Computed-Tomography-Structured Reporting in Middle Ear Opacification: Surgical Results and Clinical Considerations From a Large Retrospective Analysis.

Michele Cavaliere,Antonella Miriam Di Lullo,Gaetano Motta,Giuseppe Di Lorenzo,Camilla Russo,Andrea Elefante,Massimo Mesolella,Elena Cantone

doi:10.3389/fneur.2021.615356

Michele Cavaliere, Antonella Miriam Di Lullo + Show 6 more

Open Access

https://doi.org/10.3389/fneur.2021.615356

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Abstract

Purpose: The aim of the study is to compare the accuracy of unstructured preoperative Computed Tomography (CT) reports from non-tertiary diagnostic centers with intraoperative findings in a large cohort of patients with Chronic Otitis Media (COM) undergone surgery.Methods: From 2012 to 2019, a total number of 301 patients were considered for our purposes. All patients with clinical evidence of COM had preoperative non-contrast high resolution CT scan of the temporal bone in non-tertiary diagnostic centers, performed within 3 months before surgery.Results: The accuracy of CT reports was analyzed in terms of nature, anatomical site, disease extension, bony erosion, vascular structures abnormalities relevant to surgical planning, and Eustachian tube patency. Compared to post-surgical findings, CT reporting critical analysis revealed a tendency to overestimation of bony erosion, coupled to underestimated description of facial canal/lateral semi-circular canal, vascular structures, and Eustachian tube.Conclusion: Discrepancies between CT reports and surgical findings in middle ear opacification can be at least in part due to limited expertise of general radiologists in ENT neuroimaging. To limit this lack of information and the limited accuracy of middle ear structures depiction, here we propose a structured checklist to adopt in the case of a temporal bone CT scan for COM, in order to optimize the communication with surgeons and provide all the crucial information for an accurate surgical planning.

Highlights

Chronic otitis media (COM) is a heterogeneous disorder with a complex pathogenesis, characterized by an altered tympanic membrane, occasional otorrhea, and conductive hearing loss [1]
The lesion nature was hypothesized in 140 cases as cholesteatomas and in 106 cases as generically inflammatory, while in the remaining 54 cases no information concerning the possible nature of the lesion was provided; at surgery, the presence of cholesteatoma was documented in 195 cases, whereas granulation tissue only was found in 106 patients
magnetic resonance imaging (MRI) examination is crucial to determine the nature of chronic inflammatory pathology of the middle ear, computed tomography (CT) scan is still mandatory to evaluate temporal bony structures, optimize pre-surgical planning and manage intra-operative complications

Summary

Introduction

Chronic otitis media (COM) is a heterogeneous disorder with a complex pathogenesis, characterized by an altered tympanic membrane, occasional otorrhea, and conductive hearing loss [1] This disorder encompasses a wide spectrum of manifestations, ranging from simple COM to COM in the setting of specific diseases, from COM with granulation tissue to cholesteatoma [1]. High resolution CT (HRCT) can provide crucial information to the surgeon, optimizing treatment planning (demolitive vs conservative surgery), preventing complications and improving clinical outcome [8, 9] To this purpose, an accurate depiction of critical findings and an appropriate description of anatomical landmarks are strictly required in radiological reports. It is undeniable that the accuracy of unstructured reports is generally influenced by radiologists’ expertise in ear, nose, and throat (ENT) imaging; to overcome this possible inconvenience and limit inter-observer variability, structured reporting has been claimed as a model for improving quality and comparability of radiology reports [10]

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