A study of comparison between preoperative HRCT temporal bone findings and intraoperative findings in patients with chronic otitis media

Abstract Introduction and aims Chronic otitis media (COM) is a persistent inflammatory disease of the middle ear and mastoid that can cause ossicular damage and intracranial complications. High-resolution computed tomography (HRCT) of the temporal bone supports preoperative assessment by depicting fine bony anatomy and disease extent. This study aimed to evaluate the diagnostic accuracy of preoperative HRCT by comparing it with intraoperative findings in patients undergoing surgery for COM. Methods This observational study was conducted over 18 months at a tertiary care center. Fifty consecutive patients with clinically diagnosed mucosal or squamosal COM meeting predefined criteria were included. All patients underwent uniform HRCT with 0.5-mm slices followed by tympanomastoid exploration. Outcomes included ossicular erosion, soft-tissue opacity, scutum erosion, posterior canal wall erosion, facial canal dehiscence, dural plate erosion, labyrinthine fistula, and sigmoid (sinus) plate status. Diagnostic performance (sensitivity, specificity, PPV, NPV) and Cohen’s κ were calculated; chi-square was used only for exploratory association across parameters. Results On HRCT, soft-tissue opacity was present in 82% (41/50) and showed perfect agreement (κ = 1.00) with surgery for presence/absence. HRCT showed almost perfect agreement for scutum erosion (κ = 0.84) and substantial agreement for posterior canal wall erosion (κ = 0.67). Facial canal dehiscence (κ = 0.54), dural plate erosion (κ = 0.43), and labyrinthine fistula (κ = 0.46) demonstrated moderate agreement. Sinus plate dehiscence occurred in one patient only; no accuracy metrics were estimated. While certain individual parameters were not statistically significant, aggregate association across variables was significant ( p < 0.001). Conclusion HRCT offers high diagnostic reliability for key bony changes in COM and strong overall concordance with intraoperative findings, while recognition of its limits for soft-tissue characterization underscores the role of diffusion-weighted MRI when differentiation of cholesteatoma from granulation is required. HRCT should be integrated with clinical and operative assessment for comprehensive surgical planning.