Hostname: page-component-5db58dd55d-qmkzp Total loading time: 0 Render date: 2026-05-25T08:36:21.186Z Has data issue: false hasContentIssue false
  • English
  • Français

Factors affecting the correlation between high-resolution computed tomography and operative findings in cholesteatoma surgery – a systematic review

Published online by Cambridge University Press:  29 July 2025

G. Finch ,
S. Patel Open the ORCID record for S. Patel [Opens in a new window] ,
B. Walters Open the ORCID record for B. Walters [Opens in a new window]  and
M. Trotter
G. Finch
Affiliation:
Department of Otolaryngology, University Hospitals Coventry and Warwickshire NHS Trust, UK
S. Patel*
Affiliation:
Department of Otolaryngology, Queen Elizabeth Hospital Birmingham, UK
B. Walters
Affiliation:
Department of Paediatric Surgery, Sheffield Children’s Hospital, UK
M. Trotter
Affiliation:
Department of Otolaryngology, University Hospitals Coventry and Warwickshire NHS Trust, UK
*
Corresponding author: S. Patel; Email: s.patel9@doctors.org
Get access Rights & Permissions [Opens in a new window]

Abstract

Objective

Cholesteatoma is a pathological growth of squamous epithelium in the middle ear and mastoid. Pre-operative high-resolution computed tomography is commonly performed to guide the surgical approach and evaluate disease extent. The purpose of this review is to demonstrate the level of correlation between high-resolution computed tomography and intra-operative findings during cholesteatoma surgery.

Method

Medline, Embase and Cochrane databases were searched in December 2024 for studies comparing high-resolution computed tomography and intra-operative findings of adult patients diagnosed with cholesteatoma.

Results

Out of 2514 abstracts identified, 15 were included. The correlation between pre-operative high-resolution computed tomography and intra-operative findings was strongest for the identification of erosion of the malleus (k = 0.77), followed by the lateral semicircular canal and tegmen tympani (k = 0.69). The weakest correlation was found for facial nerve dehiscence (k = 0.55).

Conclusion

High-resolution computed tomography is useful for providing a roadmap for surgery. It offers a strong correlation for intra-operative detection of malleus, incus, lateral semicircular canal and tegmen tympani involvement.

Keywords

CholesteatomaComputerised tomographyFacial nerveImagingTraining

Information

Type
Review Article
Information
The Journal of Laryngology & Otology , Volume 140 , Issue 1 , January 2026 , pp. 2 - 11
Copyright
© The Author(s), 2025. Published by Cambridge University Press on behalf of J.L.O. (1984) LIMITED.

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

Article purchase

Temporarily unavailable

References

Kennedy, KL, Singh, AK. Middle Ear Cholesteatoma [Updated 9 August 2024]. StatPearls Publishing [Internet]. Treasure Island: StatPearls Publishing; 2025, Jan. In: https://www.ncbi.nlm.nih.gov/books/NBK448108/Google Scholar
Basa, K, Levi, JR, Field, E, O’Reilly, RC. A pearl in the ear: Intracranial complications of pediatric cholesteatomas. Int J Ped Otorhinolaryngol 2017;92:171–5CrossRefGoogle ScholarPubMed
Kuo, C-L, Shiao, A-S, Yung, M, Sakagami, M, Sudhoff, H, Wang, C-H, et al. Updates and Knowledge Gaps in Cholesteatoma Research. BioMed Res Int;2015:854024Google Scholar
Stefanescu, EH, Balica, NC, Motoi, SB, Grigorita, L, Georgescu, M, Iovanescu, G. High-resolution computed tomography in middle ear cholesteatoma: How much do we need it? Medicina 2023, 59: 1712.CrossRefGoogle Scholar
Schwartz, KM, Lane, JI, Bolster, BD, Neff, BA. The utility of dffusion-weighted imaging for cholesteatoma evaluation. AJNR Am J Neuroradiol 2011.CrossRefGoogle ScholarPubMed
Razek, AA, Ghonim, MR, Ashraf, B. Computed tomography staging of middle ear cholesteatoma. Pol J Radiol 2015;80:328–33Google ScholarPubMed
Aromataris, E, Lockwood, C, Porritt, K, Pilla, B, Jordan, Z. JBI Manual for Evidence Synthesis JBI; 2024. Available from: https://synthesismanual.jbi.global.CrossRefGoogle Scholar
Baba, A, Kurihara, S, Ogihara, A, Matsushima, S, Yamauchi, H, Ikeda, K, et al. Preoperative predictive criteria for mastoid extension in pars flaccida cholesteatoma in assessments using temporal bone high-resolution computed tomography. Auris Nasus Larynx 2021;48:609–14CrossRefGoogle ScholarPubMed
Manik, S, Dabholkar, Y, Bhalekar, S, Velankar, H, Chordia, N, Saberwal, A. Sensitivity and specificity of high-resolution computed tomography (HRCT) of temporal bone in diagnosing cholesteatoma and its correlation with intraoperative findings. Indian J Otolaryngol Head Neck Surg 2021;73:25–9CrossRefGoogle ScholarPubMed
Ng, JH, Zhang, EZ, Soon, SR, Tan, VY, Tan, TY, Mok, PK, et al. Pre-operative high resolution computed tomography scans for cholesteatoma: has anything changed? Am J Otolaryngol 2014;35:508–13CrossRefGoogle ScholarPubMed
Plodpai, Y, Jongthitinon, T, Atchariyasathian, V, Pitathawatchai, P, Hirunpat, S, Kirtsreesakul, V. Middle ear status in cholesteatoma: associations among preoperative computed tomography scans, audiological assessments, and intraoperative endoscopic findings. Am J Otolaryngol 2022;43:103198CrossRefGoogle ScholarPubMed
Rogha, M, Hashemi, SM, Mokhtarinejad, F, Eshaghian, A, Dadgostar, A. Comparison of preoperative temporal bone CT with intraoperative findings in patients with cholesteatoma. Iran J Otorhinolaryngol 2014;26:7–12Google ScholarPubMed
Aljehani, M, Alhussini, R. The correlation between preoperative findings of high-resolution computed tomography (HRCT) and intraoperative findings of chronic otitis media (COM). Clinical Med Insights Ear, Nose and Throat 2019;12:1179550619870471CrossRefGoogle ScholarPubMed
Roy, A, Maji, S, Dhir, Y, K, R. Pre-operative HRCT of middle ear pathology with particular reference to intra-operative findings in cholesteatoma. Int J Acad Med Pharm 2023;5:2303–7Google Scholar
Nayana, M, Anusha, B, Apoorva, K, Khan, S. A study on correlation of preoperative HRCT finding with intraoperative findings in the evaluation of cholesteatoma. Journal of Cardiovascular Disease Research 2023;14:1664–8Google Scholar
Noule, V, Samala, S, Yenganti, P, Thejas, S, Ejanthkar, V. Role of HRCT temporal bones as a predictor of intra-operative findings in cases of CSOM: a prospective study. Journal of Cardiovascular Disease Research 2023;14:313–8Google Scholar
Patel, A, Patel, N, Padavi, D, Gohil, R, Patel, A, Tulsiyani, D, et al. Comparative evaluation between preoperative HRCT temporal bone findings and intraoperative findings in mastoid surgeries. International Journal of Pharmaceutical and Clinical Research 2022;14:240–5Google Scholar
Madan, G, Turamanlar, O, Bucak, A, Acay, MB, Gönül, Y, Yıldız, E, et al. Comparison of preoperative temporal bone HRCT and intraoperative findings in patients with chronic otitis media. Erciyes Med J 2015;37:138–42CrossRefGoogle Scholar
Kumar, SR, Vudumula, VP, Maghiben, M. Role of HRCT temporal bone in diagnosis of chronic suppurative otitis media in correlation with intraoperative findings. Medico-Legal Update 2020;4:2361–6Google Scholar
Gaurano, JL, Joharjy, IA. Middle ear cholesteatoma: characteristic CT findings in 64 patients. Ann Saudi Med 2004;24:442–7CrossRefGoogle ScholarPubMed
Moody, MW, Lambert, PR. Incidence of dehiscence of the facial nerve in 416 cases of cholesteatoma. Otol Neurotol 2007;28:400–4CrossRefGoogle ScholarPubMed
Gulotta, G, Pace, A, Iannella, G, Visconti, IC. Facial nerve dehiscence and cholesteatoma: a comparison between decades. J Int Adv Otol 2020;16:367–72CrossRefGoogle ScholarPubMed
Gupta, S, Mends, F, Hagiwara, M, Fatterpekar, G, Roehm, PC. Imaging the facial nerve: a contemporary review. Radiol Res Pract 2013;2013:248039Google ScholarPubMed
Liu, YC, Semaan, MT, Rayess, H, Megerian, CA. Hearing and vertigo outcomes after congenital labyrinthine cholesteatoma resection. Am J Otolaryngol 2014;35:417–23CrossRefGoogle ScholarPubMed
Egilmez, OK, Hanege, FM, Kalcioglu, MT, Kaner, T, Kokten, N. Tegmen tympani defect and brain herniation secondary to mastoid surgery: case presentation. Case Rep Otolaryngol 2014;2014:756280Google ScholarPubMed
Selwyn, D, Howard, J, Cuddihy, P. Pre-operative prediction of cholesteatomas from radiology: retrospective cohort study of 106 cases. J Laryngol Otol 2019;133:477–81CrossRefGoogle ScholarPubMed
Yates, PD, Flood, LM, Banerjee, A, Clifford, K. CT scanning of middle ear cholesteatoma: what does the surgeon want to know? Br J Radiol 2014;75:847–52CrossRefGoogle Scholar
Vercruysse, JP, De Foer, B, Somers, T, Casselman, J, Offeciers, E. Magnetic resonance imaging of cholesteatoma: an update. B-Ent 2009;5:233–40Google ScholarPubMed
Sun, WH, Fan, JK, Huang, TC. The efficacy of DW and T1-W MRI combined with CT in the preoperative evaluation of cholesteatoma. J Pers Med 2022;12:1349CrossRefGoogle Scholar
Supplementary material: File

Finch et al. supplementary material 1

Finch et al. supplementary material
Download Finch et al. supplementary material 1(File)
File 18.2 KB
Supplementary material: File

Finch et al. supplementary material 2

Finch et al. supplementary material
Download Finch et al. supplementary material 2(File)
File 23.6 KB
Supplementary material: File

Finch et al. supplementary material 3

Finch et al. supplementary material
Download Finch et al. supplementary material 3(File)
File 18 KB