The use of computerized tomographic imaging in revision mastoid surgery for chronic otitis media

Recurrent otorrhea, pain, and a conductive hearing deficit are common indicators of possible recurrent disease following mastoidectomy for chronic otitis media. High-resolution computed tomography (CT) provides an excellent method for examination of the surgically altered mastoid. Areas of residual infected air cells, cholesteatoma, cholesterol granuloma, and other surgical conditions within the mastoid are localized by this technique prior to reexploration. The technique provides information regarding the extent of disease as well as possible anatomic variations and potential complications that may be avoided during surgery. The imaging modality illustrates the detailed nature and extent of the prior mastoid surgery. CT of the temporal bone is therefore a useful guide to the surgeon in managing patients after unsuccessful surgery. Nine illustrative case examples are presented in which CT results prior to reoperation are directly compared to the surgical findings. The causes of recurrent disease and the utility of CT scanning prior to reexploration of the mastoid are discussed. High-resolution CT scanning should be performed on all patients presenting with signs or symptoms of possible recurrent disease following mastoid surgery for chronic otitis media.