Accuracy of high resolution computed tomography in pre-operative acquired cholesteatoma

Abstract

Objective: To determine the accuracy of high resolution computed tomography (HRCT) for diagnosis of acquired cholesteatoma using histopathological finding as gold standard. Materials and Methods: This cross section study of 61 patients, males and females with ages between 10- 35 years was carried out in the department of radiology, Dr Ziauddin Hospital Karachi, from November 2008 to April 2009. Patients clinically diagnosed as having cholesteotoma were referred for scanning. They were selected according to inclusion criteria. Patients were scanned using HRCT technique. Non dependent soft tissue density attenuation mass associated bony erosion in the middle ear/external ear was considered as radiological positive case of cholesteatoma while dependent soft tissue attenuation mass without bony erosion was considered radiologically negative case for Cholesteatoma. Keratinized stratified squamous epithelium with keratin debris and an underline sub-epithelial fibro connective tissue associated bone resorption in it were considered histopathologically positive case for cholesteatoma and without bony resorption were considered negative. Results: Out of 61 patients of clinically diagnosed acquired cholesteatoma 37(60.7%) were males and 24(39.3%) were females. 34(55.5%) patients showed right sided and 27(44.2%) left side temporal bone involvement. Mean age of patients was 22.93 years (SD±8.29). Sensitivity of HRCT technique was 96.4 %, specificity of 80%, positive predictive value of 98.18% and negative predictive value of 67 %. Conclusion: High resolution computed tomography (HRCT) technique is found to have accuracy for diagnosis of pre-operative acquired cholesteatoma using histopathological finding as gold standard.