Value of histopathology for diagnosis of cholesteatoma underlying pathogenesis of aural polypi in chronic suppurative otitis media
Abou-Bakr E. Ras, MD and Abdel Latif El-Balshy, MD*
Departments of ENT and Pathology*. Benha Faculty of Medicine, Zagazig University
Abstract
The study comprised 30 patients (17 males and 13 females) with mean age of 23.7± 10.5 years presented with chronic suppurative otitis media (Ch. SOM) associated with aural polypi. Patients underwent history taking, full ENT examination, bilateral X-ray examination for mastoid region, then polypi were excised using surgical microscope followed hy microscopic exploration of the mastoid. The excised polypi were examined hislopathologically. Patients were categorized according to clinical and radiological findings into cases with cholesteatoma (Group A) and cholesteatoma free cases (Group B) and according to histopathological results into three groups: Group 1 (probable underlying cholesteatoma). Group 2 (excluded cholesteatoma) and Group 3 (doubtful cholesteatoma). Most patients (19 patients) were below 30 years, with a significant (P<0.05) difference between different age groups as regards the frequency of occurrence of aural polypi. Otorrhea and deafness were encountered in all patients, while tennitus was reported in 12 patients, and vertigo and positive fistula test in only 6 patients. X-ray mastoid of all cases showed sclerosed mastoid al the side of aural polypi. However, a huge cholesteatoma cavity was detected in 6 cases. There were 17 patients (56.7%) with posterior marginal perforation, and 13 (43.3%) with central perforation of eardrum. Clinical findings defined 16 cases as having cholesteatoma and 14 patients as free cases. Hislopathologically. there were 12 cases of cholesteatoma probable. 11 cases were free of cholesteatoma, while the other 7 cases were doubtful. Throughout the surgical exploration of mastoid. 20 patients (66. 7%) were associated with cholesteatoma and 10 patients (33.3%) were free. Histopathological and operative finding coincided in 18 cases with a positive predictive value (PPV) of 94.7%, negative predictive value (NPV) of 81.8% and accuracy rate of 90% for diagnosis of the presence of cholesteatoma. Conclusion: A high percentage of aural polypi had underlying cholesteatoma and surgeons must not relay only on clinical judgment that must he supported by definite histopathological diagnosis to achieve the proper surgical decision either to do simple aural polypectomy or to carry on mastoidectomy. We recommend simple polypectomy under local anesthesia as an office procedure with subsequent histopathological examination to dejine cases required mastoidectomy.
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