Abstract
Objective: This study evaluates the benefits and limitations of
selected modalities of digital image enhancement in detection of
cholesteatoma remnants during endoscopic ear surgery (EES) and compares
their usefulness in recognizing residual disease.
Study Design: Cross-sectional study
Setting: Tertiary referral hospital
Methods: A total of 10 questionnaires of 18 intraoperative
pictures with equal numbers of cholesteatoma and non-cholesteatoma
images, each presented in three different image enhancing modalities
(clara, spectra A, spectra B), were generated. Fifty-one experienced ear
surgeons participated in the survey and were randomly assigned to a
questionnaire and completed it at two time points. The experts were
asked to rate for each picture whether cholesteatoma was present or not.
Results Clara showed the highest accuracy in cholesteatoma
detection, followed by spectra A and lastly spectra B. In contrast,
spectra B showed the highest sensitivity and clara the highest
specificity, while spectra A was placed in the middle for both values.
Using the spectra B modality, most responses agreed across the two time
points,. Ear surgeons assessed the usefulness, as well as preference
among image modalities in the following order: clara, spectra B, spectra
A.
Conclusion The suitability of image enhancement techniques for
application in EES could be shown. Clara can be considered the
state-of-art technique throughout the procedure and has subjectively
been evaluated best by surgeons. Due to its high sensitivity, spectra B
is recommended regarding the final check after resection to prevent
cholesteatoma residuals.
Keywords: Endoscopic ear surgery; cholesteatoma; outcome; image
enhancement; SPIES; Clara, Spectra A, Spectra B