Middle ear pathology constitutes a significant portion of otologic diseases, encompassing a spectrum of conditions such as chronic suppurative otitis media (CSOM), cholesteatoma, congenital malformations, and traumatic injuries. These conditions, if inadequately diagnosed or managed, can lead to a cascade of complications including ossicular erosion, labyrinthine fistula, facial nerve palsy, petrous apicitis, and even intracranial spread such as meningitis or brain abscess. Early and accurate detection of these complications is critical for timely surgical intervention and to minimize morbidity [1,2]. Clinical evaluation and otoscopic findings, although essential, may not sufficiently delineate the extent and severity of the underlying pathology. In this context, High-Resolution Computed Tomography (HRCT) of the temporal bone has emerged as a pivotal imaging modality. HRCT offers superior spatial resolution and multiplanar reconstructions, enabling precise assessment of middle and inner ear structures. It facilitates the identification of soft tissue masses, bony erosions, ossicular chain abnormalities, and the involvement of adjacent neurovascular structures, thereby enhancing diagnostic accuracy [3,4]. The integration of HRCT into preoperative planning not only improves surgical outcomes but also assists in identifying patients who may benefit from conservative management, thus avoiding unnecessary interventions. This study aims to evaluate the role of HRCT in detecting, characterizing, and aiding the management of complications associated with middle ear pathology in a cohort of 50 patients, with an emphasis on its correlation with intraoperative findings and clinical outcomes. [1,3,5]

This prospective observational study was conducted in the Department of Radiodiagnosis & Imaging at Dr. M.K. Shah Medical College, in collaboration with the Department of Otorhinolaryngology. The study enrolled patients clinically suspected of having temporal bone pathology, who were referred for high-resolution computed tomography (HRCT) evaluation. Institutional Ethics Committee approval was obtained prior to commencement, and informed consent was taken from all participants. All patients presenting with clinical suspicion of temporal bone disease were considered for inclusion. Inclusion Criteria: • Patients with suspected unsafe chronic suppurative otitis media (CSOM) • Patients with congenital deafness • Known or suspected deformities of the inner, middle, or external ear • Patients presenting with tinnitus or vertigo • Patients with suspected or proven temporal bone tumors • Patients with temporal bone fractures Exclusion Criteria: • Patients younger than 1 year or older than 70 years • Patients with prior ear surgery altering normal temporal bone anatomy • Patients unwilling to provide consent for participation All included patients underwent HRCT of the temporal bone. Scan Parameters were, axial acquisition with 0.5–1 mm collimation, high-resolution bone algorithm reconstructions, multiplanar reformations in axial, coronal, and sagittal planes, intravenous contrast was selectively administered when intracranial extension or vascular complications were suspected. Images were reviewed by two experienced radiologists independently. The following parameters were systematically evaluated: 1. Presence of soft tissue mass in the epitympanum, mesotympanum, hypotympanum, and mastoid air cells 2. Scutum erosion or blunting 3. Ossicular chain involvement – erosion or discontinuity of malleus, incus, or stapes 4. Facial nerve canal thinning, dehiscence, or erosion 5. Labyrinthine integrity – semicircular canals, vestibule, and cochlea 6. Presence of temporal bone fracture lines or deformities 7. Detection of intracranial complications including extradural abscess, sigmoid sinus thrombosis, meningitis, or brain abscess Disagreements in reporting were resolved by consensus. Data Analysis Demographic data, clinical features, and HRCT findings were recorded and correlated with operative findings where available. Statistical analysis was performed using GraphPad version 8.0. Descriptive statistics were used to summarize imaging findings, while chi-square test was applied to assess associations between HRCT findings and surgical/clinical outcomes. A p-value <0.05 was considered statistically significant.

A total of 50 patients with clinically suspected middle ear pathology and its complications underwent High Resolution Computed Tomography (HRCT) of the temporal bone. The study population included 28 males (56%) and 22 females (44%), with ages ranging from 10 to 65 years (mean age: 36.2 years). The most common clinical presentation was hearing loss, observed in 45 patients (90%), followed by ear discharge in 39 patients (78%), otalgia in 31 patients (62%), vertigo in 8 patients (16%), and facial nerve weakness in 3 patients (6%). HRCT revealed soft tissue attenuation in the middle ear cavity in 46 cases (92%). Ossicular chain erosion was identified in 33 patients (66%), while scutum erosion was present in 20 cases (40%). Tegmen tympani erosion was noted in 9 patients (18%), lateral semicircular canal fistula in 4 patients (8%), and facial canal dehiscence in 5 patients (10%). Mastoid air cell opacification was observed in 42 patients (84%). Intracranial complications, such as sigmoid sinus thrombosis or cerebellar abscess, were detected in 2 patients (4%). Among the 42 patients who underwent surgery, HRCT findings correlated well with intraoperative results in 38 cases (90.5%), with minor discrepancies in 4 cases (9.5%), primarily related to the extent of ossicular damage. HRCT proved valuable in surgical planning for 40 patients (80%) and helped avoid unnecessary surgical intervention in 4 patients (8%), by supporting conservative management.

High-Resolution Computed Tomography (HRCT) has become an essential diagnostic modality in the assessment of middle ear pathologies and their complications [1-4]. The detailed visualization of bony structures, air spaces, and soft tissue changes offered by HRCT plays a critical role not only in diagnosis but also in surgical planning [3,6-9]. Our study of 50 patients with clinically suspected middle ear disease reinforces the importance of HRCT in detecting various forms of pathology and associated complications with high accuracy [2,3,7]. . The demographic profile of our study population aligns with existing literature, with a slight male preponderance and a wide age range, reflecting the chronic and often progressive nature of middle ear disease. The most common presenting symptoms were hearing loss (90%) and ear discharge (78%), which are classic features of chronic suppurative otitis media (CSOM) and cholesteatoma. HRCT proved valuable in correlating clinical suspicion with radiological findings in the majority of these cases [1-4]. Soft tissue attenuation within the middle ear cavity, observed in 92% of patients, was a consistent feature, reflecting the presence of inflammatory or infective processes. Ossicular chain erosion, seen in 66% of patients, is a hallmark of more aggressive disease such as cholesteatoma [1,2,3]. This was well demonstrated in cases like the one involving left-sided otitis media with extension into Prussack’s space and mastoid antrum, where a discrete soft tissue lesion was noted on HRCT-a classic finding for cholesteatoma [4,5]. Scutum and tegmen tympani erosion were also notable in our study, observed in 40% and 18% of patients respectively. These findings not only indicate chronicity and aggression of the disease but also have surgical implications in terms of approach and intraoperative risk [3,7,9], The case of eroded scutum and tegmen tympani exemplifies this destructive potential, reinforcing the need for early diagnosis and intervention. Advanced complications were seen in a smaller subset of patients, yet these highlight the life-threatening potential of neglected or inadequately treated otologic disease. The case of petrous apicitis, with a lytic lesion in the petrous apex, illustrates how HRCT can detect deep-seated infection not visible on clinical examination [6,8]. Similarly, the case of otogenic brain abscess demonstrates the ability of HRCT, particularly when used in conjunction with contrast-enhanced imaging, to delineate intracranial spread [4,9]. Findings such as pneumocephalus, enhancing extradural collections, cerebellar abscesses, sinus thrombosis, and signs of impending brainstem compression are all critical indicators for urgent neurosurgical intervention [9]. Labyrinthitis ossificans, identified by ossification of the semicircular canals and cochlea, represents another significant sequela of middle ear infections [1,2]. Its detection on HRCT has implications for irreversible 5 of 8 sensorineural hearing loss and poor cochlear implant outcomes, emphasizing the need for early imaging in complicated cases of otitis media [3,4]. Auto mastoidectomy with labyrinthine fistula, as seen in one patient, reflects extensive disease progression with complete erosion of the ossicular chain and mastoid air cell septae, resulting in the formation of a single cavity [1]. The presence of focal bony erosion at the lateral semicircular canal further highlights the importance of HRCT in detecting fistulae that may not be clinically apparent but carry the risk of vertigo and perilymphatic leak [2,3]. In 42 patients who underwent surgery, HRCT findings showed excellent correlation with intraoperative observations in 90.5% of cases [1]. This concordance validates the high diagnostic reliability of HRCT in preoperative planning [2,3]. Furthermore, HRCT findings influenced management decisions in 80% of cases and helped avoid unnecessary surgical intervention in 8% by supporting conservative treatment in patients without erosive or expansive pathology [4].

High-Resolution Computed Tomography (HRCT) of the temporal bone is an invaluable tool in the evaluation of middle ear pathologies, particularly chronic suppurative otitis media and cholesteatoma. Its high spatial resolution allows for accurate detection of bony erosions, ossicular chain destruction, and potentially life threatening complications such as labyrinthine fistula and intracranial extension. In our study, HRCT findings correlated strongly with intraoperative observations in 90.5% of surgically managed cases, affirming its diagnostic accuracy. Furthermore, HRCT significantly influenced treatment planning in 80% of patients and supported conservative management in 8%, thereby preventing unnecessary surgical interventions. The ability of HRCT to delineate complex anatomy and detect subtle erosions makes it essential in preoperative planning and prognosis prediction. Routine incorporation of HRCT in patients with suspected complicated middle ear pathology improves clinical outcomes and reduces surgical risks. Therefore, HRCT should be considered a standard imaging modality in the diagnostic algorithm of middle ear diseases.

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