Özet
Habib H. The correlation of Preoperative Temporal Bone Computed Tomography Findings with Intraoperative Findings In Chronic Otitis Media Patients. Hacettepe University Faculty Of Medicine ENT Department, Speciality Thesis, Ankara 2019. Computed tomography (CT) has a very importent place for the evaluation of the anatomical structures, the localization of pathology and spread of the disease, the determination of extent of erosion in order to predict possible complications.
The aim of our study is to compare the findings of temporal bone CT with intraoperatively observed pathological findings and to assess the value of temporal bone CT in preoperative evaluation, diagnosis and prediction of complications of chronic otitis media surgery therefore to determine its value in preoperative surgical planning. A group of 261 patients who were operated between 2012 and 2016 and have preoperative temporal bone CT were included in the study. Parameters evaluated both on CT and during surgery were malleus, incus, stapes, facial canal, LSC and middle ear status. The images (CT) were evaluated by a single radiologist who is experienced on temporal bone radiology and blinded to the surgical results. The results were compared with the surgical findings and the correct classification number, concordance and correlation of CT were determined. Correlation of findings regarding malleus was found to be CCN: 79.3%, Kappa: 35.2% (moderate compliance), Cramer V: 35.2% (low level correlation) (p <0.001). For incus, the CCN: 77.8%, kappa: 57.3% (moderate compliance), Cramer V: 54.7% (moderate correlation) (p <0.001), for facial canal, CCN: 89.6%, Kappa: 46% (moderate compliance), Cramer V: 44.8% (moderate correlation) (p <0.001). For middle ear status, CCN: 46%, Kappa: 26.8% (low compliance), Cramer V: 39% (low & poor correlation) (p <0.001). For stapes,specificity was 89%, sensitivity was 86%, NPV: 97%, PPV: 62%, Kappa: 66.1% (good compliance), Phi: 67.4% (moderate correlation) (p <0.001). For incudostapedial joint, specificity was 90.3%, sensitivity: 75.5, NPV: 84.3%, PPV: 84.2%, Kappa: 66.1% (good compliance), Phi: 67.2% (moderately correlated) (p <0.001). For LSC specificity: 98.8%, sensitivity: 83.3, NPV: 99.6%, PPV: 62%, Kappa: 70.7% (good level of compliance), Phi: 71.4% (strong correlation). As a result, there was a low level of correlation and compliance between the radiological and surgical findings of malleus and middle ear while there was a moderate correlation and compliance for incus and facial canal. There was a good compliance regarding stapes and incodustapedial joint but a moderate correlation. There was only good compliance and strong correlation for LSC erosion.
Künye
1. Morris, P.J., Chronic suppurative otitis media. BMJ clinical evidence, 2012.
2012.
2. Aarhus, L., et al., Childhood otitis media: A cohort study with 30-year followup
of hearing (the HUNT study). Earhearing, 2015. 36(3): p. 302.
3. Reisser, C., Schubert, O., Forsting, M., & Sartor, K. (1996). Anatomy of the
temporal bone: detailed three-dimensional display based on image data
from high-resolution helical CT: a preliminary report. The American journal
of otology, 17(3), 473-479.
4. Gulya, A.J., Anatomy of the temporal bone with surgical implications. 2007:
CRC Press.
5. Shrapnell, H.J., On the form and structure of the membrana tympani. London
Medical Gazette, 1832. 10: p. 120-124.
6. Lim, D.J., Human tympanic membrane: an ultrastructural observation. Acta
oto-laryngologica, 1970. 70(3): p. 176-186.
7. Mansour, S., et al., Comprehensive and clinical anatomy of the middle ear.
2013: Springer.
8. Lim, D.J., Structure and function of the tympanic membrane: a review. ACTA
Oto-rhino-laryngologica Belgica, 1995. 49(2): p. 101-115.
9. Chien, W., et al., Anatomy of the distal incus in humans. Journal of the
Association for Research in Otolaryngology, 2009. 10(4): p. 485.
10. Àwengen, D.F., et al., Measurements of the stapes superstructure. Annals of
Otology, RhinologyLaryngology, 1995. 104(4): p. 311-316.
11. Brunner, H.J., Attachment of the stapes to the oval window in man. AMA
archives of otolaryngology, 1954. 59(1): p. 18-29.
12. Bluestone, C.D.J., Epidemiology and pathogenesis of chronic suppurative
otitis media: implications for prevention and treatment. International
journal of pediatric otorhinolaryngology, 1998. 42(3): p. 207-223.
13. Organization, W.H., Chronic suppurative otitis media: burden of illness and
management options. 2004.
14. Orji, F.J., A survey of the burden of management of chronic suppurative otitis
media in a developing country. Annals of medical health sciences research,
2013. 3(3): p. 598-612.
15. Rye, M.S., J.M. Blackwell, and S.E.J. Jamieson, Genetic susceptibility to otitis
media in childhood. The Laryngoscope, 2012. 122(3): p. 665-675.
16. Jolivet-Gougeon, A. and M.J. Bonnaure-Mallet, Biofilms as a mechanism of
bacterial resistance. Drug Discovery Today: Technologies, 2014. 11: p. 49-56.
17. Elmorsy, S., et al., The Role of IL-8 in Different Types of Otitis Media and
Bacteriological Correlation. Journal of International Advanced Otology,
2010. 6(2).
18. Si, Y., et al., Attenuated TLRs in middle ear mucosa contributes to
susceptibility of chronic suppurative otitis media. Human immunology, 2014.
75(8): p. 771-776.
19. Sattar, A., et al., Bacterial spectrum and their sensitivity pattern in patients
of chronic suppurative otitis media. Journal of the College of Physicians
42
Surgeons--Pakistan: JCPSP, 2012. 22(2): p. 128-129.
20. Aduda, D.S., et al., Bacteriology of chronic suppurative otitis media (CSOM)
in children in Garissa district, Kenya: a point prevalence study. International
journal of pediatric otorhinolaryngology, 2013. 77(7): p. 1107-1111.
21. Mittal, R., et al., Current concepts in the pathogenesis and treatment of
chronic suppurative otitis media. Journal of medical microbiology, 2015.
64(10): p. 1103-1116.
22. Pollack, M.J., Special role of Pseudomonas aeruginosa in chronic suppurative
otitis media. Arch Otolaryngol Head Neck Surg, 1988. 97(Suppl 131): p. 10-
13.
23. Mittal, R., et al., Pseudomonas aeruginosa Activates PKC-Alpha to Invade
Middle Ear Epithelial Cells. Front Microbiol, 2016. 7: p. 255.
24. Prakash, R., et al., Microbiology of chronic suppurative otitis media in a
tertiary care setup of uttarakhand state, India. N Am J Med Sci, 2013. 5(4):
p. 282-7.
25. Akyıldız, N.J.B.T.Y., Ankara, Kulak hastalıkları ve mikrocerrahisi. 1998. 275-
330.
26. Prunty, S., J. Ha, and S. Vijayasekaran, Management of chronic suppurative
otitis media, in Otitis Media: State of the art concepts and treatment. 2015,
Springer. p. 117-122.
27. Dohar, J.E., M.A. Kenna, and R.M.J. Wadowsky, In vitro susceptibility of aural
isolates of Pseudomonas aeruginosa to commonly used ototopical
antibiotics. The American journal of otology, 1996. 17(2): p. 207-209.
28. Acuin, J.J., Global burden of disease due to chronic suppurative otitis media:
Disease, deafness, deaths and DALYs Chronic Suppurative Otitis Media-
Burden of Illness and Management Options. Geneva: World Health
Organisation, 2004: p. 9-23.
29. Macfadyen, C.A., J.M. Acuin, and C.L.J. Gamble, Systemic antibiotics versus
topical treatments for chronically discharging ears with underlying eardrum
perforations. Cochrane database of systematic reviews, 2006(1).
30. Adriztina, I., L.I. Adenin, and Y.M.J. Lubis, Efficacy of boric acid as a treatment
of choice for chronic suppurative otitis media and its ototoxicity. Korean
journal of family medicine, 2018. 39(1): p. 2.
31. Matin, M., et al., A profile of 100 complicated cases of chronic suppurative
otitis media. Journal of the Royal Society of Health, 1997. 117(3): p. 157-159.
32. Haynes, D.S.J., Surgery for chronic ear disease. Ear, Nose Throat Journal,
2001. 80(6): p. 8-8.
33. HOUSE, W.F.J., Myringoplasty. AMA archives of otolaryngology, 1960. 71(3):
p. 399-404.
34. Schwaber, M.K.J., Postauricular undersurface tympanic membrane grafting:
some modifications of the “swinging door” technique. Otolaryngology—
Head Neck Surgery, 1986. 95(2): p. 182-187.
35. Kartush, J.M., et al., Over-under tympanoplasty. The Laryngoscope, 2002.
112(5): p. 802-807.
43
36. Das, A., et al., Myringoplasty: impact of size and site of perforation on the
success rate. Indian Journal of Otolaryngology Head Neck Surgery, 2015.
67(2): p. 185-189.
37. Sharma, C., et al., Fat graft myringoplasty in small central perforations.
Indian Journal of Otology, 2014. 20(4): p. 211.
38. Alain, H., et al., Butterfly myringoplasty for total, subtotal, and annular
perforations. The Laryngoscope, 2016. 126(11): p. 2565-2568.
39. Dhanapala, N., B. Ramya, and L.S.J. Reddy, A Comparative Study of the
Efficacy of Fat Plug Myringoplasty and Conventional Myringoplasty in
Chronic Suppurative Otitis Media with Small Central Perforation. Indian
Journal of Otolaryngology Head Neck Surgery, 2018: p. 1-5.
40. Wullstein, H.J.T.L., Theory and practice of tympanoplasty. The Laryngoscope,
1956. 66(8): p. 1076-1093.
41. Flint, Cummings Otolaryngology, Sixth Editon. 2015: Elsevier.
42. Shambaugh, G. and M.J.S.o.t.e.r.e.P.W.S. Glasscock, Tympanoplasty. 1980.
43. Merkus, P., et al., Classifications of mastoid and middle ear surgery: A
scoping review. The journal of international advanced otology, 2018. 14(2):
p. 227.
44. Tos, M., Manual of middle ear surgery. 1993: Georg Thieme Stuttgart.
45. Sanna, M., et al., Middle ear and mastoid microsurgery. 2003: Thieme
Stuttgart New York.
46. Ümit, T., et al., Results of primary ossiculoplasty and prognostic factors in
canal wall-down tympanoplasty. Journal of Craniofacial Surgery, 2010.
21(2): p. 407-410.
47. Cho, Y.-S., et al., Revision surgery for chronic otitis media: characteristics and
outcomes in comparison with primary surgery. Auris Nasus Larynx, 2010.
37(1): p. 18-22.
48. Çelik, O., Kulak burun boğaz hastalıkları ve baş boyun cerrahisi. 2007: Asya
Tıp Kitabevi.
49. Goyal, R., et al., Modified radical mastoidectomy with type III tympanoplasty:
Revisited. Indian Journal of Otolaryngology Head Neck Surgery, 2016. 68(1):
p. 52-55.
50. Dornhoffer, J.L.J., Retrograde mastoidectomy. Otolaryngologic Clinics of
North America, 2006. 39(6): p. 1115-1127.
51. Khan, M.I., S. Patel, and K.J. Dasgupta, Is HRCT Temporal Bone Necessary in
All Cases of Active Squamous Chronic Otitis Media? Indian Journal of
Otolaryngology Head Neck Surgery, 2018: p. 1-5.
52. Chatterjee, P., S. Khanna, and R.J. Talukdar, Role of high resolution computed
tomography of mastoids in planning surgery for chronic suppurative otitis
media. Indian Journal of Otolaryngology Head Neck Surgery, 2015. 67(3): p.
275-280.
53. Walshe, P., et al., The role of computerized tomography in the preoperative
assessment of chronic suppurative otitis media. Clinical Otolaryngology,
2002. 27(2): p. 95-97.
44
54. Jackler, R.K., W.P. Dillon, and R.A.J. Schindler, Computed tomography in
suppurative ear disease: a correlation of surgical and radiographic findings.
The Laryngoscope, 1984. 94(6): p. 746-752.
55. Karki, S., et al., Correlation between preoperative high resolution computed
tomography (CT) findings with surgical findings in chronic otitis media (COM)
squamosal type. Kathmandu Univ Med J, 2017. 15(57): p. 84-87.
56. Beig, S., S. Sharma, and M.J. Khalid, Revisiting Correlation Between Pre
Operative High Resolution Computed Tomography and Operative Findings in
Attico Antral Disease. Indian Journal of Otolaryngology Head Neck Surgery,
2018: p. 1-6.
57. Yildirim-Baylan, M., et al., An evaluation of preoperative computed
tomography on patients with chronic otitis media. %J Indian Journal of
Otolaryngology, 2012. 64(1): p. 67-70.
58. Keskin, S., H. Çetin, and H.J. Gürkan Töre, The Correlation of Temporal Bone
CT With Surgery Findings in Evaluation of Chronic Inflammatory Diseases of
The Middle Ear. European Journal of General Medicine, 2011. 8(1).
59. Prata, A.A.S., et al., Comparative study between radiological and surgical
findings of chronic otitis media. Arquivos Internacionais de
Otorrinolaringologia, 2011. 15(01): p. 072-078.
60. Mandal, S., K. Muneer, and M.J. Roy, High Resolution Computed
Tomography of Temporal Bone: The Predictive Value in Atticoantral Disease.
Indian Journal of Otolaryngology Head Neck Surgery, 2018: p. 1-5.
61. O'reilly, B., et al., The value of CT scanning in chronic suppurative otitis
media. The Journal of Laryngology Otology, 1991. 105(12): p. 990-994.
62. Chee, N. and T.J. Tan, The value of pre-operative high resolution CT scans in
cholesteatoma surgery. Singapore medical journal, 2001. 42(4): p. 155-159.
63. Ahmed, M.A.E., et al., Correlation Between Role of Preoperative
Computerized Tomography and Intraoperative Findings in Revision
Myringoplasty. Egyptian Journal of Hospital Medicine, 2019. 75(1).
64. Datta, G., et al., Correlation of preoperative HRCT findings with surgical
findings in Unsafe CSOM. IOSR Journal of Dental Medical Sciences, 2014.
13(1): p. 120-25.
