SYNOPSIS

RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES, KARNATAKA

BANGALORE

Name of the candidate :Dr. SYEDA JAVERIYA FARHEEN

Guide : Dr. THIMMAPPA T.D

Course and Subject : M.S. ENT

Topic :ROLE OF HRCT TEMPORALBONE IN THE DIAGNOSIS

AND ITS COMPARISON WITH INTRAOPERATIVE FINDINGS

OF CHRONIC SUPPURATIVE OTITIS MEDIA.

DEPARTMENT OF ENT

SHIMOGA INSTITUTE OF MEDICAL SCIENCES

SHIVAMOGGA
2023-24
Rajiv Gandhi University of Health Sciences,
Karnataka Bangalore
ROLE OF HRCT TEMPORAL BONE IN THE DIAGNOSIS
AND ITS COMPARISON WITH INTRAOPERATIVE
FINDINGS OF CHRONIC SUPPURATIVE OTITIS MEDIA

1
 RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES

ANNEXURE-II

PROFORMA FOR REGISTRATION OF SUBJECTS FOR DISSERTATION

Name of the candidate &

1 address : SYEDA JAVERIYA FARHEEN
(in block letters)

#3687, ABDUL ALI ROAD, SAIT COMPOUND, BANGARPET,

Permanent Address :
KOLAR DISTRICT,563114

2 Name of the institution : SHIMOGA INSTITUTE OF MEDICAL SCIENCES

3 Course of study & subjects : M.S. OTORHINOLARYNGOLOGY

Date of admission to the

4 :
course 12/10/2023

ROLE OF HRCT TEMPORAL BONE IN THE DIAGNOSIS

5 Title of Topic : AND ITS COMPARISON WITH INTRAOPERATIVE
FINDINGS OF CHRONIC SUPPURATIVE OTITIS MEDIA.

2
6 Brief Resume of the intended work:

6.1 Need for the study: Chronic suppurative otitis media (CSOM) is a prevalent infectious
disease condition affecting the middle ear mucosa and mastoid. According to the World
Health Organization (WHO),65-330 million people globally suffer from CSOM with
associated otorrhea, and approximately 60% (39-200 million) experience hearing
impairment. WHO also reports 28,000 annual deaths due to complications like
intracranial issues, contributing to a disease burden exceeding 2 million Disability
Adjusted Life Years (DALYs).[1] In India, the disease burden is 1-6% among
developing countries, with higher incidence attributed to low socioeconomic standards,
inadequate nutrition, and a lack of health education.[2]

The diagnosis is mostly on clinical examination with otoscope or oto-endoscope. High

Resolution Computed Tomography (HRCT) is now the investigation of choice for
temporal bone disease. This study emphasizes on the importance of HRCT scan in
diagnosis of inflammatory ear diseases and most importantly identifying pitfalls or
complications which a surgeon can come across during surgery.[3]

The present study is intended to draw the attention to the fact that there is a need to
study the role of HRCT temporal bone to know the anatomy like ossicular chain
variations, sino-dural angle variations, temporal bone pneumatization, chorda tympani
nerve course, temporal bone thickness, congenital anomalies, such as a high-riding
jugular bulb or aberrant course of vessels, may pose challenges during middle ear
surgeries and the changes brought about by the disease pathology in CSOM and also
complications in CSOM if any. HRCT temporal bone also enables the surgeon to
classify the disease as atticoantral or tubotympanic type.

3
6.2 Review of Literature :

 Herizal et al. Studied the concordance between preoperative temporal bone

Computed Tomography (CT) scan interpretation and intraoperative findings in
Chronic Suppurative Otitis Media (CSOM). Over a six-month period
(November 2020 to April 2021), 18 subjects were included. The study revealed
that preoperative temporal bone CT scans exhibit high accuracy in evaluating
the scutum, ossicles, tympanic tegmen, and posterior wall. However, accuracy
remains lower when assessing cholesteatoma and the sigmoid sinus. The
findings suggest that CT scans of the temporal bone in CSOM patients serve as
a valuable guide for evaluating cholesteatoma and other structures, emphasizing
their clinical significance.[1]

 Juveria Majeed et al. Studied the role of CT mastoids in surgical management

of Chronic inflammatory ear diseases. A total of 25 cases were studied in the
hospital’s ENT department between the year 2013 and 2014 with ear diseases
and findings of CT and surgery were correlated. HRCT and improvements in
radiological technique has definitely improved study of the temporal bone in
patients with CSOM, which includes evaluation of the extent and sites of
involvement. But CT was found to be inconsistent with facial nerve
involvement and Lower Semicircular Canal.[3]
 Thripthi Rai: Over an 18-month period, 50 patients diagnosed with Chronic
Otitis Media (COM) were randomly selected from the Outpatient Department.
A detailed examination of these patients was conducted using a standardized
proforma to assess the efficacy of radiological investigations in identifying
various pathological and anatomical variations, which were then compared with
intraoperative findings. The study revealed that 90% of patients with COM and
cholesteatoma exhibited non-dependent soft tissue opacity. Consequently, the
findings led to the conclusion that High-Resolution Computed Tomography
(HRCT) is not only recommended for cases suspected of potential
complications but also for all cases of COM, providing valuable insights into
the extent of the disease, diverse pneumatization, and the presence of
anatomical variations.[4]

 Gulay Madan et al. Studied the correlation between preoperative temporal

bone High-Resolution Computed Tomography (HRCT) and intraoperative
observations in individuals with Chronic Suppurative Otitis Media (CSOM). A
total of 55 patients with middle ear pathology, presenting to the Department of
Otorhinolaryngology at Afyon Kocatepe University School of Medicine, were
retrospectively included in the study. The results revealed a high concordance
between HRCT and surgical findings for LSC dehiscence and dural plate
defects, while the agreement was moderate for FCD and tympanic segment
dehiscence.[5]

4
 Mariam Aljehani studied the role of preoperative findings of high-resolution
computed tomography (HRCT) of temporal bone in chronic otitis media (COM)
and the intraoperative findings. This retrospective study was conducted in ORL-
HNS Unit at Ohud Hospital in Medina city of Saudi Arabia between January to
September of the year 2018.There were 99 patients who participated in this
study. Thereby, this study concluded that the correlation and diagnostic value of
HRCT was strong. Hence we can infer from this study that preoperative HRCT
temporal bone is helpful in deciding the plan of surgery.[6]
 Allyn Gul et al. Studied the efficiency of preoperative CT temporal bone in
detecting the pathologies of middle ear in CSOM. In this study around 350
patients diagnosed with CSOM between September 1, 2010, and June 1, 2013,
were compared. Comparison parameters were as follows: the presence of
cholesteatoma, erosion of the outer ear bone canal, erosion of the middle ear
chain, erosion of the dural plate, erosion of the lateral semicircular canal,
erosion of the sigmoid sinus wall, and dehiscence of the facial canal. And in this
study CT was found to have more sensitivity in detecting cholesteatoma and
erosion of the ossicular chain.[7]
 Firas Q Alzoubi et al studied 50 patients retrospectively the preoperative CT
results with operative findings who had scan between January 2003 and
December 2007. And the clinical presentation were checked with the scan for
the presence of cholesteatoma and if it had any effect from the previous surgery,
and it was concluded that CT scan could not be relied upon to differentiate
between cholesteatoma and chronic mucosal disease.[8]

5
 6.3 Objectives of the study: 1. To study the role of HRCT temporal bone in diagnosing
CSOM and its complications.
2.To study the comparison between HRCT temporal bone findings with intraoperative
findings of CSOM.

7 Materials and Method

7.1 Source Of Data:
Data for the present study will be obtained from males and females of all age groups
with a diagnosis of CSOM undergoing surgery for the same and also the hospital
records and OT register of ENT and head & neck department of McGann teaching
hospital, Shivamogga.
7.2 Method of collection of Data

6
 Place of study: SIMS, SHIMOGA

 Duration of study: 18 months(May 2024-Nov 2025)

 Study Design: Observational-Cross sectional

 Sample size: Considering p=90% sensitivity, for cholesteatoma detection by

HRCT temporal bone (According to study conducted by Triphthi Rai, Mysore)
[4]
. With population size of 40 expected and response rate of 90% the study
would require a sample size of 35(n=35 minimum no. of cases studied) for
estimating the expected proportion (sensitivity=90%) with 5% absolute
precision 95% confidence level.

Sample size is calculated with the help of EPI-INFO statistical software.

 Methodology:

After obtaining valid informed consent, detailed history and clinical

examination will be carried out of the patients presenting to ENT Outpatient
Department (OPD) and diagnosed as CSOM and undergoing surgery for CSOM
excluding patients undergoing tympanoplasty alone without mastoidectomy.
Preoperative HRCT temporal bone findings will be then compared with
intraoperative findings of CSOM. All the data will be collected in a predesigned
self-administered proforma which was designed keeping the objective of the
study at the center point.

 Inclusion Criteria:
1. All patients with clinical diagnosis of CSOM undergoing surgery for the
same.
2.All age groups.

 Exclusion Criteria
1.Patients with malignant ear pathology.
2. Patients with granulomatous lesions.
3. Patients undergoing tympanoplasty without mastoidectomy.

 Data Analysis: The data will be entered in excel spread sheet. The data will be
analyzed with the help of EPI-INFO software, data will be presented in
proportion and percentages in table, sensitivity and specificity, bar diagrams
and pie charts. The tests like Chi-square test, student t test will be used to find
the association.

7
7.3 Does the study require any investigation or intervention to be conducted on
patients or other humans or animals? If so, please describe briefly.
Yes.

7.4 Has ethical clearance been obtained from your institution in case of 7.3?
Awaited

8
8. List of References:

1. Herizal, & Ridwan, Azwar & Fadhlia, & Machilah, Nurul & Mutawakkil, Azzam.
(2023). The Compatibility of Preoperative Temporal Bone CT Scan Interpretation and
Intraoperative Findings in Chronic Suppurative Otitis Media at Dr. Zainoel Abidin
Hospital Banda Aceh. GSC Advanced Research and Reviews. 15. 207-215.
10.30574/gscarr.2023.15.3.0176.

2. Mittal R, Lisi CV, Gerring R, Mittal J, Mathee K, Narasimhan G, Azad RK, Yao Q,
Grati M, Yan D, Eshraghi AA, Angeli SI, Telischi FF, Liu XZ. Current concepts in the
pathogenesis and treatment of chronic suppurative otitis media. J Med Microbiol. 2015
Oct;64(10):1103-1116. doi: 10.1099/jmm.0.000155. Epub 2015 Aug 5. PMID:
26248613; PMCID: PMC4835974.

3. Majeed J, Sudarshan Reddy L. Role of CT Mastoids in the Diagnosis and Surgical

Management of Chronic Inflammatory Ear Diseases. Indian J Otolaryngol Head Neck
Surg. 2017 Mar;69(1):113-120. doi: 10.1007/s12070-016-1023-z. Epub 2016 Oct 13.
PMID: 28239591; PMCID: PMC5305634.

4. Rai T. Radiological study of the temporal bone in chronic otitis media: Prospective
study of 50 cases. Indian J Otol 2014;20:48-55.

5. Madan G, Turamanlar O, Bucak A, Beker-Acay M, Gönül Y, Yildiz E, & Gülsarı Y.

(2015). Comparison of Preoperative Temporal Bone HRCT and Intraoperative
Findings in Patients with Chronic Otitis Media. Erciyes Tıp Dergisi/Erciyes Medical
Journal, 37, 138-142. DOI: 10.5152/etd.2015.0037.

6. Aljehani M, Alhussini R. The Correlation Between Preoperative Findings of High-

Resolution Computed Tomography (HRCT) and Intraoperative Findings of Chronic
Otitis Media (COM). Clin Med Insights Ear Nose Throat. 2019 Aug 19;
12:1179550619870471. doi: 10.1177/1179550619870471. PMID: 31452605; PMCID:
PMC6700852.

7. Gül A, Akdağ M, Kiniş V, Yilmaz B, Şengül E, Teke M, Meriç F. Radiologic and

surgical findings in chronic suppurative otitis media. J Craniofac Surg. 2014
Nov;25(6):2027-9. doi: 10.1097/SCS.0000000000001017. PMID: 25377960.

8. Alzoubi, Firas & Odat, Haitham & Al-Balas, Hassan & Saeed, S. (2008). The role of
preoperative CT scan in patients with chronic otitis media. European archives of oto-
rhino-laryngology: official journal of the European Federation of Oto-Rhino-
Laryngological Societies (EUFOS): affiliated with the German Society for Oto-Rhino-
Laryngology - Head and Neck Surgery. 266. 807-9. 10.1007/s00405-008-0814-6.

9
9 Signature of candidate

10 Remarks of Guide
.

DR THIMMAPPA T.D

PROFESSOR & HOD

Name & Description of the
11 11.1 Guide
DEPARTMENT OF ENT
(in block letters)
SHIMOGA INSTITUTE OF MEDICAL
SCIENCES, SHIMOGA

11.2 Signature

11.3 Co-guide

11.4 Signature
-

11.5 Head Of the Department

11.6 Signature

10
 Remarks of the Chairman
12 12.1
and Principal

12.2 Signature

CASE PROFORMA

01 NAME

02 AGE AND SEX

03 ADDRESS
04 OCCUPATION

05 CHIEF COMPLAINTS
06 HISTORY OF
PRESENTINGILLNESS
07 EXAMINATION FINDINGS
08 PROVISIONAL DIAGNOSIS
09 PARAMETERS COMPUTED INTRAOPERATIVE
TOMOGRAPHY FINDINGS FINDINGS
a. PNEUMATIZATION OF
MASTOID
b.SCUTUM
c.OSSICLULAR STATUS
d.LABYRINTHINE STATUS
e.SIGMOID SINUS PLATE
f.MASTOID CORTEX
g.TEGMEN
h.MASTOIDITIS

11
i.FACIAL NERVE
j.ANY OTHER FINDINGS

10. FINAL DIAGNOSIS

12
 ANNEXURE II

INFORMED CONSENT FORM

I _____________________, aged ______ years, have been informed about

the study
ROLE OF HRCT TEMPORAL BONE IN THE DIAGNOSIS AND ITS
COMPARISON WITH INTRAOPERATIVE FINDINGS OF CHRONIC
SUPPURATIVE OTITIS MEDIA
I have been explained about this study in my mother tongue/local language
in detail.

I have no objections for furnishing the necessary documents required for

the study. I will co-operate for the study. I have been informed that I will
not receive any remuneration for this study and personal details will be kept
confidential. This study material can be utilised for publication/educational
purposes.
There is no compulsion of any kind. I_______________ the undersigned,
in my full senses and unreservedly give my consent to participate in the
above study.
The above consent form has been read and explained.
I have understood the above-mentioned details.
Only then I myself have given consent.

Name:
Address:
Phone no:
Date: Signature/Left thumb
Impression

13
 :
ROLE OF HRCT TEMPORAL BONE IN THE DIAGNOSIS AND ITS
COMPARISON WITH INTRAOPERATIVE FINDINGS OF CHRONIC
SUPPURATIVE OTITIS MEDIA.

: _____________________________

: ____________________________

1. ,

.
2. .
.

.
3.

.
4. .

/ : ________________

: __________________

( ): ________________________ : _____________

14