RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES
BANGALORE, KARNATAKA
ANNEXURE-II
PROFORMA FOR REGISTRATION OF SUBJECTS FOR DISSERTATION
1. / Name of the Candidate andAddress(In Block Letters) / Dr. NIVEDITHA .J
NO.305, VISHRANTHI DHAMA
VICTORIA HOSPITAL,
FORT ROAD,
BANGALORE: 560002.
2. / Name of the institution / BANGALORE MEDICAL COLLEGE AND RESEARCH INSTITUTE,
BANGALORE.
3. / Course of study and Subject / M.S. IN ENT
4. / Date of admission to the course / 27-04-2010
5 / Title of the topic / STUDY OF THE CORRELATION OF OPERATIVE FINDINGS IN CHOLESTEATOMA WITH HIGH RESOLUTION COMPUTERISED TOMOGRAPHY
6. BRIEF SUMMARY OF THE INTENDED WORK:
6.1 NEED FOR THE STUDY:
Chronic suppurative otitis media is a common condition seen in patients attending otolaryngological department. It is a condition in which there is chronic infection of middle ear cleft, which can cause severe destruction of the middle ear and mastoid ,leading on to various sequelae1
Cholesteatoma can be associated with lot of complications, since temporal bone is surrounded by many vital structures[ Brain, Internal carotid artery, Jugular bulb, Facial nerve etc] and its gross anatomical variation of landmarks makes the surgery difficult at times.
Prior knowledge of such anatomical variations and potential complications before surgery can help the surgeon in avoiding further complications.
Since considerable number of patients with cholesteatoma attend the ENT department of our hospital, it was felt necessary to study the clinical presentation of cholesteatoma, HRCT findings and intraoperative findings so that it helps us to formulate proper surgical intervention and to avoid intraoperative complications by understanding the exact anatomical variations of landmarks in the temporal bone.
6.2 REVIEW OF LITERATURE:
Cholesteatoma is of significant importance to the otolaryngologist as it poses many challenges. otologist must make a correct and an early diagnosis. must provide a disease free ear that will remain safe throughout adulthood and can be easily followed up2.
Tomographic criteria for the diagnosis of cholesteatoma in my study is based on a study by Buckingham & Valvossori3 who correlated operative findings with tomographic findings and made following observations :
Tomographic findings in pars tensa cholesteatoma particularly involving posterosuperior marginal perforation were
a. The posterior portion of the lateral wall of the attic was eroded in 15 of 27 cases.
b. Erosion of long process of the incus in 22 of the 27 cases.
c. In 8 of 27 cases, the head of the malleus and body of the incus were displaced laterally, and this was pathognomonic of pars tensa cholesteatoma.
Later they correlated these findings with surgical findings of cholesteatoma and found that the tomographs accurately predicted the extent of the surgical lesion in most of the cases. .
Brunner and Sandberg4, in their series of 90 cases of cholesteatoma found distended antral cavity in 71 % of cases, smooth walled cavity in 58% of cases, destruction of the lateral attic wall in 51 % of the cases, absence of tip of the spur in 46% of the cases, destruction of the tip of the spur in 16% of the cases and destructive changes in the medial wall of the tympanic cavity in21%.
Berret et a15 in their series of 25 children, found destruction of the radiological spur in only 60% of the cases and were able to diagnose cholesteatoma in only 80% of the cases using high resolution computerized tomography
In another study forty-two patients with chronic otitis media underwent preoperative CT scanning followed by surgical exploration of the middle ear and mastoid. The CT finding of abnormal soft tissue density associated with bone erosion was highly correlated with the surgical finding of cholesteatoma.
Sneyers and Debrryne6 in their series of 45 patients proved that their correlation is good for lesions localized in attic and antrum ,for those of the malleus, incus and lateral semicircular canal.
Robillard et a17 in their series of 37 cases have proved that CT scan confirms the diagnosis of cholesteatoma ,delineates the spread and serves as a guideline for surgical treatment
A study conducted in department of otolaryngology Tan Tock Seng hospital Singapore, concluded that there is good to excellent radiosurgical correlation of cholesteatoma and alerts surgeon to potential surgical dangers and complications of the disease. HRCT scan is an important investigation tool prior to surgery8
6.3. AIMS AND OBJECTIVE OF THE STUDY:
Study of the correlation of intraoperative findings of cholesteatoma with High resolution computerized tomography
1 To check the sensitivity and specificity of HRCT before surgery, in diagnosing cholesteatoma
2 Assessing extent of the disease, ossicular destruction and other potential complications
7. MATERIALS AND METHODS:
7.1 SOURCE OF DATA:
The study will be conducted on patients of all age groups of either sex presenting with chronic suppurative otitis media with cholesteatoma at Sri Venkateshwara ENT institute , Victoria hospital and Bowring and Lady Curzon hospital attached to Bangalore medical college and research institute ,Bangalore during the study period from October 2010 to September 2012
7.2 METHODS OF COLLECTION OF DATA.
Detailed history taking
Clinical examination
Relevant haematological and audiometric investigations
HRCT temporal bone- computerised tomography high resolution on serial 1mm thick sections in both axial and coronal planes
All patients are required to undergo mastoid exploration
SAMPLE SIZE- a minimum of 50 cases will be taken up for the study
Statistical analysis is by Chi square test.
7.3 INCLUSION CRITERIA.
1. All chronic suppurative otitis media patients with cholesteatoma diagnosed clinically
2. All age groups and either sex group
..
7.4 EXCLUSION CRITERIA.
- Chronic suppurative otitis media without cholesteatoma
- Patient refuses surgery
7.5 Does the study require any investigation or intervention to be conducted on patients or other humans or animals? If so, please describe briefly:
Yes
1. Haemogram, Bleeding Time, Clotting Time, Urine analysis.
2. Random Blood Sugar, Blood Urea, Serum Creatinine.
3. Chest X-Ray, ECG.
4. Pure Tone Audiometry.
5. Ear swab pus Culture and Sensitivity.
After informing the patients and obtaining prior written consent, the patient will be subjected to investigations, as indicated. Then the patient will be confirmed to well recognized, practiced and established modalities of treatment.
No animal study is required.
7.6 Has the ethical clearance been obtained from your institution in case of 7.5?
Yes
8. LIST OF REFERENCES
1Mahamood F Mafee et al. Cholesteatoma of the middle ear and mastoid. A comparison of CT scan and operative findings. OCNA 1998: 21(2): 265-293.
2. O'Reithy BJ et al.. The value of CT scanning in chronic suppurative otitis media. The J Laryngol Otol 2000: 105: 990-994.
3. Jackler RK, Witham P Dillon and Schindler RA. Computed tomography in suppurative ear disease: A correlation of surgical and radiographic findings. Laryngoscope 2004; 94: 746-752.
4. Garber LZ and Dort JC. Cholesteatoma: Diagnosis and Staging by CT scan. J Otolaryngol 2003; 23(2): 121-124.
5. Johnson DW et al.. Cholesteatoma of the temporal bone : Role of computed tomography. Radiology 2003; 148: 733- 737.
6. O'Donoghue GM. Imaging the temporal bone (Editorial). Clin Otolaryngol 2000; 12: 157-160.
7 David P.C. Liu and Thomas Bergeron R. Contemporary radiologic imaging in the evaluation of middle ear-attic-antral complex cholesteatoma. Otolaryngol Clin North Am 2002; 22(No. 5): 897909.
8. Schwartz JD. High resolution computed tomography of the middle ear and mastoid. Radiology 2003; 148: 449-454.
9.Brunner and Sandberg LE. Tomography in cholesteotoma. Arch otol 2000:91:567.
10.Mohammed F Mafee et al. The role of radiology in surgery of ear and skull base.OCNA 1999:5(no 4):723-753..
9. Signature of the candidate :
10. Remarks of the Guide : Comparative analysis of preoperative HRCT and
Intraoperative findings at the time of mastoid
Exploration helps the otologist to decide
Accurately the mode of surgery to be adopted
And to take necessary precautions to avoid
Iatrogenic complications. As this institution
Has got all facilities , this study can be
Undertaken.
11.1 Name and Designation of the Guide: Dr. M RAJASHEKAR
MBBS, DLO, MS (ENT)
PROFESSOR AND HEAD
DEPARTMENT OF ENT
BOWRING AND LADY CURZON
HOSPITAL
BANGALORE: 560002.
11.2. Signature :
11.3. Co-guide (If Any) : Dr. SATISH CHANDARA
MBBS, MD , F .I.C.R[RADIOLOGY]
PROFESSOR AND HEAD
DEPARTMENT OF RADIOLOGY
MEDICAL SUPERINTENDENT
BOWRING AND LADY CURZON
HOSPITAL
BANGALORE 560002
11.4. Signature :
11.5. Head of the Department : Dr. H. S. SATISH
MBBS, DLO, MS (ENT)
PROFESSOR AND HEAD
DEPARTMENT OF ENT
BANGALORE MEDICAL COLLEGE
AND RESEARCH INSTITUTE.
BANGALORE: 560002.
11.6. Signature :
12.1. Remarks of the Chairman and Principal:
12.2. Signature :