High-resolution Computed Tomography of Temporal Bone as a Diagnostic Technique for Early Diagnosis of Cholesteatoma and Prevention of Its Severe Complications.

BACKGROUND

Cholesteatoma is a locally destructive lesion of the temporal bone characterized by progressive bone erosion and potential extracranial and intracranial complications. High-resolution computed tomography (HRCT) plays a crucial role in early detection and preoperative assessment.

OBJECTIVE

To evaluate the diagnostic performance of HRCT in detecting cholesteatoma and its complications through correlation with intraoperative findings.

MATERIALS AND

METHODS

This prospective observational study included 77 patients with clinically suspected cholesteatoma over 18 months. HRCT of the temporal bone was performed using a 32-slice multidetector CT scanner with thin-section (0.6-1 mm) bone algorithm reconstruction. Parameters assessed included soft tissue presence, scutum erosion, ossicular erosion, mastoid involvement, tegmen tympani erosion, sigmoid plate erosion, facial canal erosion, lateral semicircular canal fistula, and sinus tympani involvement. Surgical findings served as the reference standard, and diagnostic performance was calculated.

RESULTS

The mean age was 40.64 ± 16.28 years, with peak incidence in the 21-40-year group. Conductive hearing loss (57.1%) and ear discharge (32.5%) were common presentations. HRCT demonstrated excellent concordance with surgery for scutum erosion (98.7%), ossicular erosion (97.4%), and facial canal erosion (100%). Sensitivity ranged from 68% (sinus tympani involvement) to 100% (scutum and facial canal erosion), while specificity was 90.9%-100%. Overall diagnostic accuracy ranged from 89.6% to 100%. Histopathology confirmed cholesteatoma in 94.8% of cases.

CONCLUSION

HRCT of the temporal bone demonstrates high diagnostic accuracy and strong surgical correlation in cholesteatoma evaluation, supporting its role as a reliable preoperative imaging modality for early detection and complication assessment.