY OF RADIOLOGICAL CHANGES IN CSOM AND THEIR CO-RELATION WITH INTRA-OPERATIVE SURGICAL FINDING

Introduction: HRCT temporal bone is the currently widely used investigation for the chronic otitis media patient especially in unsafe disease. Aim: This study was conducted to assess the condition of the middle ear in CSOM by HRCT temporal bone and compare them with intraoperative finding of the middle ear cleft . Method: Study group includes patients of Attico-antral variety of CSOM presenting in ENT OPD in our institution over a period of 18 months who undergone Computed Tomography Temporal bone followed by Surgical Procedure. Results: After study it was observed that CT scan can reliably detect bony & soft tissue changes in middle ear and intracranial complication. It can detect soft tissue in the middle ear but can not differentiate between soft tissue and cholesteatoma. Conclusion: CT scan provides excellent anatomical details and pathological changes of the ear and mastoid. Scanning all the patients is not feasible and justified, so we need to select patients in whom diagnosis and extend of the diseases is in doubt.

Role of HRCT Temporal Bone in Pre-operative Assessment of Tegmen Height in Chronic Otitis Media Patients

Objectives: High-resolution CT (HRCT) temporal bone has emerged as a useful option in pre-operative assessment of tegmen height in chronic otitis media patients. Material and Methods: A total of 60 patients with clinical suspicion of chronic otitis media were enrolled in the study. HRCT evaluation was done using Siemens Somatom Force 384 slice multidetector computed tomography machine. We radiologically assess tegmen height using lateral semicircular canal as a reference point on HRCT. Final result has been based on correlation of radiological and intraoperative findings. Diagnostic efficacy of HRCT temporal bone was evaluated in terms of sensitivity, specificity, PPV, NPV, and accuracy for pre-operative assessment of tegmen height. Results: The correlation between actual tegmen height and estimated tegmen height (by equation) was 0.457 which is highly significant (P < 0.001). In the study, the mean tegmen height of exposed dura (ED) was 5.81 ± 1.71 (95% CI 4.91–6.70) while the mean tegmen height of non-exposed dura (NED) was 8.40 ± 1.31 (95% CI 8.02– 8.78). Highly significant difference was found in mean tegmen height between ED and NED cases (P < 0.001). Conclusion: Pre-operative CT assessment of tegmen height is an important parameter in assessing risk of dural injury during tympanomastoid surgeries.