Role of HRCT temporal bone in diagnosis of chronic suppurative otitis media in correlation with intraoperative findings.

Abstract

Objective: To evaluate the role of high-resolution computed tomography (HRCT) of the temporal bone in diagnosing and delineating disease in chronic suppurative otitis media (CSOM) by comparing preoperative HRCT findings. Study Design: Prospective Diagnostic Evaluation study. Setting: Departments of Radiology and Otolaryngology, CMH, Gujranwala, Pakistan. Period: January 2024 to December 2024. Methods: A total of 57 patients aged 1–60 years, clinically diagnosed with CSOM and scheduled for mastoid surgery were analyzed. Patients underwent preoperative HRCT of the temporal bone. Radiological findings were documented and compared with intraoperative observations. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and overall accuracy were calculated for each anatomical structure. Results: In a total of 57 patients, the median age was 26.00 years (IQR: 17.50-41.50). There were 38 (66.7%) males and 19 (33.3%) females. HRCT demonstrated 100% sensitivity and specificity for incus, malleus, scutum, stapes suprastructure erosion, sigmoid plate erosion, and jugular bulb dehiscence. Bony external auditory canal erosion showed 80% sensitivity and 100% specificity. Facial canal dehiscence had 50% sensitivity and 100% specificity. Mastoid cortex erosion had high sensitivity (100%) but lower PPV (66.7%), while tegmen erosion had 100% sensitivity and 98.2% specificity. Overall diagnostic concordance was excellent (Cohen’s Kappa=0.935, p<0.001). The McNemar-Bowker test showed no significant discordance between HRCT and surgical findings (p=0.223). Conclusion: HRCT of the temporal bone demonstrated excellent diagnostic accuracy and agreement with surgical findings in evaluating structural changes associated with CSOM.