[Diagnostic value of multi-slice spiral CT in tympanic wall destruction of middle ear cholesteatoma].

Objective:To investigate the correlation between preoperative temporal bone Computed Tomography （CT） findings and intraoperative manifestations in patients with middle ear cholesteatoma. Methods:The patients with cholesteatoma undergoing surgery in our hospital from March 2017 to November 2020 were retrospectively analyzed.The temporal bone CT findings of tympanoid wall status before operation and the state of tympanic wall during operation were compared. Results: A total of 148 cases （148 ears） were included in the analysis. Compared with intraoperative observation, 142 cases showed the same findings of tympanoid lid by preoperative CT examination, and 144 cases showed the same findings of mastoid lid by preoperative CT examination.The CT manifestations of facial nerve canal state in 18 patients was different from intraoperativen findings. Among the 12 cases of lateral wall destruction of the tympanic chamber observed by CT, 10 cases were consistent with the intraoperative findings.CT showed sigmoid sinus destruction in 6 cases, of which 5 cases were consistent with intraoperative findings. In 142 cases no sigmoid sinus destruction was found by CT , but in one case the CT findingswas different from intraoperative findings.The diagnostic efficiency of the exposed opposite neural tube was poor in the tympanoid wall observed by CT（Se=78.6%，Sp=90.0%，PPV=64.7%，NPV=94.7%，AUC=0.84，Kappa=0.63，P<0.05）, but the diagnostic efficiency of lateral wall failure of the drum chamber was good （Se=83.5%，Sp=98.5%，PPV=83.3%，NPV=98.6%，AUC=0.91，Kappa=0.82，P<0.05）. Conclusion:CT is effective in preoperative diagnosing of tympanic wall destruction caused by cholesteatoma of the middle ear, especially in detecting the destruction of tympanic lid, mastoid lid, lateral wall of the tympanic chamber and sigmoid sinus.Preoperative temporal bone CT scan is beneficial to clincal preoperative decision-making and intraoperative guidance.