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Abstract

Objective: To compare the diagnostic accuracy of clinical examination and high-resolution computed tomography (HRCT) of the temporal bone in detecting cholesteatoma.
Methods: A prospective observational study was conducted on 50 patients with suspected cholesteatoma who presented with chronic otitis media and were scheduled for surgery. All patients underwent detailed clinical otoscopic examination and HRCT of the temporal bone. Intraoperative findings were considered the gold standard. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were calculated for both diagnostic modalities. McNemar’s test was applied to assess the statistical significance of differences.
Results: Among 50 patients, intraoperative confirmation of cholesteatoma was found in 30 (84%). Clinical examination detected cholesteatoma in 8 cases (sensitivity 26.7%, specificity 90%, PPV 80%, NPV 45%). HRCT correctly identified 20 cases (sensitivity 66.7%, specificity 90%, PPV 90%, NPV 64.3%). McNemar’s test revealed a statistically significant difference in accuracy between clinical examination and HRCT (p = 0.004), favoring HRCT.
Conclusion: HRCT of the temporal bone demonstrates significantly higher accuracy than clinical examination in the diagnosis of cholesteatoma. It should be considered an essential adjunct in preoperative assessment, particularly for delineating extent and complications.