Role of high-resolution CT scans in the management of cholesteatoma
Reviewed by Madhup K Chaurasia

This review article has looked at 15 publications, comparing features noted in high-resolution CT (HRCT) scans of patients having cholesteatoma with actual intraoperative findings. This comparison was used to assess sensitivity and specificity of various abnormalities picked up by HRCT scans. The best correlation, as determined by Cohen’s kappa coefficient, was found for tegmen tympani dehiscence and erosion of malleus, followed by dehiscence of lateral semicircular canal and destruction of incus. Correlation was less for the stapes. Facial nerve dehiscence had only a moderate correlation. Some of these studies also looked at correlation of HRCT extent of cholesteatoma with what was found at surgery but this correlation was only moderate. The delay between imaging and surgery, and also the fact that CT scans do not differentiate between granulation tissue and cholesteatoma, did not help this correlation. It is emphasised that no imaging modality has specificity and sensitivity of 100% and every step of dissection is fraught with danger. However, some of the findings – such as fallopian canal, lateral semicircular canal and tegmen tympani dehiscence – if picked up in this way, can advocate early surgery. This establishes the specific role of HRCT scans.

Factors affecting correlation between high-resolution computed tomography and operative findings in cholesteatoma surgery – a systematic review.
Finch G, Patel S, Walters B, Trotter M.
J LARYNGOLOGY OTOL 
2026;140:2–11.