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<p>Chronic Otitis Media (COM) is categorized into mucosal and squamous types, with the latter often associated with cholesteatoma formation. Cholesteatoma represents an “unsafe” disease due to its potential for bone erosion and complications. High-Resolution Computed Tomography of the temporal bone plays a pivotal role in preoperative assessment. The ChOLE classification system—evaluating Cholesteatoma extension (Ch), Ossicular chain status (O), Complications (L), and Eustachian tube function (E)—provides a standardized framework for staging and predicting surgical outcomes. This study adapts the ChOLE framework for preoperative radiological assessment to evaluate concordance with intraoperative ChOLE scores. This prospective observational pilot study was conducted over 18 months (June 2023–December 2024) at a tertiary care hospital in Western Maharashtra. Fifty adult patients (&gt;18 years) diagnosed with COM squamous undergoing surgery were included. Preoperative HRCT findings were documented using the ChOLE system and compared with intraoperative scores. Statistical analysis assessed sensitivity, specificity and agreement using Cohen’s Kappa. HRCT showed moderate agreement for cholesteatoma extension (Kappa = 0.40; sensitivity 71%, specificity 69%) and fair agreement for ossicular chain status (Kappa = 0.23; sensitivity 78%, specificity 48%). Complications demonstrated strong agreement (Kappa = 0.85; sensitivity 96%, specificity 90%), while mastoid pneumatization/Eustachian tube function showed perfect agreement (Kappa = 1.0). Overall ChOLE staging showed slight agreement (Kappa = 0.15), with HRCT overestimating disease severity in 22% and underestimating in 24% of cases. Stage II disease was most common radiologically (80%) and intraoperatively (84%), showing 76% concordance. HRCT temporal bone provides excellent preoperative assessment of cholesteatoma extension, complications, and mastoid pneumatization, aiding surgical planning. However, its limited precision in ossicular erosion and total ChOLE score estimation necessitates intraoperative confirmation for accurate staging. Incorporating ChOLE-based staging enhances standardized disease assessment.</p>

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HRCT Temporal Bone Accuracy and Concordance with Intraoperative ChOLE Staging in COM Squamous: A Pilot Study

  • 期刊论文

  • 发表日期：

    2026年2月20日

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  • Kamalpreet Singh,
  • Bhagath Kumar,
  • Poonam Raj,
  • Vikas Gupta,
  • Anandita Gupta,
  • Rahul Kurkure,
  • Vishal Gaurav,
  • Salil Kumar Gupta,
  • Meenakshi Rajput,
  • V. S. Sreejith

摘要

Chronic Otitis Media (COM) is categorized into mucosal and squamous types, with the latter often associated with cholesteatoma formation. Cholesteatoma represents an “unsafe” disease due to its potential for bone erosion and complications. High-Resolution Computed Tomography of the temporal bone plays a pivotal role in preoperative assessment. The ChOLE classification system—evaluating Cholesteatoma extension (Ch), Ossicular chain status (O), Complications (L), and Eustachian tube function (E)—provides a standardized framework for staging and predicting surgical outcomes. This study adapts the ChOLE framework for preoperative radiological assessment to evaluate concordance with intraoperative ChOLE scores. This prospective observational pilot study was conducted over 18 months (June 2023–December 2024) at a tertiary care hospital in Western Maharashtra. Fifty adult patients (>18 years) diagnosed with COM squamous undergoing surgery were included. Preoperative HRCT findings were documented using the ChOLE system and compared with intraoperative scores. Statistical analysis assessed sensitivity, specificity and agreement using Cohen’s Kappa. HRCT showed moderate agreement for cholesteatoma extension (Kappa = 0.40; sensitivity 71%, specificity 69%) and fair agreement for ossicular chain status (Kappa = 0.23; sensitivity 78%, specificity 48%). Complications demonstrated strong agreement (Kappa = 0.85; sensitivity 96%, specificity 90%), while mastoid pneumatization/Eustachian tube function showed perfect agreement (Kappa = 1.0). Overall ChOLE staging showed slight agreement (Kappa = 0.15), with HRCT overestimating disease severity in 22% and underestimating in 24% of cases. Stage II disease was most common radiologically (80%) and intraoperatively (84%), showing 76% concordance. HRCT temporal bone provides excellent preoperative assessment of cholesteatoma extension, complications, and mastoid pneumatization, aiding surgical planning. However, its limited precision in ossicular erosion and total ChOLE score estimation necessitates intraoperative confirmation for accurate staging. Incorporating ChOLE-based staging enhances standardized disease assessment.