Role of CT Mastoids in the Diagnosis and Surgical Management of Chronic Inflammatory Ear Disease

Introduction: Chronic Suppurative Otitis Media (CSOM) is a chronic inflammation of middle ear cleft. It presents with discharging ear and decreased hearing. The diagnosis is mostly on clinical examination with otoscope or otoendoscope. Computerized Tomography (CT) of mastoids is done to evaluate the extent of the disease and its complication. High resolution CT is now the investigation of choice for temporal bone disease. This study emphasizes on the importance of CT scan in diagnosis of inflammatory ear diseases and most importantly identifying pitfalls or complications which a surgeon can come across during surgery. Objectives of the Study: The aims and objectives of this study is:  To establish the efficacy of CT in the diagnosis of the complications and surgical management of chronic inflammatory pathologies of middle ear.  To find subgroups of CSOM where CT is particularly useful. In this series, a total of 25 cases presenting to our OPD at Govt. ENT Hospital between 2013 to 2014 have been diagnosed and findings of surgery correlated with HRCT scan of temporal bones done preoperatively. Results: In this study, 64% of the patients were male and incidence of CSOM with patients undergoing surgery belonged to the age group 21-30 years (32%). The most common presenting symptom was ear discharge (92%) and decreased hearing (96%). The most common type of pathology in this study was attic perforation (36%) and granulations (40%) followed by cholesteatoma (36%) and mucosal edema (16%). Not all cases presented with complications, facial palsy (12%) and mastoid abscess (8%) were among few complications seen. 14 patients (56%) of 25 cases underwent simple cortical mastoidectomy followed by 9 cases (36%) for modified radical mastoidectomy and atticotomy for 2 cases (8%). CT scan findings correlated well with surgical findings for cholesteatoma, middle ear mass and bone erosions. Whereas for ossicular integrity and facial canal dehiscence, there was a discrepancy.