Suat KESKİN, Hüseyin ÇETİN, Hüseyin Gürkan TÖRE

The correlation of temporal bone CT with surgery findings in evaluation of chronic inflammatory diseases of the middle ear

Amaç: Orta kulak hastalıklarında temporal kemiğin bilgisayarlı tomografi (BT) incelemesi rutin bir yöntemdir. Bu çalışma orta kulağın inflamatuar patolojilerine bağlı olarak gelişen komplikasyonların tanısında BT’nin etkinliğini ortaya koymak amacıyla yapılmıştır. Metod: Birimimizde Ağustos 2006-Haziran 2008 tarihleri arasında orta kulak patolojisi düşünülen hastalara temporal BT incelemesi yapıldı. Kronik otitis media (KOM) ve kolesteatoma bağlı gelişen değişik komplikasyonlar saptanarak cerrahi uygulanan 56 hasta çalışma grubuna dahil edildi. Çekimler Siemens Emotion Duo spiral BT cihazı ile koronal planda 1 mm kesit kalınlığında yapıldı. Tanıya katkısı olacağı düşünülen olgularda aksial planda reformat görüntüler elde edildi. Görüntüler iki radyolog tarafından aynı anda değerlendirildi. Kronik inflamasyona sekonder gelişen komplikasyonlardan timpanoskleroz, kemikçik erozyonu, skutum erozyonu, tegmen erozyonu, mastoid kemik korteks düzensizliği, fasial sinir kemik kontur düzensizliği, semisirküler kanal (SSK) defekti ve kronik mastoidit BT ile değerlendirilerek sonuçlar cerrahi bulgularıyla karşılaştırıldı ve BT’nin etkinliği ortaya konulmaya çalışıldı. Bulgular: Komplikasyonların sensitivite, spesifite, (+) ve (-) prediktif değeri timpanoskleroz için %84.6, %88.3, %68.7 ve %95, kemikçik erozyonu için %81.3, %46.1, % 83.3 ve % 42.8, skutum erozyonu için %80, %90.4, % 84.8 ve % 73.7, tegmen erozyonu için %0, %97.7, % 0 ve %80, mastoid kemik korteks düzensizliği için %40, %97.8, % 80 ve % 88.2, fasial sinir kemik kontur düzensizliği için %66.6 %98, % 80 ve %96.07, SSK defekti için %45.4, %95.5, %71.4 ve %87.7, kronik mastoidit için %0.02, %100, %100 ve %27.2 olarak bulundu. Sonuç: Komplikasyonların değerlendirilmesinde timpanoskleroz, kemikçik erozyonu, skutum erozyonu ve fasial sinir kemik kontur düzensizliği ile cerrahi bulguları arasında yüksek korelasyon varken tegmen erozyonu, mastoid kemik korteks düzensizliği, kronik mastoidit ve SSK defekti ile cerrahi arasındaki korelasyon cerrahi tekniğine ve BT limitasyonlarına bağlı olarak düşük bulundu.

Kronik inflamatuar orta kulak hastalıklarının değerlendirilmesinde temporal kemik BT ile cerrahi bulguların korelasyonu

Aim: Computerized tomography (CT) examination of temporal bone is a routine procedure in the diseases of the middle ear. The aim of this study is to establish the efficacy of CT in the diagnosis of the complications due to inflammatory pathologies of middle ear. Method: Patients with suspected middle ear pathology were undergone temporal CT examination between August 2006- June 2008. 56 patients who underwent operation with various complications due to chronic otitis media and choleostatoma were included in the study group. Complications that developed chronic inflammation secondary were established as tympanosclerosis, ossicle erosion, scutum erosion, tegmen erosion, irregularity in mastoid bone cortex and contour of facial nerve, semicircular canal defect and chronic mastoiditis. Result: Sensitivity, specificty, positive and negative predictive value of complications were 84.6%, 88.3%, 68.7% and 95% for timpanosclerosis, 80%, 46.1%, 83.3% and 42% for ossicle erosion, 80%, 90.4%, 84.8% and 73.7% for scutum erosion, 0%, 97.7%, 0% and 80% for tegmen erosion, 40%, 97.8%, 80% and 88.2% for irregularity in mastoid bone cortex, 66.6%, 98%, 80% and 96.07% for irregularity in bone contour of facial nerve, 45.4%, 95.5%, 71.4% and 87.7% for SSC defect, 0.02%, 100%, 100% and 27.2% for chronic mastoiditis. Conclusion: In the evaluation of the complications, surgical findings were highly compatible with tympanosclerosis, ossicle erosion, scutum erosion, irregularity in bone contour of facial nerve. However, CT findings were inconsistent with surgical findings in terms of tegmen erosion, irregularity in mastoid bone cortex, chronic mastoiditis, SSC defects. We suggest that these inconsistencies were related to the surgical technique and CT limitations.

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