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Correlation of pre-operative computed tomography, intra-operative findings and surgical outcomes in revision tympanomastoidectomy

Published online by Cambridge University Press:  07 January 2021

A Košec Open the ORCID record for A Košec [Opens in a new window] ,
V Matišić ,
T Gregurić ,
H Falak ,
J Ajduk  and
M Ries
A Košec*
Affiliation:
Department of Otorhinolaryngology and Head and Neck Surgery, Zagreb, Croatia Department of School of Medicine, University of Zagreb, Zagreb, Croatia
V Matišić
Affiliation:
Department of School of Medicine, University of Zagreb, Zagreb, Croatia
T Gregurić
Affiliation:
Department of Clinical and Interventional Radiology, University Hospital Center Sestre Milosrdnice, Zagreb, Croatia
H Falak
Affiliation:
Department of Internal Medicine, Clinical Hospital Dubrava, Zagreb, Croatia
J Ajduk
Affiliation:
Department of Otorhinolaryngology and Head and Neck Surgery, Zagreb, Croatia Department of School of Medicine, University of Zagreb, Zagreb, Croatia
M Ries
Affiliation:
Department of Otorhinolaryngology and Head and Neck Surgery, Zagreb, Croatia Department of School of Medicine, University of Zagreb, Zagreb, Croatia
*
Author for correspondence: Dr Andro Košec, Department of Otorhinolaryngology and Head and Neck Surgery, University Hospital Center Sestre Milosrdnice, Vinogradska Cesta 29, Zagreb, Croatia E-mail: andro.kosec@yahoo.com Fax: +385 1376 9067
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Abstract

Objective

To correlate pre-operative computed tomography findings, intra-operative details and surgical outcomes with cholesteatoma recurrence in revision tympanomastoidectomy.

Methods

This retrospective, non-randomised, single-institution cohort study included 42 patients who underwent pre-operative computed tomography imaging and revision surgery for recurrent chronic otitis media. Twelve disease localisations noted during revision surgery were correlated with pre-operative temporal bone computed tomography scans. A matched pair analysis was performed on patients with similar intra-operative findings, but without pre-operative computed tomography scans.

Results

Pre-operative computed tomography identified 25 out of 31 cholesteatoma recurrences. Computed tomography findings correlated with: recurrent cholesteatoma when attic opacification and ossicular chain involvement were present; and revision surgery type. Sinodural angle disease, posterior canal wall erosion and dehiscent dura were identified as predictors of canal wall down tympanomastoidectomy. Patients with pre-operative computed tomography scans had a higher rate of cholesteatoma recurrence, younger age at diagnosis of recurrent disease, more revision surgical procedures and less time between previous and revision surgical procedures (all p < 0.05).

Conclusion

Pre-operative imaging and intra-operative findings have important clinical implications in revision surgery for chronic otitis media. Performing pre-operative computed tomography increases diagnosis accuracy and reduces the time required to diagnose recurrent disease.

Keywords

TympanoplastyOtitis Media, SuppurativeCholesteatomaComputed Tomography, X-Ray
Type
Main Articles
Information
The Journal of Laryngology & Otology , Volume 134 , Issue 12 , December 2020 , pp. 1096 - 1102
Copyright
Copyright © JLO (1984) Limited, 2021

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Footnotes

Dr A Košec takes responsibility for the integrity of the content of the paper

References

Yung, M, Tono, T, Olszewska, E, Yamamoto, Y, Sudhoff, H, Sakagami, M et al. EAONO/JOS Joint Consensus Statements on the Definitions, Classification and Staging of Middle Ear Cholesteatoma. J Int Adv Otol 2017;13:1–8CrossRefGoogle ScholarPubMed
Kuo, CL, Shiao, AS, Yung, M, Sakagami, M, Sudhoff, H, Wang, CH et al. Updates and knowledge gaps in cholesteatoma research. Biomed Res Int 2015;2015:854024CrossRefGoogle ScholarPubMed
Schwarz, D, Gostian, AO, Shabli, S, Wolber, P, Hüttenbrink, KB, Anagiotos, A. Analysis of the dura involvement in cholesteatoma surgery. Auris Nasus Larynx 2018;45:51–6CrossRefGoogle ScholarPubMed
Swartz, JD. Imaging diagnosis of middle ear lesions. Curr Probl Diagn Radiol 2002;31:4–21CrossRefGoogle ScholarPubMed
Stasolla, A, Magliulo, G, Cortese, A, Roncacci, A, Marini, M. Preoperative image assessment of chronic otitis media: what does the otologist need to know? Radiol Med 2011;116:114–24CrossRefGoogle Scholar
Nadol, JB Jr. Revision mastoidectomy. Otolaryngol Clin North Am 2006;39:723–40CrossRefGoogle ScholarPubMed
Veldman, JE, Braunius, WW. Revision surgery for chronic otitis media: a learning experience. Report on 389 cases with long-term follow-up. Ann Otol Rhinol Laryngol 1998;107:486–91CrossRefGoogle ScholarPubMed
Yu, Y, See, J, Ng, JH, Low, D, Tan, TY, Yuen, HW. Patterns of middle-ear cholesteatoma and implications for surgical approach. J Laryngol Otol 2020;134:116–20CrossRefGoogle Scholar
Campos, A, Mata, F, Reboll, R, Peris, ML, Basterra, J. Computed tomography and magnetic resonance fusion imaging in cholesteatoma preoperative assessment. Eur Arch Otorhinolaryngol 2017;274:1405–11CrossRefGoogle ScholarPubMed
Coralles, CE, Blevins, NH. Imaging for evaluation of cholesteatoma: current concepts and future directions. Curr Opin Otolaryngol Head Neck Surg 2013;21:461–7CrossRefGoogle Scholar
Kasenõmm, P. Intraoperative findings of revision canal wall-down tympanomastoid surgery. Acta Otolaryngol 2013;133:826–32CrossRefGoogle ScholarPubMed
Košec, A, Kelava, I, Ajduk, J, Ries, M, Trotic, R, Bedekovic, V. Significance of intraoperative findings in revision tympanomastoidectomy. Am J Otolaryngol 2017;38:462–5CrossRefGoogle ScholarPubMed
Faramarzi, A, Motasaddi-Zarandy, M, Khorsandi, MT. Intraoperative findings in revision chronic otitis media surgery. Arch Iran Med 2008;11:196–9Google ScholarPubMed
Gul, A, Akdag, M, Kinis, V, Yilmaz, B, Sengul, E, Teke, M et al. Radiologic and surgical findings in chronic suppurative otitis media. J Craniofac Surg 2014;25:2027–9CrossRefGoogle ScholarPubMed
Romano, A, Covelli, E, Confaloni, V, Rossi-Espagnet, MC, Butera, G, Barbara, M et al. Role of non-echo-planar diffusion-weighted images in the identification of recurrent cholesteatoma of the temporal bone. Radiol Med 2020;125:75–9CrossRefGoogle ScholarPubMed
Lingam, RK, Bassett, P. A meta-analysis on the diagnostic performance of non-echoplanar diffusion-weighted imaging in detecting middle ear cholesteatoma: 10 years on. Otol Neurotol 2017;38:521–8CrossRefGoogle Scholar
Khemani, S, Singh, A, Lingam, RK, Kalan, A. Imaging of postoperative middle ear cholesteatoma. Clin Radiol 2011;66:760–7CrossRefGoogle ScholarPubMed
Stutzki, M, Jahns, E, Mandapathil, MM, Diogo, I, Werner, JA, Güldner, C. Indications of cone beam CT in head and neck imaging. Acta Otolaryngol 2015;135:1337–43CrossRefGoogle ScholarPubMed
Songu, M, Altay, C, Onal, K, Arslanoglu, S, Balci, MK, Ucar, M et al. Correlation of computed tomography, echo-planar diffusion-weighted magnetic resonance imaging and surgical outcomes in middle ear cholesteatoma. Acta Otolaryngol 2015;135:776–80CrossRefGoogle ScholarPubMed
Alzahrani, M, Alhazmi, R, Bélair, M, Saliba, I. Postoperative diffusion weighted MRI and preoperative CT scan fusion for residual cholesteatoma localization. Int J Pediatr Otorhinolaryngol 2016;90:259–63CrossRefGoogle ScholarPubMed
Allam, HS, Abdel Razek, AAK, Ashraf, B, Khalek, M. Reliability of diffusion-weighted magnetic resonance imaging in differentiation of recurrent cholesteatoma and granulation tissue after intact canal wall mastoidectomy. J Laryngol Otol 2019;133:1083–6CrossRefGoogle ScholarPubMed
Selwyn, D, Howard, J, Cuddihy, P. Pre-operative prediction of cholesteatomas from radiology: retrospective cohort study of 106 cases. J Laryngol Otol 2019;133:477–81CrossRefGoogle ScholarPubMed