Pre-Operative Temporal Bone CT Scan Readings and Intraoperative Findings During Mastoidectomy

Abstract

ABSTRACT Objective: To determine the correlation between pre-operative in-house temporal bone CT scan readings and intraoperative findings during mastoidectomy for cholesteatoma in a tertiary government hospital from January 2018 to December 2019. Methods: Design: Review of Records Setting: Tertiary Government Hospital Participants: A total of 25 charts were included in the study. Surgical memoranda containing intraoperative findings were scrutinized. Data on key structures or locations were filled into a data gathering tool. Categorical descriptions were used for surgical findings: “present” or “absent” for location, and “intact” or “eroded” for status of ossicles and critical structures. Radiological readings to describe location and extent of disease were recorded as either “involved” or “uninvolved,” while “intact” or “eroded” were used to describe the status of ossicles and critical structures identified. Statistical correlations were computed using Cohen kappa coefficient. Sensitivity, specificity, and predictive values were also computed.   Results: No correlation between radiologic readings and surgical findings were found in terms of location and extent of cholesteatoma (κ < 0). However, moderate agreement was noted in terms of status of the malleus (κ = .42, 95% CI, .059 to .781, p<.05), substantial agreement noted for the incus status (κ = 0.682, 95% CI, .267 to .875, p<.05), and fair agreement noted for the stapes status (κ = .303, 95% CI, -.036 to .642, p>.05). Slight agreement was also noted in description of facial canal and labyrinth (κ =.01, 95% CI, -.374 to .394, p>.05), while no correlation was noted for the status of the tegmen (κ = 0, 95% CI, -.392 to .392, p<.05). Conclusion: Our study shows the unreliability and shortcomings of CT scan readings in our institution in detecting and predicting surgical findings. An institutional policy needs to be considered to ensure that temporal bone CT scans be obtained using techniques that can appropriately describe the status of the middle ear and adjacent structures with better reliability.