INTEGRATED OTOENDOSCOPIC AND HIGH-RESOLUTION COMPUTED TOMOGRAPHIC ASSESSMENT IN THE SURGICAL MANAGEMENT OF CHRONIC SUPPURATIVE OTITIS MEDIA

Background: Chronic suppurative otitis media (CSOM) encompasses a broad spectrum of tympanic membrane, middleear, mastoid and ossicular pathology, and management depends on accurate preoperative definition of disease extent and on surgery tailored to the anatomy encountered. This study evaluated an integrated approach combining otoendoscopy, highresolution computed tomography (HRCT) and tympanomastoid surgery. Methods: Ninety-two consecutive patients undergoing surgery for CSOM (January 2024 to June 2026) were prospectively evaluated with otoendoscopy, pure-tone audiometry and HRCT of the temporal bone. Surgery was individualised to disease extent and anatomy. HRCT was compared with operative findings as the reference standard, with 95% confidence intervals (CI); paired hearing categories were compared by exact McNemar test. Results: Large perforations were the commonest category (33 patients, 35.9%). The mastoid was well pneumatised in 36 patients (39.1%), moderately cellular in 35 (38.0%) and acellular in 21 (22.8%); middle-ear soft-tissue density was present in 41 (44.6%) and ossicular erosion in 39 (42.4%). HRCT identified cholesteatoma in 32 patients and surgery in 28, giving a sensitivity of 92.9% (95% CI 77.4-98.0), specificity 90.6% (81.0– 95.6), positive predictive value 81.2% (64.7–91.1) and accuracy 91.3% (83.8–95.5). Intact canal-wall mastoidectomy was used in 66 patients, canal-wall-down in 19 and an inside-out approach in seven. Graft uptake was achieved in 97.8%, and the proportion with a pure-tone average of 25 dB or better rose from none to 64.1% (p<0.001). Conclusion: Otoendoscopy and HRCT provided complementary information for surgical planning, and HRCT performed well against operative findings, although its positive predictive value confirms that soft-tissue opacification is not synonymous with cholesteatoma.