Utility and limitations of CT in otitis media

To assess the degree of reliability of computed tomography (CT) and the agreement between the imaging studies and intraoperative findings in chronic otitis media (COM) with cholesteatoma. We studied 51 patients diagnosed clinically as having inflammatory disease of the middle ear. All the patients under-went high-resolution Ct of temporal bone in axial and coronal planes. The imaging studies were retrospectively correlated with the intraoperative findings and the sensitivity of CT in the detection of erosive cholesteatoma was determined. Open radical mastoidectomy is the surgical technique most frequently used to treat cholesteatoma in our center. The greatest radio-surgical correlation was achieved in the detection of masses presenting soft tissue attenuation in air-filled cavities in middle ear (100%) and in bone erosion (87.5%). The 20 patients (39%) who were diagnosed as having COM with cholesteatoma underwent surgical treatment in our center. CT is the technique of choice in the study of COM with cholesteatoma, providing basic and necessary information for the image-based diagnosis of this disease, the detection of masses presenting soft tissue attenuation and bone erosion. We also point out the role of CT as an intraoperative guide and discuss its low sensitivity for the detection of small areas of dura mater exposure, ossicular luxation and facial canal dehiscence. (Author) 8 refs