Efficacy of pre-operative computed tomography scans on clinical management and temporal bone surgery in cases of chronic otitis media
Jumaily, Zaid H.
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The purpose of this study is to evaluate the past and recent literature in order to determine the role of pre-operative CT scans in chronic otitis media. We aim to find consensus on the diagnostic ability of CT imaging in various anatomical parts of the middle ear and mastoid, and how this knowledge can affect clinical and surgical management. In context of all literature, there has been mixed results when looking at the sensitivity and specificity of middle ear structures. There was favorable consensus for CT's diagnosis of erosion of the malleus-incus complex, lateral semicircular canal, the facial nerve canal, and presence of soft tissue in the middle ear cavity. There were mixed results with respect to the erosion of tegmen tympani, and sigmoid sinus. Lastly, there was an unfavorable consensus when looking at the erosion of the stapes, oval window, and round window. Various studies conclude that the information gained from CT regarding the condition of the mastoid and middle ear can influence both the type of surgical method used and the success rate by reducing the risk of complications and recurrence of disease. In many studies, the methodology and interpretation of the CT scans are not very well presented. This unfortunately disallows meta-analysis between studies as the number of uncontrolled variables is too large. In the future, we hope that more information is provided as to the method of interpretation as well as the type of CT scanner and dosage. This will allow for a more meaningful result when comparing sensitivities and specificities towards middle ear pathologies, and it will allow for better examination of image quality and usefulness in context of the risk of radiation. Many otologists make routine use pre-operative CT scans in cases of chronic otitis media while others are more selective. In order to reach a consensus, however, more research focused on specific the decision-making process of physicians.