锥形束计算机断层扫描后慢性中耳炎(粘膜)治疗方案改变的研究

R. Rajguru, Shantha Nitin, Dilip Raghawan
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引用次数: 0

摘要

颞骨成像有助于耳科医生在耳外科术前计划手术。锥形束计算机断层扫描(CBCT)与传统x射线相比具有更高的空间分辨率和清晰度,与HRCT相比具有更低的辐射暴露。目的:探讨慢性中耳炎(粘膜)CBCT后治疗方案的变化。通过与研究参与者的术中表现进行比较,确定CBCT表现的敏感性和特异性。我们于2017年10月至2019年10月在一家三级专科医院的耳鼻喉科进行了一项观察性描述性研究。我们纳入了95例患者,将其CBCT前的管理计划与CBCT后的计划进行比较,并确定了CBCT后管理改变的病例百分比。统计CBCT表现与术中表现在特异性和敏感性方面的相关性。影像学检查后,仅有4例患者改变了治疗方案,差异无统计学意义。CBCT对乳突、颈静脉高位球及硬脑膜低位充气的敏感性、特异性、阳性预测值及阴性预测值均为100%。检测听骨糜烂的灵敏度为98.9%。彻底的临床检查是慢性中耳炎(粘膜)患者决策的最重要因素,影像学检查后治疗方案不变。尽管彻底的临床检查仍然是制定慢性中耳炎(粘膜)患者治疗计划的金标准,但CBCT凭借其可用的细节和最小的辐射有助于最大限度地减少术中因正常解剖变异(如低位硬脑膜、前躺窦、乳突腔收缩等)可能导致的意外伤害。
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A study to evaluate the change in management plan of chronic otitis media (mucosal) after cone beam computed tomography
: Imaging of temporal bone helps the Otologists in preoperative surgical planning in ear surgery. Cone Beam Computed Tomography (CBCT) has much higher spatial resolution and clarity as compared to conventional X-Ray and much lower radiation exposure as compared to HRCT Temporal Bones.: To evaluate the change in management plan of Chronic Otitis Media (Mucosal) after CBCT. Also to determine the sensitivity and specificity of the CBCT findings by comparing with intra operative findings in the study participants. We conducted an observational descriptive study in the ENT Department of an academic Tertiary care hospital from October 2017 to October 2019. We included 95 patients whose management plan before CBCT was compared with the plan after CBCT and the percentage of cases undergoing a change in the management after CBCT was determined. The correlation of CBCT findings and intra operative findings in terms of specificity and sensitivity was also statistically calculated. : Subsequent to imaging, the management plan was changed in only 4 patients which was statistically non-significant. CBCT showed a 100% sensitivity, specificity, positive predictive value and negative predictive value to detect pneumatisation of the Mastoid, high jugular bulb and low-lying dura. The sensitivity to detect ossicular erosion was 98.9%. : Thorough clinical examination is the most important factor in decision making in patients with Chronic Otitis Media (Mucosal) and management plan remains unchanged after imaging. Though thorough clinical examination remains the gold standard in making a management plan of patients with Chronic Otitis Media (Mucosal), CBCT with its available details and minimal radiation helped to minimise intraoperative inadvertent injuries which might result due to normal anatomic variations like low lying dura, forward lying sinus, contracted mastoid cavity etc.
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