Comparative Study Between Radiological Findings AndIntraOperative Findings In Patients With Unsafe CSOM – A Prospective Cross Sectional Study.

Abstract

Background: Unsafe chronic suppurative otitis media (atticoantral) is one of the common conditions in otolaryngologic practice in developing countries.The disease manifests most commonly as hearing loss and otorrhea. Unsafe CSOM has long been acknowledged as one of the most common diagnoses in primary care setting worldwide.Severalinvestigations have been used in the evaluation of CSOM like X ray, HRCT, and MRI. Method: Prospective comparative study conducted From May 2021 to April 2023 at tertiary care hospital .70 patients presenting to ENT OPD and casualty and getting operated for unsafe CSOM are included in the study. Demographic data, nature of ear discharge, and presence or absence of symptoms showing complications, otoscopic examination, hearing assessment by Pure tone Audiometry was recorded for all the patients. Radiological investigations namely-X-RAY MASTOID SCHULLER’S VIEW and HRCT TEMPORAL BONE were advised to all the patients.  NCCT BRAIN was done to rule out or detect intracranial complications in selected cases suspicious of having the same.
Results: In our study the patients were between 5 to 66 years of age with mean age of 26.2 years, showed a male preponderance. the commonest complaint was otorrhoea (100%) Most, 68(97.14%) patients, presented with complaints of foul smelling discharge, Blood- stained discharge is often noted with granulation tissue or polyps and was presented by 31 (44.29%) patients, Tympanic membrane pathology was noted in 34 (48.57%) patients with perforation in 15 (21.42%) patients and retraction pockets in 19(27.14%) patients. Among 70 patients 57 (81.43%) patients were found to have mastoid sclerosis on digital X-ray mastoid Schuller’s view, Pre operative HRCT could diagnose soft tissue density suspicious of cholesteatoma in all 70 (100%).Bony erosion, an additional sign for the presence of cholesteatoma was identified in 25(35.71%) case. HRCT was 100% sensitive for cholesteatoma in petrous apex followed by mastoid antrum 97.1 %, aditus 97  %,and epitympanum 94.9 %, HRCT to be 80% sensitive and 86.7 % specific in identifying ossicular destruction. Out of 70 patients, NCCT Brain was done in 20 (28.57%) patients. In out of 20 patients, 3 (4.28%) patients had abnormal findings.
Conclusions: We made an attempt to compare the usability of radiological findings (X-ray, HRCT, and NCCT) in preoperative assessment of unsafe CSOM but INTRAOPERATIVE FINDINGS by skillful surgeon still remains the mainstay of successful diagnosis and treatment of unsafe CSOM.