Haydarpasa Numune Research and Training Hospital, 1st ENT Clinic, Uskudar, Istanbul, Turkey.
Eur Arch Otorhinolaryngol. 2012 Jan;269(1):33-8. doi: 10.1007/s00405-011-1577-z. Epub 2011 Mar 24.
The purpose of this study was to determine the role of high-definition computed tomography (CT) in chronic otitis media (COM) patients and to present which parameters were useful or misleading for preoperative evaluation for management. Fifty cases of COM that underwent preoperative CT scanning at a tertiary referral center were retrospectively analyzed. Their CT scan reports were compared with the operative findings. The patients had undergone tympanoplasty with or without mastoidectomy for COM between April 2008 and January 2010. Patient charts were used to obtain the necessary data. In 62% (31/50) of cases, the CT scan showed the presence of cholesteatoma. Operative findings revealed cholesteatoma in 61.8% (19/31) of these cases. However, when a bone eroding soft tissue mass involved the epitympanum on CT, the presence of cholesteatoma was observed in 83.3% (15/18) of cases intraoperatively. Cholesteatoma was present in the mastoid or middle ear intraoperatively in 77.7% (7/9) of patients with an external ear bony canal defect found on CT. Despite 89.7, 85.29, and 90% agreement ratios for dehiscence of facial canal, lateral semicircular canal, and tegmen, respectively, CT could not detect dehiscence of these anatomic structures successfully. Based on these results, CT scanning has limitations but is a useful adjunct for the surgical management of COM patients.
本研究旨在探讨高分辨率 CT（CT）在慢性中耳炎（COM）患者中的作用，并提出哪些参数对手术前评估和管理具有指导意义。我们回顾性分析了在一家三级转诊中心接受术前 CT 扫描的 50 例 COM 患者的病例。将他们的 CT 扫描报告与手术结果进行比较。这些患者因 COM 接受了鼓室成形术或乳突切除术，手术时间为 2008 年 4 月至 2010 年 1 月。通过查阅患者病历获取必要的数据。在 62%（31/50）的病例中，CT 扫描显示存在胆脂瘤。在这些病例中，有 61.8%（19/31）的手术结果发现胆脂瘤。然而，当 CT 显示鼓窦区骨侵蚀软组织肿块累及上鼓室时，术中发现胆脂瘤的比例为 83.3%（15/18）。CT 发现外耳道骨性骨管缺损的患者中，术中发现乳突或中耳内有胆脂瘤的比例为 77.7%（7/9）。尽管面神经管、水平半规管和鼓室盖的不连续在 CT 上的符合率分别为 89.7%、85.29%和 90%，但 CT 并不能成功地检测到这些解剖结构的不连续。基于这些结果，CT 扫描具有一定的局限性，但对 COM 患者的手术治疗具有一定的辅助作用。
