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The role of preoperative gadolinium enhanced magnetic resonance imaging (MRI) in anticipating postoperative middle ear aeration after canal wall up tympanoplasty for cholesteatoma

Presenting Author: Noriaki Nagai

Published online by Cambridge University Press:  03 June 2016

Noriaki Nagai ,
Tetsuya Tono ,
Keiji Mtsuda  and
Shinya Hirahara
Noriaki Nagai
Affiliation:
University of miyazaki
Tetsuya Tono
Affiliation:
University of miyazaki
Keiji Mtsuda
Affiliation:
University of miyazaki
Shinya Hirahara
Affiliation:
University of miyazaki
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Abstract

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Type
Abstracts
Information
The Journal of Laryngology & Otology , Volume 130 , Supplement S3: Abstracts for the 10th International Conference on Cholesteatoma , May 2016 , pp. S212
Copyright
Copyright © JLO (1984) Limited 2016 

Learning Objectives:

Objective: This study was designed to anticipate the postoperative middle ear aeration using preoperative gadolinium enhanced magnetic resonance imaging (MRI) after canal wall up tympanoplasty (CWU) for cholesteatoma.

Materials and methods: Retrospective review was performed on 56 patients with mastoid involvement undergoing CWU tympanomastoidectomy without mastoid obliteration at a single institution from 2010 to 2013. In all patients, the cholesteatoma was removed by a combined approach. The communication between the Eustachian tube and the attic was reestablished with a posterior and anterior tympanotomy. The attic bony wall defect was reconstructed using sliced auricular cartilage and fibrin glue (scutum plasty). Patients were classified into two groups according to the status of enhancement around the cholesteatoma sac using pre-operative MRI: Group A (strongly enhanced) and Group B (weakly or no enhanced). In each groups, restoration of the middle ear aeration was assessed with high-resolution computed tomography (CT) before and after operation. Status of aeration was classified into 4 grades (no aeration, mesotympanum, epitympanum, mastoid).

Results: Although the middle ear aeration ameliorated in both groups, the range of re-aeration was much better in Group A (strongly enhanced group) than Group B. Re-aeration to the mastoid was achieved in 68% of the cases in Group A, 36% of the cases in Group B.

Discussion and Conclusion: The enhanced MR image was found to be related to postoperative middle ear aeration. These findings might be particularly useful for predicting re-aeration of acquired cholesteatoma.