SENSITIVITY OF HRCT TEMPORAL BONE IN UNSAFE CHRONIC SUPPURATIVE OTITIS MEDIA AND CHOLESTEATOMA

Background: Chronic suppurative otitis media (CSOM) poses a significant burden in low- and middle-income countries, with India showing a prevalence of 7.8%. Cholesteatoma, an aggressive subtype of CSOM, can lead to destructive complications such as ossicular damage, facial nerve involvement, and intracranial extension if left untreated. High-resolution computed tomography (HRCT) of the temporal bone is widely used for preoperative evaluation; however, its utility hinges on its diagnostic accuracy in reliably identifying cholesteatoma and related complications. Objective: To evaluate the sensitivity, specificity, and overall diagnostic accuracy of HRCT in detecting cholesteatoma and its complications in patients with unsafe CSOM, using intraoperative findings as the gold standard. Methods: A prospective, observational study was conducted at CMH Rawalpindi from March 2024 to December 2024, involving 50 patients clinically diagnosed with unsafe CSOM and suspected cholesteatoma. HRCT temporal bone imaging was performed prior to surgery, assessing soft tissue density, ossicular erosion, scutum erosion, tegmen tympani erosion, facial canal dehiscence, and labyrinthine fistula. All patients subsequently underwent surgical intervention, and intraoperative findings were meticulously recorded. Diagnostic performance was assessed by comparing radiological and surgical data to calculate sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and overall accuracy. Results: HRCT showed a sensitivity of 95.8%, specificity of 90%, PPV of 96%, NPV of 89.5%, and overall diagnostic accuracy of 94% for detecting cholesteatoma. Ossicular erosion was identified in 41 patients (82%), scutum erosion in 38 (76%), tegmen tympani erosion in 9 (18%), facial canal dehiscence in 6 (12%), and labyrinthine fistula in 3 (6%). Cholesteatoma was surgically confirmed in 48 of 50 patients, resulting in a concordance rate of 96%. Conclusion: HRCT demonstrates high sensitivity and diagnostic accuracy in evaluating cholesteatoma in unsafe CSOM, with excellent agreement to surgical findings. It remains an indispensable tool for preoperative assessment and surgical planning in cholesteatoma management.