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

Published online by Cambridge University Press:  07 January 2021

A Košec Open the ORCID record for A Košec [Opens in a new window] ,
V Matišić ,
T Gregurić ,
H Falak ,
J Ajduk  and
M Ries
A Košec*
Affiliation:
Department of Otorhinolaryngology and Head and Neck Surgery, Zagreb, Croatia Department of School of Medicine, University of Zagreb, Zagreb, Croatia
V Matišić
Affiliation:
Department of School of Medicine, University of Zagreb, Zagreb, Croatia
T Gregurić
Affiliation:
Department of Clinical and Interventional Radiology, University Hospital Center Sestre Milosrdnice, Zagreb, Croatia
H Falak
Affiliation:
Department of Internal Medicine, Clinical Hospital Dubrava, Zagreb, Croatia
J Ajduk
Affiliation:
Department of Otorhinolaryngology and Head and Neck Surgery, Zagreb, Croatia Department of School of Medicine, University of Zagreb, Zagreb, Croatia
M Ries
Affiliation:
Department of Otorhinolaryngology and Head and Neck Surgery, Zagreb, Croatia Department of School of Medicine, University of Zagreb, Zagreb, Croatia
*
Author for correspondence: Dr Andro Košec, Department of Otorhinolaryngology and Head and Neck Surgery, University Hospital Center Sestre Milosrdnice, Vinogradska Cesta 29, Zagreb, Croatia E-mail: [email protected] Fax: +385 1376 9067
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Abstract

Objective

To correlate pre-operative computed tomography findings, intra-operative details and surgical outcomes with cholesteatoma recurrence in revision tympanomastoidectomy.

Methods

This retrospective, non-randomised, single-institution cohort study included 42 patients who underwent pre-operative computed tomography imaging and revision surgery for recurrent chronic otitis media. Twelve disease localisations noted during revision surgery were correlated with pre-operative temporal bone computed tomography scans. A matched pair analysis was performed on patients with similar intra-operative findings, but without pre-operative computed tomography scans.

Results

Pre-operative computed tomography identified 25 out of 31 cholesteatoma recurrences. Computed tomography findings correlated with: recurrent cholesteatoma when attic opacification and ossicular chain involvement were present; and revision surgery type. Sinodural angle disease, posterior canal wall erosion and dehiscent dura were identified as predictors of canal wall down tympanomastoidectomy. Patients with pre-operative computed tomography scans had a higher rate of cholesteatoma recurrence, younger age at diagnosis of recurrent disease, more revision surgical procedures and less time between previous and revision surgical procedures (all p < 0.05).

Conclusion

Pre-operative imaging and intra-operative findings have important clinical implications in revision surgery for chronic otitis media. Performing pre-operative computed tomography increases diagnosis accuracy and reduces the time required to diagnose recurrent disease.

Keywords

TympanoplastyOtitis Media, SuppurativeCholesteatomaComputed Tomography, X-Ray
Type
Main Articles
Information
The Journal of Laryngology & Otology , Volume 134 , Issue 12 , December 2020 , pp. 1096 - 1102
Copyright
Copyright © JLO (1984) Limited, 2021

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Footnotes

Dr A Košec takes responsibility for the integrity of the content of the paper

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