Abstract

Background: Temporal bone pathologies including infections, cholesteatoma, and tumors pose significant diagnostic and surgical challenges. High-resolution computed tomography (HRCT) provides detailed anatomical information, yet its diagnostic accuracy relative to surgical findings in East Africa remains underexplored.
Methods: We conducted a retrospective diagnostic accuracy study of 63 patients at Kilimanjaro Christian Medical Centre (2021–2024), comparing preoperative HRCT findings with intraoperative diagnoses. Sensitivity, specificity, predictive values, and kappa statistics (with 95% confidence intervals) were calculated.
Results: Chronic suppurative otitis media (CSOM) was the most common pathology (76.2%), followed by cholesteatoma (19.0%) and glomus tumors (4.8%). HRCT demonstrated high diagnostic accuracy for CSOM (sensitivity 95.9%, 95% CI 86.0–99.5; specificity 92.9%, 95% CI 66.1–99.8) and cholesteatoma (sensitivity 91.7%, 95% CI 61.5–99.8; specificity 98.0%, 95% CI 86.9–100.0). Agreement was substantial (kappa >0.8) for epitympanum, mesotympanum, hypotympanum, and antrum involvement. Sensitivity was lower for ossicular erosions, particularly the incus (43.8%) and facial nerve canal dehiscence (20.0%).
Conclusion: HRCT is a reliable diagnostic tool for temporal bone pathologies, particularly CSOM and cholesteatoma, showing strong correlation with surgical findings. However, its sensitivity for subtle ossicular and nerve canal erosions is limited. Complementary MRI especially for cholesteatoma and soft-tissue characterization remains essential. In resource-limited settings, routine HRCT use is recommended for preoperative planning, with surgical confirmation required for fine bony details.

Key words: Temporal bone pathologies; Chronic suppurative otitis media; Cholesteatoma; High-resolution computed tomography; Diagnostic accuracy; Tanzania