ROLE OF HIGH-RESOLUTION CT TEMPORAL BONE IN PREDICTING OSSICULAR CHAIN EROSION IN CHRONIC OTITIS MEDIA: A PROSPECTIVE OBSERVATIONAL STUDY
Main Article Content
Keywords
Chronic otitis media; HRCT temporal bone; ossicular chain erosion; cholesteatoma; tympanomastoidectomy; pre-operative imaging
Abstract
Background: Chronic otitis media (COM) is a major cause of preventable hearing loss globally, with the World Health Organization estimating over 297 million affected individuals, the majority in low- and middle-income countries including India.[1] The atticoantral (unsafe) subtype, frequently associated with cholesteatoma, leads to ossicular chain erosion (OCE) through osteoclast-mediated bone resorption, causing significant conductive hearing loss and posing risks of serious complications.[3,4] Accurate pre-operative assessment of ossicular integrity is essential to surgical planning; operative exploration remains the reference standard.[5] High-resolution computed tomography (HRCT) of the temporal bone provides non-invasive anatomical detail, yet its predictive accuracy for OCE in the north Indian tertiary care setting requires systematic prospective evaluation.
Objectives: To determine the sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of HRCT temporal bone in predicting intra-operative ossicular chain erosion in patients with COM undergoing tympanomastoid surgery at Saraswati Medical College, Unnao, Uttar Pradesh.
Methodology: A prospective observational study was conducted from January 2018 to December 2018. Eighty-two adult patients with COM were enrolled. Pre-operative HRCT temporal bone (0.625 mm slice thickness) was interpreted by two independent blinded radiologists, with intra-operative ossicular status serving as the reference standard. Statistical analysis used the Chi-square test, Clopper–Pearson sensitivity/specificity calculations, and Cohen’s kappa coefficient (SPSS v22).
Results: Of 82 patients (mean age 38.6 ± 14.2 years; 59.8% male), operative OCE was confirmed in 47 ears (57.3%). HRCT sensitivity was 83.0% (95% CI: 69.2–91.1%) and specificity 88.6% (95% CI: 74.6–95.7%). PPV was 90.7%, NPV 79.5%, and overall diagnostic accuracy 85.4%. The long process of the incus was the most frequently eroded component (80.9%). Substantial radiological–operative agreement was observed (kappa=0.694; p<0.001). Duration of symptoms ≥5 years was significantly associated with OCE (p=0.001).
Conclusion: HRCT temporal bone demonstrates high sensitivity and specificity for predicting ossicular chain erosion in COM and reliably guides pre-operative surgical planning. Systematic adoption in tertiary care settings serving high-burden north Indian populations is recommended.
References
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Dr. Madhavi Dilipkumar Aher
Assistant Professor, Department of Otorhinolaryngology, Saraswati Medical College, Unnao, Uttar Pradesh, India
Dr. Darji Parth Jitendrakumar
Assistant Professor, Department of Radiodiagnosis, Saraswati Medical College, Unnao, Uttar Pradesh, India
