DOI: http://dx.doi.org/10.18203/issn.2454-5929.ijohns20192723

Assessment of chronic suppurative otitis media patients with cholesteatoma on the basis of gadolinium enhanced T1-T2 weighted images of MRI

Sumeer Verma, Anshu Arora, Ajay Kumar Jain

Abstract


Background: The propensity for ossicular destruction is much greater in case of unsafe CSOM due to presence of cholesteatoma and/or granulations. Partial or total destruction of ossicles is seen in approximately 80% of patients with cholesteatoma, whereas in chronic otitis media without cholesteatom, ossicular chain erosion can be seen in approximately 20% cases.The present study aims to evaluate the clinical profile of patients of unsafe chronic suppurative otitis media with cholesteatoma and assesses patients on the basis of gadolinium enhanced T1-T2 weighted images of MRI.

Methods: The study was conducted among patients who were fulfilling the criteria for unsafe CSOM i.e., retraction pocket in pars tensa, marginal perforation, perforation in pars flaccida, presence of granulation tissue, presence of polyp, blood stained discharge etc. were selected for the study. MRI was performed in all cases by using gadolinium enhanced T1-T2 sequences for diagnosis of cholesteatoma. Mastoidectomy was done to confirm the findings of MRI.  

Results: In maximum number of cases perforation was found in attic region. Most common complication of disease is the ossicular chain erosion. In present study sensitivity was 84%, specificity was 100% and positive predictive value and negative predictive value were 100% and 66% respectively.

Conclusions: It can be concluded that MRI can differentiate cholesteatoma from other inflammatory etiology. By using MRI with 1.5 or 3T unit a small cholesteatoma (even 2-3 mm) can be easily detected at its early stage and further complications can be prevented.


Keywords


Chronic suppurative otitis media, Cholesteatoma, MRI

Full Text:

PDF

References


Rout MR, Mohanty D, Vijaylaxmi Y, Kamalesh B, Chakradhar M. Prevalence of cholesteatoma in chronic suppurative otitis media with central perforation. Indian J Otol. 2012;18(1):7.

Shrikrishna BH. Ossicular defects in patients with non cholesteatomatous CSOM, OJ Otol HNS. 2010;4:14-7.

Hossain MD, Ahamed MN, Sumon MM, Shoyeb BA. Status of ossicles in cholesteatoma, Bangladesh J Otorhinolaryngol . 2015;21(2):97-101.

Vaid S, Kamble Y, Vaid N, Bhatti S, Rawat S, Nanivadekar A, et al. Role of magnetic resonance imaging in cholesteatoma: the Indian experience. Indian J Otolaryngol Head Neck Surg. 2011;65(3):485-92.

Trojanowska A, Drop A, Trojanowski P, Rosińska-Bogusiewicz K, Klatka J, Bobek-Billewicz B. External and middle ear diseases: radiological diagnosis based on clinical signs and symptoms. Insights Imaging. 2011;3(1):33-48.

Vercruysse JP, De Foer B, Somers T, Casselman J, Offeciers E. Magnetic resonance imaging of cholesteatoma: an update. B-ENT. 2009;5(4):233-40.

Sade J, Fuchs C. Secretory otitis media in adults: I. The role of mastoid pneumatization as a risk factor. Ann Otol Rhinol Laryngol. 1996;105(8):643-7.

Sadé J, Fuchs C. Secretory otitis media in adults: II. The role of mastoid pneumatization as a prognostic factor. Ann Otol Rhinol Laryngol. 1997;106(1):37-40.

Varshney S, Nangia A, Bist SS, Singh RK, Gupta N, Bhagat S. Ossicular chain status in chronic suppurative otitis media in adults. Indian J Otolaryngol Head Neck Surg. 2011;62(4):421-6.

Khater NH, Fahmy HS, Shahat HM, Khater AM. Chronic inflammatory middle ear disease: postoperative CT and MRI findings. The Egyptian J Radiol Nuclear Med. 2015;46(3):629-38.

Martin N, Sterkers O, Nahum H. Chronic inflammatory disease of the middle ear cavities: Gd-DTPA-enhanced MR imaging. Radiology. 1990;176(2):399-405.