Computed Tomography scans of middle ear versus surgical findings in chronic otitis media

We evaluated the data provided by Computed Tomography (CT) scan reports for assessing otologic disease and planning surgery; we also examined their correspondence with surgical findings. Methods: We retrospectively analyzed preoperative CT reports of 202 patients (57% men, 43% women) aged between 15 and 78 years, suffering from chronic otitis media and underwent radical mastoidectomy (17%), closed (31%) or open (52%) tympanoplasty at the Department of Otorhinolaryngology of Federico II University in Naples between January 2003 and October 2010. We then compared ‘quantity’ and ‘quality’ of informations contained in CT reports with intraoperative findings. Results: Radiologic reports show the presence of cholesteatoma in 28% (intraoperatively found in 69%), defining the remaining 72% as inflammatory tissue. In 50% the involvement of middle ear generally refers to tympanic cavity and/or mastoid, without considerations of single subsites. Ossicular chain is described in 77% (73% intraoperatively), but 69% of reports refer to the whole chain, mentioning each ossicle only in 8%. Alterations in tegmen tympani are overestimated (20% versus 10%), as erosion of labyrinthine structures (18% versus 6%). Involvement of facial nerve canal is underestimated (7% versus 26%). Procidentia of sigmoid sinus is described in 2% (10% intraoperatively); jugular bulb, really high in 2%, is never described. Obstruction of eustachian tube is reported in 3% (21% intraoperatively). Conclusions: CT is essential to assess chronic otitis media; however insufficient informations should lead to greater cooperation between surgeon and radiologist through more detailed descriptions of the ear to operate or alternative imaging techniques (Magnetic Resonance).