High Resolution Computed Tomography Imaging Findings in Chronic Otitis Media with and Without Cholesteatoma

ABS TRACT Objective: To correlate high-resolution computed tomography (HRCT) imaging findings of chronic otitis media (COM) with and without cholesteatoma regarding the presence, site, and severity of bone defects. Material and Methods: Temporal bone HRCT images of patients with COM, obtained between 2011 and 2022, were retrospectively reviewed. Patients with a soft tissue mass in the tympanic cavity were allocated into either COM with cholesteatoma (CH+COM) or without cholesteatoma group (CH-COM) based on pathology results and-/or magnetic resonance imaging findings. Computed tomography images were analyzed with regard to the presence, site and severity of middle ear bone erosions/defects and group comparisons were made. Results: A total of 60 patients (CH+COM: 23 patients, CH-COM: 37 patients) were included. Blunting of the scutum, defect of the tegmen tympani, absence/incompleteness of the Körner's septum, erosion of the ossicular chain, and destruction of the medial and lateral tympanic walls were significantly more frequent in the CH+COM group (p<0.05). While small bone discontinuities ( ≤ 2 mm) of the tegmen tympani or blunting of the scutum were present in both groups, a greater defect of these structures was observed only in the CH+COM group. No significant difference was detected neither regarding the location of the soft tissue masses nor the presence of posterior wall defects (p>0.05). Con-clusion: Radiologists should be aware of bone erosions when evaluating temporal bone HRCT images of patients with COM, even if cholesteatoma is not suspected. Furthermore, reporting the severity of bone destruction could be a helpful hint regarding the presence of cholesteatoma and might impact surgical planning.