1. “ROLE OF HIGH RESOLUTION COMPUTED TOMOGRAPHY IN
EVALUATION OF TEMPORAL BONE PATHOLOGIES.”
Thesis protocol for MD RADIOLOGY.
MGM Medical College and Hospital, Aurangabad.
Guided by DR. PRASANNA MISHRIKOTKAR
Associate Professor
Department of RADIOLOGY.
MGM Medical College and Hospital, Aurangabad.
Submitted by
DR. ANJALI DESHMUKH
Resident in MD RADIOLOGY
MGM Medical College and Hospital,Aurangabad.
2. INTRODUCTION
• The temporal bone is a complex anatomic structure that contains
the organs of hearing and balance. In addition, major vessels and
nerves course through it and it also has a close proximity to the
brain. Temporal bone has direct contact with brainstem, cerebellum
and temporal lobe of brain. Before computed tomography (CT)
imaging modalities available for the evaluation of temporal bone
were plain radiograph, polytomography, angiography, and
cisternography. Plain radiograph remains inexpensive tool of the
study of temporal bone but has major limitations due to complex
anatomy and overlapping of various bony structures.
3. • High-resolution computed tomography (HRCT) offers excellent
spatial and density resolution using special algorithms. It
provides information not only about bony outline but also soft
tissue changes making it possible to demonstrate the location
and extent of disease as well as its complications.
Furthermore, coronal and axial CT scanning together has
dramatically improved the imaging of temporal bone. HRCT
accurately depicts the boundaries between the external,
middle and inner ear cavities thereby localized the disease
precisely and also greatly demarcate thin boundary between
temporal bone and intracranial compartment with exact
details of intracranial spread of primary temporal bone
disease. Contrast media help to evaluate the vascularity and
contrast enhancing characteristics particularly in soft tissue
lesions of temporal bone giving clues to the histopathology.
4. AIM AND OBJECTIVES
AIM
To study the role of Role of high resolution computed
tomography in evaluation of temporal bone pathologies.
OBJECTIVES
1. To evaluate pathologies of temporal bone such as congenital
anomales, infections, trauma, neoplasms and their disease
distribution.
2. To evaluate the extent of pathological process and sites of
involvement of the middle ear and the mastoid air cell system in
these patients.
3. To study the intracranial complications.
4. To study the relationship of the tympanomastoid
compartment to the adjacent , critical neurovascular structures .
5. REVIEW OF LITERATURE
• Zelikovich EI (2004),et al used temporal bone CT to examine 87
patients with chronic otitis media . The patients' age ranged from 2
to 74 years. The CT signs of chronic purulent otitis media with and
without cholesteatoma were identified. CT shows changes in the
walls of the middle ear cavity, including the roof and allows
labyrinthine fistula and intracranial complications to be detected .
• The study conducted by Luchikhin LA et al on 30 patients with
chronic otitis media (1995) compared temporal bone computed
tomography findings with the surgical findings . The study showed
that CT temporal bones provided excellent information on the
pathological process and was found to be of immense value before
subjecting the patients for surgery
6. • Boyraz E et al (2009) conducted a study to show ability of CT temporal
bones to detect tympanosclerotic plaques on 19 tympanoplasty cases
between January 2006 and May 2006. The tympanosclerotic plaques
obtained from surgical specimens were sent for histopathological
examination and preoperative temporal bone CT scans were evaluted.
This study showed that temporal bone CT scan is a valuable tool to
diagnose the localize the tympanosclerosis, in patients with chronic
otitis media and conductive hearing loss. When combined with
clinical findings, CT scans can be useful for preoperative evaluation of
tympanosclerosis.18
• Study conducted by Sandeep Berry et al (1998) on 30 patients of
unsafe chronic suppurative otitis media with pre-operative CT
scanning and surgical exploration of the middle ear and mastoid, and
comparison of CT findings with the surgical findings. The study
showed that CT scan was highly sensitive for soft tissue density mass
in the tympanomastoid compartment. They concluded that the CT
scan of the temporal bone was best to depict pathology which is not
clinically evident.
7. MATERIALS AND METHOLDOLGY
STUDY SUBJECTS: Patients referred to the radiology department for HRCT
evaluation of temporal bone.
STUDY CENTER: This study will be carried out at Department of
Radiology,MGM Medical college & Hospital,Aurangabad.
STUDY DURATION: Study will be done for a period of 2 years after approval
from ethical committee.
STUDYDESIGN: Cross sectional descriptive study.
SAMPLE SIZE:
n=Z^2P[1-P]/d^2
P=Prevalance.
Z= 1.96 for 95% confidence interval.
d=Allowable error.
N=Sample size.
MINIMUM SAMPLE SIZE = Time Bound
8. INCLUSION AND EXCLUSION
CRITERIA
INCLUSI0N CRITERIA:
1)The patients who were referred from OPD and IPD with complaints and
clinical findings pertaining to temporal bone disease ( earache, ear
discharge, hearing loss).
2) Evaluation of congenitally deaf child, having known or suspected
deformities of inner, middle or external ear, trauma and tumors of
temporal bone.
3) Incidentally detected lesions on radiography and other modalities.
4) Previously diagnosed temporal bone neoplasms to know the extent.
EXCLUSION CRITERIA :
• Pregnant women.
• Patients with electric device such as cochlear implants.
• Patients requiring contrast study but is clinically unfit for contrast
workup.
9. METHODOLOGY
DATA ACQUISITION:
After clinical evaluation , the patients who are willing to participate in the study
and fulfilling the inclusion and exclusion criteria’s of the study will be subjected
to HRCT scan of temporal bone and the findings will be noted and data will be
collected. Contrast imaging will be used wherever indicated. HRCT findings
will be correlated with operative findings to determine the accuracy of HRCT
findings wherever available.
STUDY FLOW CHART:
PATIENT’S ARRIVAL
SCREENING AS PER INCLUSION AND EXCLUSION CRITERIA.
FULFILMENT NON-FULFILMENT
INFORMED CONSENT
STUDY EXCLUSION
ANALYSIS, RESULT , CONCLUSION
10. Magnetic Resonance Imaging
Technique and Imaging Protocol-
METHODOLOGY
• Every patient will undergo a meticulous detailed history taking,
consent will be obtained. Risks of contrast administration will be
explained to the patients and consent will be obtained prior to
the contrast study. Routine antero-posterior topogram of the
temporal bone will be initially taken in all the patients in supine
position. Plain scans will be followed by intravenous contrast
scans in supine position with clinically suspected temporal bone
lesion will be subjected for HRCT examination. The visualization
of small bony structures, extent of lesions and attenuation values
in pre and post contrast imaging will be considered. All data and
detailed findings will be collected and observed . The data
collected from patients will be analyzed using descriptive tools
and scientific methods will be adopted to conclude the study and
summarizing key points of study will be conducted.
11. ETHICAL CLEARANCE:
Application for ethical clearance will be submitted to the
institutional ethical review board at MGM Medical College and
Hospital.
STATISTICAL ANALYSIS:
Data will be entered in Microsoft Excel and analyzed using SPSS
version 24.Mean and SD will be calculated for qualitative variables.
Also data will be represented in form of visual impression like bar-
diagram etc.
Chi-square will be applied to check significant outcomes. ‘P’ value
will be checked at 5% level of significance.
12. • PROFORMA
NAME : AGE :
SEX : ADDRESS :
OCCUPATION :
SOCIOECONOMIC :
STATUS
HISTORY:
PRESENTING COMPLAINTS:
1. Ear discharge : `Side, Onset, Duration, Amount, Type of discharge,
Aggravating / Relieving Factors, Response to
treatment
2. Hard of hearing : Side, Acute / Insidious, Degree Progressive
/continuous/
Intermittent , Whether handicapping, Family
history,
H/o trauma to ear,
H/o exposure to loud nice.
3. Earache : Duration, Side, Mild/Server, More on movement of
ear /
during mastication, Increase during ear discharge or
not
4. Giddiness : Duration, Intermittent / Continuous, Associated
with
posture, H/o intake of ototoxic drugs, Aggravating /
relieving factors.
5. Tinnitus : Side, Unilateral / Bilateral, Duration, Sudden /
Gradual,
• Progression – Severe / Static / Decreasing,
Continuous / intermittent/ Pulsatile/ Clicking,
Aggravating / Relieving factors.
6. Headache/ vomiting
7. Fever
8. Facial weakness
• MENSTRUAL HISTORY
PERSONAL HISTORY:
FAMILY HISTORY :- H/O HOH, H/O Consanguinous marriage
PAST HISTORY :- H/O Previous surgery,
H/O Ototoxic drug intake as in TB.
H/O DM/HTN
EXAMINATION OF EAR:
R L
Pinna
•
Preauricular area
Postauricular area
EAC
Tympanic Membrane:
•
Mastoid tenderness
Tragal tenderness
Fistula test
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