Evaluating Mastoid Involvement in Chronic Suppurative Otitis Media: Diagnostic Accuracy of High-Resolution Computed Tomography in Southern Iraq

The study aimed to assess the diagnostic accuracy of high-resolution computed tomography (HRCT) in evaluating mastoid involvement in patients with chronic suppurative otitis media (CSOM) in southern Iraq. This multicenter study was conducted in three medical centers across southern Iraq from September 2023 to February 2024. A total of 120 patients diagnosed with attico-antral CSOM, scheduled for mastoidectomy across three medical centers, underwent HRCT scanning and subsequent intraoperative evaluation. The research compared HRCT findings with intraoperative results across various parameters, including soft tissue lesions, mastoid pneumatization, and erosion of the scutum, tegmen plate, sinus plate, ossicular chain, facial canal, and lateral semicircular canal (LSCC). The study found that HRCT and intraoperative findings showed good agreement in assessing soft tissue involvement in the mastoid, attic, middle ear, Eustachian tube, and facial recess (P>0.05). Mastoid pneumatization also noted a strong agreement (P=0.75). However, significant discrepancies were observed in scutum erosion (P=0.047), sinus plate positioning (P=0.036), and ossicular status, with HRCT being less sensitive for detecting stapes erosion (P=0.013). For facial canal erosion, no significant differences were observed (P=0.58), while HRCT identified fewer cases of LSCC erosion compared to intraoperative findings, though the difference was not statistically significant. The results demonstrate that while HRCT is a reliable tool for assessing most aspects of middle ear involvement in CSOM, certain areas such as scutum erosion and stapes erosion require careful intraoperative evaluation for comprehensive diagnosis and management.