engleski

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

Objectives: This paper aims to correlate preoperative computed tomography (CT) findings, intraoperative details and surgical outcomes, cholesteatoma recurrence in revision tympanomastoidectomy. Material and Methods: A retrospective non-randomized single-institution cohort study in a tertiary referral center. The study included 42 patients who underwent preoperative CT imaging and revision surgery for recurrent chronic otitis media. The study correlated 12 localizations of disease noted during revision surgery with preoperative temporal bone CT scans. In addition, a matched pair analysis on patients with similar intraoperative findings, but without preoperative CT scans was performed. Results: Preoperative CT identified 25 out of 31 cholesteatoma recurrences (80.65% sensitivity and 81.82% specificity). Binary logistic regression correlated CT findings with recurrent cholesteatoma when attic opacification and ossicular chain involvement were present (p=0.040). CT findings correlated with revision surgery type, identifying sinodural angle disease, posterior canal wall erosion and dehiscent dura as risk factors correlating with canal wall down tympanomastoidectomy. The matched pair analysis using the Kruskal Wallis test showed that patients with preoperative CT scans have a statistically higher rate of diagnosed cholesteatoma recurrence (p=0.043), younger age at diagnosis of recurrent disease (p=0.044), a higher number of revision surgeries (p=0.0001) and a shorter period of time between previous and revision surgeries (p=0.043). Type of surgery (CWU or CWD) was not statistically different regarding presence/absence of preoperative CT scanning (p=0.267). Conclusion: Preoperative imaging and intraoperative findings have important clinical implications in revision surgery for chronic otitis media. The results argue that peforming preoperative CT scans increases the rate of accurate diagnosis and reduces time required to diagnose recurrent disease.

tympanoplasty ; otitis media, suppurative ; cholesteatoma ; computed tomography (CT)

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