A Comparative Analysis of Intraoperative Assessment Versus Preoperative Computed Tomography in Determining Aditus Ad...

Background and Objectives: Patency of the aditus ad antrum is essential for middle ear and mastoid ventilation and may influence surgical outcomes in chronic otitis media (COM). Although preoperative computed tomography (CT) is commonly used to assess patency, its reliability remains uncertain. This study compared preoperative CT findings with intraoperative saline and suction testing and evaluated the impact of intraoperative assessment on surgical planning. Materials and Methods: This observational study included 55 patients with mucosal COM who underwent middle ear surgery with preoperative CT assessment of the aditus. After limited antrostomy, aditus patency was assessed intraoperatively using saline and suction tests, which served as the reference standard. CT and intraoperative findings were cross-tabulated, diagnostic accuracy for CT-detected obstruction was calculated, and changes in surgical planning were recorded. Associations were tested using the chi-square test, with significance set at p < 0.05. Analysis was performed using SPSS version 22.0. Results: Intraoperative testing showed a patent aditus in 31 patients (56.4%), while CT indicated patency in 19 (34.5%). CT and intraoperative findings were concordant in 23 cases (41.8%) and discordant in 32 (58.2%), with a Cohen kappa of -0.12. CT detected obstruction with 58.3% sensitivity, 29.0% specificity, 38.9% positive predictive value, 47.4% negative predictive value, and 41.8% accuracy. Intraoperative findings changed the surgical plan in 26 patients (47.3%). Intraoperative patency was significantly associated with antral mucosal appearance (p < 0.001). Conclusions: Preoperative CT alone may not reliably assess aditus ad antrum patency. Intraoperative saline and suction testing provides a simple, practical method to confirm patency and guide mastoid surgery.