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Van Dijk SW, Peters JPM, Stokroos RJ, Thomeer HGXM. Surgical decision-making in superior canal dehiscence syndrome with concomitant otosclerosis. Eur Arch Otorhinolaryngol 2024; 281:3859-3865. [PMID: 38780629 PMCID: PMC11211118 DOI: 10.1007/s00405-024-08679-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Accepted: 04/12/2024] [Indexed: 05/25/2024]
Abstract
OBJECTIVE The diagnosis and management of Superior Canal Dehiscence Syndrome (SCDS) with concomitant otosclerosis can be a challenge. Otosclerosis can mask SCDS symptoms and stapes surgery may reveal or exacerbate vestibular symptoms. Our aim is to present four cases of SCDS with concomitant otosclerosis and thereby informing the reader about the possibility of this dual occurrence and its implications for treatment. CASES Four patients with SCDS and concomitant otosclerosis are presented. Two patients underwent surgical treatment for both SCDS and otosclerosis and two patients opted for conservative management. OUTCOMES The main differences between surgically and non-surgically treated cases are the presence of autophony and pressure-induced vertigo and a more severe experience of symptoms in surgically treated cases. Surgically treated cases achieved a sizeable reduction in postoperative air-bone gap and resolution of vestibular symptoms. CONCLUSION The subjective severity of symptoms in combination with shared decision-making is key in determining the appropriate treatment plan for SCDS and concomitant otosclerosis.
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Affiliation(s)
- S W Van Dijk
- Department of Otorhinolaryngology and Head and Neck Surgery, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, Netherlands
| | - J P M Peters
- Department of Otorhinolaryngology and Head and Neck Surgery, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, Netherlands
| | - R J Stokroos
- Department of Otorhinolaryngology and Head and Neck Surgery, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, Netherlands
| | - H G X M Thomeer
- Department of Otorhinolaryngology and Head and Neck Surgery, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, Netherlands.
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Kimura A, Morita Y, Kitazawa M, Yagi C, Takahashi K, Ohshima S, Yamagishi T, Izumi S, Horii A. Otic Capsule Demineralization and Hearing Outcome of Stapes Surgery for Osteogenesis Imperfecta in Comparison With Otosclerosis. Otol Neurotol 2024; 45:e376-e380. [PMID: 38518766 DOI: 10.1097/mao.0000000000004166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/24/2024]
Abstract
OBJECTIVE To assess the location/number of otic capsule demineralization and hearing outcomes of stapes surgery (SS) for osteogenesis imperfecta (OI) compared with otosclerosis (OS). PATIENTS This study included 11 and 181 consecutive ears from 6 and 152 patients with OI and OS, respectively. INTERVENTIONS Demineralization loci observed as hypodense area of the otic capsule were examined using high-resolution computed tomography. All patients underwent SS. MAIN OUTCOME MEASURES Locations of the hypodense areas were classified into the anterior oval window, anterior internal auditory canal, and pericochlear area. The location/number of hypodense areas and preoperative/postoperative hearing parameters were correlated. Postoperative hearing outcome was evaluated 12 months after surgery. RESULTS Hypodense area was more frequently observed in OI (9 of 11 ears [81.8%]) than in OS (96 of 181 ears [53.0%]), with significant differences. Multiple sites were involved in 81.8% OI and 18.8% OS patients, showing significant differences. Preoperative air conduction (AC), bone conduction, and air-bone gap (ABG) were 48.9 ± 17.8, 28.0 ± 11.3, and 20.7 ± 8.4 dB, respectively, in OI and 56.2 ± 13.5, 30.5 ± 9.9, and 26.4 ± 9.7 dB, respectively, in OS, demonstrating greater AC and ABG in OS than in OI. Postoperative AC (31.3 ± 20.5 dB), ABG (10.6 ± 10.0 dB), and closure of ABG (12.1 ± 4.7 dB), that is, preoperative ABG minus postoperative ABG of OI, were comparable to those of OS (AC, 30.9 ± 13.3 dB; ABG, 7.0 ± 7.4 dB; closure of ABG, 20.1 ± 11.6 dB). CONCLUSION OI ears showed more severe demineralization of otic capsule than OS ears. However, favorable hearing outcomes could be obtained through SS for OI and OS ears.
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Affiliation(s)
- Akira Kimura
- Department of Otolaryngology Head and Neck Surgery, Niigata University Graduate School of Medical and Dental Sciences, Niigata
| | - Yuka Morita
- Department of Otolaryngology Head and Neck Surgery, University of Toyama, Toyama
| | - Meiko Kitazawa
- Department of Otolaryngology Head and Neck Surgery, Niigata University Graduate School of Medical and Dental Sciences, Niigata
| | - Chihiro Yagi
- Department of Otolaryngology Head and Neck Surgery, Niigata University Graduate School of Medical and Dental Sciences, Niigata
| | - Kuniyuki Takahashi
- Department of Otolaryngology Head and Neck Surgery, Faculty of Medicine, University of Miyazaki, Miyazaki, Japan
| | - Shinsuke Ohshima
- Department of Otolaryngology Head and Neck Surgery, Niigata University Graduate School of Medical and Dental Sciences, Niigata
| | - Tatsuya Yamagishi
- Department of Otolaryngology Head and Neck Surgery, Niigata University Graduate School of Medical and Dental Sciences, Niigata
| | - Shuji Izumi
- Department of Otolaryngology Head and Neck Surgery, Niigata University Graduate School of Medical and Dental Sciences, Niigata
| | - Arata Horii
- Department of Otolaryngology Head and Neck Surgery, Niigata University Graduate School of Medical and Dental Sciences, Niigata
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Sanford CA, Brockett JE, Aithal V, AlMakadma H. Implementation of Wideband Acoustic Immittance in Clinical Practice: Relationships among Audiologic and Otologic Findings. Semin Hear 2023; 44:65-83. [PMID: 36925656 PMCID: PMC10014207 DOI: 10.1055/s-0043-1763295] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/06/2023] Open
Abstract
A number of studies have produced normative and developmental data and examples of wideband acoustic immittance (WAI) obtained in ears with pathologies and or dysfunction. However, incorporation of this tool into clinical audiology and otolaryngology practice has been slower than expected, potentially due to challenges with interpretation, integration into existing test batteries, and confidence in practical application. This article presents information aimed at helping clinicians increase their confidence in using this new tool by becoming more familiar and making connections with the ways that WAI outcomes both align with and add to standard immittance, audiometric and otologic diagnostic test outcomes. This article presents several case studies to demonstrate the use of WAI in realistic clinical settings. Each case presents a brief background, case history, audiologic/otologic findings, and initial recommendations, followed by a discussion on how the inclusion of WAI test outcomes aids in diagnostic decisions. The overall aim of this work is to identify the relationships among different diagnostic test outcomes, to demonstrate basic WAI interpretation principles, and encourage the reader to engage with this diagnostic tool in clinical practice.
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Affiliation(s)
- Chris A Sanford
- Department of Communication Sciences and Disorders, Idaho State University, Pocatello, Idaho
| | - Jeff E Brockett
- Department of Communication Sciences and Disorders, Idaho State University, Pocatello, Idaho
| | - Venkatesh Aithal
- Audiology Department, Townsville University Hospital and Hearing Research Unit for Children, University of Queensland, Queensland, Australia
| | - Hammam AlMakadma
- Department of Otolaryngology and Communicative Disorders, School of Medicine, University of Louisville, Louisville, Kentucky
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Stenz NA, Hashmi S, Lehnick D, Treumann T, Linder T. [Role of computed tomography in the preoperative diagnosis of otosclerosis]. HNO 2023; 71:92-99. [PMID: 36326852 PMCID: PMC9895003 DOI: 10.1007/s00106-022-01241-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/06/2022] [Indexed: 11/06/2022]
Abstract
BACKGROUND Otosclerosis is an osteodystrophy of the otic capsule and presents with progressive conductive hearing loss. Imaging studies, especially computed tomography (CT) and cone-beam CT, have gained increased relevance in the diagnosis of otosclerosis. OBJECTIVE This study investigated whether there is a correlation between the extent of otosclerosis in high-resolution or cone-beam CT and hearing loss in pure-tone audiometry. MATERIALS AND METHODS Based on an existing classification of otosclerotic foci, a classification was established. Preoperative CT scans of patients undergoing stapedotomy between 2015 and 2019 were evaluated and classified by two independent otorhinolaryngologists. The preoperative pure-tone audiograms were analysed and compared to the results of CT. RESULTS A total of 168 CT studies (i.e., 168 ears) in 156 patients with intraoperatively confirmed otosclerosis were included in our study. A correlation between the extent of the otosclerotic focus or the calculated scores and hearing loss in pure-tone audiometry (air conduction, bone conduction and air-bone-gap) could not be proven. CONCLUSION Preoperative CT is not obligatory. However, preoperative imaging using CT or cone-beam CT can be helpful to confirm the diagnosis and exclude other middle or inner ear pathologies as well as in planning of the surgical procedure in the overall context of otoscopy and audiometry. A correlation with the degree of hearing impairment could not be demonstrated and remains unclear.
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Affiliation(s)
- Nadja Angela Stenz
- Klinik für Hals‑, Nasen- Ohren- und Gesichtschirurgie (HNO), Luzerner Kantonsspital, Spitalstraße, 6004, Luzern, Schweiz.
| | - Salman Hashmi
- Klinik für Hals‑, Nasen- Ohren- und Gesichtschirurgie (HNO), Luzerner Kantonsspital, Spitalstraße, 6004, Luzern, Schweiz
| | - Dirk Lehnick
- Gesundheitswissenschaften und Medizin, Universität Luzern, Luzern, Schweiz
| | - Thomas Treumann
- Klinik für Radiologie, Luzerner Kantonsspital, Luzern, Schweiz
| | - Thomas Linder
- Klinik für Hals‑, Nasen- Ohren- und Gesichtschirurgie (HNO), Luzerner Kantonsspital, Spitalstraße, 6004, Luzern, Schweiz
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Tuset M, Baptiste A, Cyna Gorse F, Sterkers O, Nguyen Y, Lahlou G, Ferrary E, Mosnier I. Facial nerve stimulation in adult cochlear implant recipients with far advanced otosclerosis. Laryngoscope Investig Otolaryngol 2022; 8:220-229. [PMID: 36846428 PMCID: PMC9948588 DOI: 10.1002/lio2.984] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Accepted: 11/15/2022] [Indexed: 12/05/2022] Open
Abstract
Objectives The objective of this study was to predict occurrence of facial nerve stimulation (FNS) in cochlear implanted patients for far-advanced otosclerosis (FAO) by correlating preoperative computed tomography (CT)-scan data to FNS and to evaluate FNS impact on hearing outcomes. Methods Retrospective analysis on 91 ears (76 patients) implanted for FAO. Electrodes were straight (50%) or perimodiolar (50%). Demographic data, extension of otosclerosis on preoperative CT scan, occurrence of FNS, and speech performance were analyzed. Results Prevalence of FNS was 21% (19 ears). FNS appeared during the first month (21%), 1-6 months (26%), 6-12 months (21%), and over 1 year (32%) postimplantation. Cumulative incidence of FNS at 15 years was 33% (95% CI = [14-47%]). Extension of otosclerotic lesions on preimplantation CT-scan was more severe in FNS ears compared to No-FNS (p < .05): for Stage III, 13/19 (68%) and 18/72 (25%) ears for FNS and No-FNS groups, respectively (p < .05). Location of otosclerotic lesions relative to the facial nerve canal was similar whatever the presence or not of FNS. Electrode array had no impact on FNS occurrence. At 1 year post-implantation, duration of profound hearing loss (≥5 years) and previous stapedotomy were negatively associated with speech performance. FNS did not impact hearing outcomes, despite a lower percentage of activated electrodes (p < .01) in the FNS group. Nevertheless, FNS were associated with a decrease of speech performance both in quiet (p < .001) and in noise (p < .05). Conclusion Cochlear implanted patients for FAO are at greater risk of developing FNS affecting speech performance over time, probably due to a higher percentage of deactivated electrodes. High resolution CT-scan is an essential tool allowing FNS prediction but not time of onset. Level of evidence 2b, Laryngoscope Investigative Otolaryngology, 2022.
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Affiliation(s)
- Maria‐Pia Tuset
- Unité Fonctionnelle Implants Auditifs, ORL, GH Pitié‐SalpêtrièreAP‐HP Sorbonne UniversitéParisFrance
| | - Amandine Baptiste
- Département de Biostatistique, Santé Publique et Information médicale, GH Pitié‐SalpêtrièreAP‐HP Sorbonne UniversitéParisFrance
| | | | - Olivier Sterkers
- Unité Fonctionnelle Implants Auditifs, ORL, GH Pitié‐SalpêtrièreAP‐HP Sorbonne UniversitéParisFrance,Technologies et thérapie génique pour la surdité, Institut de l'auditionInstitut Pasteur / Inserm / Université Paris CitéParisFrance
| | - Yann Nguyen
- Unité Fonctionnelle Implants Auditifs, ORL, GH Pitié‐SalpêtrièreAP‐HP Sorbonne UniversitéParisFrance,Technologies et thérapie génique pour la surdité, Institut de l'auditionInstitut Pasteur / Inserm / Université Paris CitéParisFrance
| | - Ghizlène Lahlou
- Unité Fonctionnelle Implants Auditifs, ORL, GH Pitié‐SalpêtrièreAP‐HP Sorbonne UniversitéParisFrance,Technologies et thérapie génique pour la surdité, Institut de l'auditionInstitut Pasteur / Inserm / Université Paris CitéParisFrance
| | - Evelyne Ferrary
- Unité Fonctionnelle Implants Auditifs, ORL, GH Pitié‐SalpêtrièreAP‐HP Sorbonne UniversitéParisFrance,Technologies et thérapie génique pour la surdité, Institut de l'auditionInstitut Pasteur / Inserm / Université Paris CitéParisFrance
| | - Isabelle Mosnier
- Unité Fonctionnelle Implants Auditifs, ORL, GH Pitié‐SalpêtrièreAP‐HP Sorbonne UniversitéParisFrance,Technologies et thérapie génique pour la surdité, Institut de l'auditionInstitut Pasteur / Inserm / Université Paris CitéParisFrance
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6
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Albera A, Parandero F, Andriani R, Albera R, Riva G, Canale A. Prognostic factors influencing postoperative air-bone gap in stapes surgery. ACTA OTORHINOLARYNGOLOGICA ITALICA : ORGANO UFFICIALE DELLA SOCIETA ITALIANA DI OTORINOLARINGOLOGIA E CHIRURGIA CERVICO-FACCIALE 2022; 42:380-387. [PMID: 36254654 PMCID: PMC9577682 DOI: 10.14639/0392-100x-n0612] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Accepted: 04/19/2022] [Indexed: 11/23/2022]
Abstract
Objective Otosclerosis is an osteodystrophic disease of the otic capsule, determining conductive or mixed hearing loss, which can be successfully treated with stapedotomy. The aim of the present multicentric retrospective study was to identify prognostic factors related to better auditory outcomes in stapes surgery. Methods 581 patients affected by otosclerosis were submitted to stapedotomy under local anaesthesia in two different hospitals. Both Teflon and titanium prostheses were adopted. Results A statistically significant decrease of postoperative air-conduction thresholds and air-bone gap (ABG) values was seen, whereas the mean bone-conduction threshold did not differ from the preoperative condition. Among the various parameters investigated, the prosthetic material, duration of surgery and intraoperative detection of unexpected anatomical anomalies of the middle ear were found to be related to lower postoperative ABG values. Conclusions All the previously mentioned parameters played a significant role in determining the postoperative auditory outcomes and can therefore be considered prognostic factors for the success of the stapedotomy.
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Affiliation(s)
- Andrea Albera
- Department of Surgical Sciences, University of Turin, Turin, Italy
| | - Fiorella Parandero
- Section of Ear Nose and Throat, Fatebenefratelli Hospital, University of Milan, Milan, Italy
| | - Roberto Andriani
- Section of Ear Nose and Throat, Fatebenefratelli Hospital, University of Milan, Milan, Italy
| | - Roberto Albera
- Department of Surgical Sciences, University of Turin, Turin, Italy,Correspondence Andrea Albera Department of Surgical Sciences, University of Turin, Via Genova 3, 10124, Turin, Italy Tel. +39 011 6709582 E-mail:
| | - Giuseppe Riva
- Department of Surgical Sciences, University of Turin, Turin, Italy
| | - Andrea Canale
- Department of Surgical Sciences, University of Turin, Turin, Italy
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Walker BA, Thorwarth RM, Stull LL, Hoxworth JM, Deep NL, Weisskopf PA. Incidence of Concomitant Semicircular Canal Dehiscence With Otosclerosis. OTOLOGY & NEUROTOLOGY OPEN 2022; 2:e012. [PMID: 38516327 PMCID: PMC10950147 DOI: 10.1097/ono.0000000000000012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Accepted: 04/07/2022] [Indexed: 03/23/2024]
Abstract
Objective The concurrence of otosclerosis and superior semicircular canal dehiscence (SSCD) presents a diagnostic challenge and failure to differentiate between these 2 diagnoses results in mischaracterization and unsuccessful surgery. The objective of this study is to identify the incidence of SSCD in patients who have computed tomography (CT) evidence of otosclerosis. Study Design Retrospective chart review. Setting Tertiary referral hospital. Patients Adults with CT scan of the temporal bone diagnosed with radiological unilateral or bilateral fenestral otosclerosis from January 1995 to April 2018. Methods Retrospective review of patient imaging from a multi-center tertiary-referral health system from January 1995 to April 2018. Imaging was reviewed to quantify the incidence of SSCD among patients with CT-diagnosed bilateral fenestral otosclerosis. Poor quality imaging was excluded from review. Results One-thousand two-hundred eight patients (1214 CT scans) were identified with otosclerosis, of which 373 were diagnosed with fenestral otosclerosis (663 ears) with imaging of sufficient quality for review. This population was predominantly female (57.2%) with bilateral fenestral otosclerosis (78%). Of these, 23 ears (3.5%) had definitive evidence of SSCD, with an additional 15 ears (2.3%) with possible radiographic evidence of SSCD. There was no significant difference in laterality between the SSCD and otosclerosis. Conclusions Among 373 patients with fenestral otosclerosis per CT temporal bone imaging at a tertiary referral hospital, as many as 8.3% of patients had radiographic evidence of SSCD. Given this incidence, it continues to be important to consider SSCD when diagnosing and treating otosclerosis.
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Affiliation(s)
- Brian A. Walker
- Department of Otorhinolaryngology, The Mayo Clinic in Arizona, Phoenix, AZ
| | - Ryan M. Thorwarth
- Department of Otorhinolaryngology, The Mayo Clinic in Arizona, Phoenix, AZ
| | - Lindsey L. Stull
- Department of Otorhinolaryngology, The Mayo Clinic in Arizona, Phoenix, AZ
| | - Joseph M. Hoxworth
- Department of Radiology, Division of Neuroradiology, The Mayo Clinic in Arizona, Phoenix, AZ
| | - Nicholas L. Deep
- Department of Otorhinolaryngology, Division of Neurotology, The Mayo Clinic in Arizona, Phoenix, AZ
| | - Peter A. Weisskopf
- Department of Otorhinolaryngology, Division of Neurotology, The Mayo Clinic in Arizona, Phoenix, AZ
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Manning PM, Shroads MR, Bykowski J, Mafee MF. Role of Radiologic Imaging in Otosclerosis. CURRENT OTORHINOLARYNGOLOGY REPORTS 2022. [DOI: 10.1007/s40136-021-00377-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Abstract
Purpose of Review
To review the role of imaging in otosclerosis with an emphasis on pre- and post-operative imaging evaluation.
Recent Findings
Pre-operative CT imaging can help define the extent of bone involvement in otosclerosis and may help avoid surgical complications due to variant anatomy or unsuspected alternative causes of conductive hearing loss. In patients with recurrent hearing loss after surgery, CT imaging can clarify prosthesis position and re-assess anatomy.
Summary
CT imaging complements otologic exam and audiometry findings in patients with suspected otosclerosis, for pre-operative planning, and post-operative assessment for patients with recurrent symptoms.
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Measuring the density of the fissula antefenestram and the section of the basal turn of the cochlea: are they useful in the radiological diagnosis of otosclerosis? J Otol 2022; 17:84-89. [PMID: 35949553 PMCID: PMC9349010 DOI: 10.1016/j.joto.2022.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Revised: 12/22/2021] [Accepted: 01/03/2022] [Indexed: 11/28/2022] Open
Abstract
Introduction The role of objective parameters in terms of improvement of the accuracy of high-resolution computed tomography (HRCT) of the temporal bone in the diagnosis of otosclerosis remains unclear. Objectives To investigate the relationship between the density of the fissula antefenestram (FAF) and of the width of the transversal section of the basal turn of the cochlea (BTC), and the diagnosis of otosclerosis. Methods This is a retrospective study in which preoperative HRCT data from ears of patients submitted to stapedotomy due to otosclerosis (case group) were evaluated. For the control group, normal hearing ears having undergone HRCT for other purposes were included. Case and control HRCT images were objectively assessed by an experienced blinded radiologist. During this evaluation, measurements of the relative radiological density of the FAF and of the transversal section of the BTC were obtained. The results were compared between the groups. Also, a receiver operating characteristic curve was created and the area under the curve (AUC) was calculated for each variable. Significance level was set at .05. Results 40 ears were included in each group. Case ears presented reduced values for the relative radiological density on the FAF (p-value<0.0001). Moreover, ears with otosclerosis (p-value: 0.022) presented lower transversal section of the BTC. The AUC for these variables reached 0.929 and 0.646, respectively. Conclusions Otosclerotic ears present reduced radiological density on the FAF and narrower BTC. The relative density of the FAF also shows a great diagnostic power in the context of this disease.
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Cakmak V, Cakmak P. Does otosclerosis affect the dimensions of the facial canal and cochlear aquaduct? Eur Arch Otorhinolaryngol 2021; 278:1845-1852. [PMID: 33550475 DOI: 10.1007/s00405-021-06655-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Accepted: 01/27/2021] [Indexed: 12/18/2022]
Abstract
PURPOSE Our aim was to evaluate the relationship of the dimensions of the facial canal (FC) and cochlear aqueduct (CA) in otosclerosis (OS) with the type and severity of OS. METHODS Two radiologists retrospectively evaluated temporal bone high-resolution computed tomography (HRCT) images obtained from 48 healthy individuals and 94 OS patients between January 2015 and July 2020. In the study group, the CA width, funnel base width, and funnel length, in addition to the FC transverse length, were measured in the axial plane. The CA length was measured in the coronal plane on HRCT images. The FC craniocaudal length was measured in the same plane as the fissula ante fenestram (FAF) in coronal reformatted HRCT images. Grading of OS was based on otosclerotic plaque density and new bone formation extending toward the tympanic cavity at the FAF level. RESULTS In the OS patients, the CA width and FC craniocaudal and FC transverse diameters were significantly decreased on both sides compared to those in the control group (p < 0.001). In fenestral OS, the FC craniocaudal and transverse widths on both sides were statistically significantly lower than the FC widths in the control group (p < 0.0001). A statistically negative correlation was found in the FC craniocaudal (r = - 0.831/- 0.818) and transverse (r = - 0.742/- 0.750) measurements on both sides in accordance with an increase in the otosclerotic plaque density (p < 0.0001). CONCLUSION The presence of narrowing in the FC and CA adjacent to the FAF supports the role of autoimmunity theory in the etiology of OS.
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Affiliation(s)
- Vefa Cakmak
- Department of Radiology, Faculty of Medicine, Pamukkale University, Denizli, Turkey.
| | - Pinar Cakmak
- Department of Radiology, Faculty of Medicine, Pamukkale University, Denizli, Turkey
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Effects of Otosclerosis on Middle Ear Function Assessed With Wideband Absorbance and Absorbed Power. Ear Hear 2020; 42:547-557. [PMID: 33156125 DOI: 10.1097/aud.0000000000000968] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Wideband absorbance and absorbed power were evaluated in a group of subjects with surgically confirmed otosclerosis (Oto group), mean age 51.6 years. This is the first use of absorbed power in the assessment of middle ear disorders. Results were compared with control data from two groups of adults, one with normal hearing (NH group) mean age of 31 years, and one that was age- and sex-matched with the Oto group and had sensorineural hearing loss (SNHL group). The goal was to assess group differences using absorbance and absorbed power, to determine test performance in detecting otosclerosis, and to evaluate preoperative and postoperative test results. DESIGN Audiometric and wideband tests were performed over frequencies up to 8 kHz. The three groups were compared on wideband tests using analysis of variance to assess group mean differences. Receiver operating characteristic (ROC) curve analysis was also used to assess test accuracy at classifying ears as belonging to the Oto or control groups using the area under the ROC curve (AUC). A longitudinal design was used to compare preoperative and postoperative results at 3 and 6 months. RESULTS There were significant mean differences in the wideband parameters between the Oto and control groups with generally lower absorbance and absorbed power for the Oto group at ambient and tympanometric peak pressure (TPP) depending on frequency. The SNHL group had more significant differences with the Oto group than did the NH group in the high frequencies for absorbed power at ambient pressure and tympanometric absorbed power at TPP, as well as for the tympanometric tails. The greatest accuracy for classifying ears as being in the Oto group or a control group was for absorbed power at ambient pressure at 0.71 kHz with an AUC of 0.81 comparing the Oto and NH groups. The greatest accuracy for an absorbance measure was for the comparison between the Oto and NH groups for the peak-to-negative tail condition with an AUC of 0.78. In contrast, the accuracy for classifying ears into the control or Oto groups for static acoustic admittance at 226 Hz was near chance performance, which is consistent with previous findings. There were significant mean differences between preoperative and postoperative tests for absorbance and absorbed power. CONCLUSIONS Consistent with previous studies, wideband absorbance showed better sensitivity for detecting the effects of otosclerosis on middle ear function than static acoustic admittance at 226 Hz. This study showed that wideband absorbed power is similarly sensitive and may perform even better in some instances than absorbance at classifying ears as having otosclerosis. The use of a group that was age- and sex-matched to the Oto group generally resulted in greater differences between groups in the high frequencies for absorbed power, suggesting that age-related norms in adults may be useful for the wideband clinical applications. Absorbance and absorbed power appear useful for monitoring changes in middle ear function following surgery for otosclerosis.
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Mangia LRL, Coelho LODM, Carvalho B, de Oliveira AKP, Hamerschmidt R. Imaging Studies in Otosclerosis: An Up-to-date Comprehensive Review. Int Arch Otorhinolaryngol 2020; 25:e318-e327. [PMID: 33968239 PMCID: PMC8096512 DOI: 10.1055/s-0040-1715149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Accepted: 06/21/2020] [Indexed: 11/06/2022] Open
Abstract
Introduction
Otosclerosis is a primary osteodystrophy of the otic capsule, frequently responsible for acquired hearing loss in adults. Although the diagnostic value of imaging investigations in otosclerosis is debatable, they might still be employed with different goals within the context of the disease.
Objectives
The present paper aims to review the most recent literature on the use of imaging studies in otosclerosis for the most varied purposes, from routine application and differential diagnosis to prognostic prediction and investigation of surgical failure.
Data Synthesis
The diagnosis of otosclerosis is usually clinical, but computed tomography (CT) is paramount in particular cases for the differential diagnosis. The routine use, however, is not supported by strong evidence. Even so, there is growing evidence of the role of this method in surgical planning and prediction of postoperative prognosis. In specific scenarios, for example when superior semicircular canal dehiscence (SSCD) syndrome is suspected or in surgical failure, CT is crucial indeed. Magnetic resonance imaging (MRI), however, has limited – although important – indications in the management of individuals with otosclerosis, especially in the evaluation of postoperative complications and in the follow-up of medical treatment in active ostosclerosis.
Conclusion
Imaging studies have a broad range of well-established indications in otosclerosis. Besides, although the routine use of CT remains controversial, the most recent papers have shed light into new potential benefits of imaging prior to surgery.
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Affiliation(s)
- Lucas Resende Lucinda Mangia
- Department of Otolaryngology and Head and Neck Surgery, Hospital de Clínicas, Universidade Federal do Paraná, Curitiba, PR, Brazil
| | | | - Bettina Carvalho
- Department of Otolaryngology and Head and Neck Surgery, Hospital de Clínicas, Universidade Federal do Paraná, Curitiba, PR, Brazil
| | | | - Rogerio Hamerschmidt
- Department of Otolaryngology and Head and Neck Surgery, Hospital de Clínicas, Universidade Federal do Paraná, Curitiba, PR, Brazil
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Kan T, Ueda H, Kishimoto M, Tsuchiya Y, Ogawa T, Uchida Y. Availability of audiological evaluation for the differential diagnosis of clinical otosclerosis. Auris Nasus Larynx 2020; 47:343-347. [DOI: 10.1016/j.anl.2020.03.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2019] [Revised: 03/15/2020] [Accepted: 03/25/2020] [Indexed: 12/23/2022]
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Maxwell AK, Shokry MH, Master A, Slattery WH. Sensitivity of High-Resolution Computed Tomography in Otosclerosis Patients undergoing Primary Stapedotomy. Ann Otol Rhinol Laryngol 2020; 129:918-923. [PMID: 32432485 DOI: 10.1177/0003489420921420] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To determine the incidence of abnormal otospongiotic or otosclerotic findings on high-resolution computed tomography (HRCT) as read by local radiologists in patients with surgically-confirmed otosclerosis. STUDY DESIGN Retrospective chart review. SETTING Tertiary-referral private otology-neurotology practice. PATIENTS Adults (>18 years old) with surgically-confirmed otosclerosis between 2012 and 2017 with a HRCT performed preoperatively. INTERVENTION Preoperative HRCT then stapedotomy. MAIN OUTCOME MEASURES Positive identification and location of radiographic otosclerosis as reported by the local radiologist. We then correlated the CT with surgical location as documented at time of surgery. Audiometry, demographic data, intraoperative findings, and surgical technique were secondarily reviewed. RESULTS Of the 708 stapes surgeries were performed during the study time frame. Preoperative HRCT scans were available for 68 primary stapedotomy surgeries performed in 54 patients. Otosclerosis was reported in 20/68 (29.4%). Following a negative report by the local radiologist, a re-review by the surgeon and/or collaborating neuroradiologist confirmed otosclerosis in 12/48 additional cases (25.0%). There was an overall sensitivity of 47.1%. Intraoperatively, cases with negative reads tended to have more limited localization at the ligament (8.7%) or anterior crus (39.1%), compared with positive reads, which demonstrated more extensive involvement, with bipolar foci (30.0%) or diffuse footplate manifestations (20.0%) more common. Acoustic reflexes were characteristically absent. CONCLUSIONS While HRCT may aid in the diagnosis of otosclerosis and rule out concomitant pathology in certain cases of clinical uncertainty or unexplained symptoms, its sensitivity for otosclerosis remains low. HRCT should not be relied upon to diagnose routine fenestral otosclerosis.
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Affiliation(s)
| | | | - Adam Master
- Department of Otorhinolaryngology, Ochsner Clinic, New Orleans, LA, USA
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Varadarajan VV, Antonelli PJ. Is Preoperative Computed Tomography Necessary or Useful for Primary Stapes Surgery? Laryngoscope 2020; 131:703-704. [PMID: 32396215 DOI: 10.1002/lary.28732] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2020] [Revised: 03/30/2020] [Accepted: 04/18/2020] [Indexed: 11/06/2022]
Affiliation(s)
- Varun V Varadarajan
- Department of Otolaryngology - Head and Neck Surgery, The Ohio State University, Columbus, OH, USA
| | - Patrick J Antonelli
- Department of Otolaryngology, University of Florida, Gainesville, Florida, USA
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Brown LA, Mocan BO, Redleaf MI. Diagnostic Protocol for Detecting Otosclerosis on High-Resolution Temporal Bone CT. Ann Otol Rhinol Laryngol 2019; 128:1054-1060. [PMID: 31288548 DOI: 10.1177/0003489419859036] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
OBJECTIVES To present a systematic checklist to improve diagnosing otosclerosis (OS) on high-resolution computed tomography (HRCT) of the temporal bones and review this protocol's efficacy in diagnosing OS on HRCT. METHODS A retrospective case series was performed at a University Referral Hospital in urban Chicago, Illinois. High-resolution computed tomographies of the temporal bone were reviewed including 17 ears in the test group with surgically confirmed OS and 21 ears in the control group surgically confirmed to not have OS. Preoperative HRCTs were evaluated by a single neuroradiologist using a systematic protocol created to assist in diagnosing OS. This looked for radiolucency at the fissula ante fenestram and pericochlear region, and new bone formation around the oval and round windows. RESULTS The radiologist accurately diagnosed OS in all 17 test group ears and ruled out OS in all 21 control group ears using the protocol. All 17 test ears were read to have lucency at the fissula ante fenestram, 9 (53.0%) to have new bone formation, and 8 (47.1%) to have cochlear lucency. The radiologist was more confident in diagnosing OS when cochlear lucency was present with the fissula ante fenestram lucency. CONCLUSIONS This HRCT checklist is a highly accurate tool for evaluating the presence of OS when images are reviewed in the systematic fashion described. Imaging prior to surgery aids in counseling patients, preparing surgically, and excluding other pathologies.
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Affiliation(s)
- Lisa A Brown
- Department of Otolaryngology-Head and Neck Surgery, The University of Illinois at Chicago, USA
| | | | - Miriam I Redleaf
- Department of Otolaryngology-Head and Neck Surgery, The University of Illinois at Chicago, USA
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Otosclerosis: anatomical distribution of otosclerotic loci analyzed by high-resolution computed tomography. Eur Arch Otorhinolaryngol 2019; 276:1335-1340. [PMID: 30887165 DOI: 10.1007/s00405-019-05385-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2019] [Accepted: 03/12/2019] [Indexed: 12/15/2022]
Abstract
PURPOSE To clarify the anatomical distribution of otosclerotic loci in otosclerosis. METHODS Ninety-five patients with surgically confirmed uni- or bilateral otosclerosis were enrolled into the study. Hypodense areas observed in the otic capsule by high-resolution computed tomography (HRCT) were defined as otosclerotic loci. The location and number of lesions were examined, and the probability of lesion overlap and correlation with age/hearing parameters (air and bone conduction threshold, air-bone gaps) were tested. RESULTS Otosclerotic loci were confirmed by HRCT in 77 out of 115 operated ears. The three commonly affected sites were the anterior part of the oval window (ant-OW), anterior part of the internal auditory canal (ant-IAC), and pericochlear area (PCochA), with lesions detected in 96.1%, 46.8%, and 26.0% of ears, respectively. Only the ant-OW area was affected in 48.1% of the ears; the ant-IAC in 3.9%; and PCochA in none with significant differences (p < 0.01). The ant-OW lesions preferentially overlapped with ant-IAC (44.6%) than PCochA lesions (27.0%) (p < 0.05). Among double sites diseases, triple sites diseases occurred more commonly in the ant-OW + PCochA group (80%) than ant-OW + ant-IAC group (48.5%) (p < 0.05). There was no correlation between a number of lesions and age/hearing parameters. CONCLUSIONS Based on the probability of lesion overlap, otosclerotic lesions may initiate at ant-OW followed by ant-IAC and later PCochA. Although the number of lesions showed no immediate correlation with hearing level or age, anatomical stage of the disease estimated by the location and the number of otosclerotic loci could be useful in predicting the future hearing status.
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Png LH, Pang JY, Karandikar A, Goh JP, Yeo SB, Yuen HW. Otosclerosis in a nonendemic population: Utility of CT scan and correlation with audiometry and surgical outcome. EAR, NOSE & THROAT JOURNAL 2018; 97:156-162. [PMID: 30036411 DOI: 10.1177/014556131809700612] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
The incidence of otosclerosis in nonendemic patients is low, and preoperative diagnosis can be challenging. The aim of this study was to evaluate computed tomography (CT) findings in patients with otosclerosis and determine their correlation with audiometric findings and surgical outcome in a nonendemic population. We retrospectively reviewed 17 patients from August 2011 to August 2013 with surgically confirmed otosclerosis who underwent preoperative high-resolution CT scans and pre- and postoperative audiometry. Otosclerotic foci were identified on the scans. The density ratio of these foci was calculated and compared with pre- and postoperative audiometric parameters. One patient with Paget disease was excluded from the study. A total of 19 ears were operated on and included in the data analysis. CT scans were normal in 4 ears (21.1%). Hypodense lesions were detected in the remaining 15 (78.9%) ears and the region of interest mapped out. The density ratio was obtained between the hypodense area and adjacent normal labyrinthine bone. No statistically significant correlation was found between the density ratio and any of the audiometric parameters tested (p > 0.05). The diagnosis of otosclerosis in nonendemic areas is challenging. A preoperative CT scan can be useful when otosclerotic foci are present. However, the density ratio of the otosclerotic foci did not correlate with audiometric parameters or surgical outcome.
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Affiliation(s)
- Lu Hui Png
- Department of Otorhinolaryngology-Head and Neck Surgery, Changi General Hospital, 2 Simei Street 3, Singapore 529889.
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Molher J, Pujol EDMD, Zounon ADS, Darrouzet V, Bonnard D. Middle Ear Osteoma Causing Mixed Hearing Loss: A Case Report. J Int Adv Otol 2018; 14:493-496. [PMID: 30431014 DOI: 10.5152/iao.2018.5265] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
Osteomas of the middle ear are rare benign tumors. Their consequences and symptoms are due to their specific location, such as the promontory or the epitympanum and their contact with the facial nerve, the semicircular canal, the ossicles, and the oval or round windows. We report a very unusual case of middle ear osteoma (MEO) in a 23-year-old male patient causing a right mixed hearing loss by contacting and overwhelming the incus and stapes. The lesion was also closely attached to the tympanic portion of the fallopian canal. Since the stapes was not clearly visible behind the lesion, careful observation was preferred to surgery owing to the high risk of inner ear damage and facial palsy with removal of the lesion. MEOs are rarely situated at this critical site. Regular clinical and computerized tomography monitoring is warranted to check their growth. This case also supports the etiological theory of chronic middle ear inflammation causing osteomas.
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Affiliation(s)
- Joffrey Molher
- Department of Otolaryngology Head and Neck Surgery, and Skull Base Surgery, Centre Hospitalier Universitaire (CHU) de Bordeaux, Bordeaux, France
| | - Erwan De Mones Del Pujol
- Department of Otolaryngology Head and Neck Surgery, and Skull Base Surgery, Centre Hospitalier Universitaire (CHU) de Bordeaux, Bordeaux, France
| | - Alexis do Santos Zounon
- Department of Otolaryngology Head and Neck Surgery, and Skull Base Surgery, Centre Hospitalier Universitaire (CHU) de Bordeaux, Bordeaux, France
| | - Vincent Darrouzet
- Department of Otolaryngology Head and Neck Surgery, and Skull Base Surgery, Centre Hospitalier Universitaire (CHU) de Bordeaux, Bordeaux, France
| | - Daimen Bonnard
- Department of Otolaryngology Head and Neck Surgery, and Skull Base Surgery, Centre Hospitalier Universitaire (CHU) de Bordeaux, Bordeaux, France
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RESPONSE TO "MICHAEL YONG, ERICA ZAIA, BRIAN WESTERBERG, AND JANE LEA. DIAGNOSIS OF SUPERIOR SEMICIRCULAR CANAL DEHISCENCE IN THE PRESENCE OF CONCOMITANT OTOSCLEROSIS". OTOL NEUROTOL 2017;38: 1071-1075. Otol Neurotol 2018; 39:517-518. [PMID: 29494468 DOI: 10.1097/mao.0000000000001729] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Gilifanov EA, Lepeiko BA, Andreeva LB, Klimov SV, Ivanets IV, Kislukhina LF, Babushkina EV. [The diagnostics and surgical treatment of the patients presenting with otosclerosis in the Primorye Territory]. Vestn Otorinolaringol 2018; 83:25-28. [PMID: 29953050 DOI: 10.17116/otorino201883325] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
The objective of the present study was to characterize the effectiveness of the audiological and radiological diagnostic techniques as well as the results of the surgical treatment of the patients presenting with otosclerosis based at the hospital clinic of the Pacific State Medical University. The analysis included 49 surgical interventions for stapedoplasty carried out on 42 patients during the period from 2015 to 2017. The tympanic form of the disorder was diagnosed in 51.02% of the cases, the mixed form I in 16.28%, and the mixed form II in 32.7%. The excellent results within two months after surgery were obtained in 87.2% of the treated patients, the good and satisfactory results in 8.72% and 4.08% of them respectively.
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Affiliation(s)
- E A Gilifanov
- Department of Ophthalmology and Otorhinolaryngology, Pacific State Medical University, Ministry of Health of the Russian Federation, Vladivostok, Russia, 690002
| | - B A Lepeiko
- Department of Otorhinolaryngology, Regional state budgetary public health institution 'Vladivostok Clinical Hospital #1', Vladivostok, Russia, 690078
| | - L B Andreeva
- Department of Ophthalmology and Otorhinolaryngology, Pacific State Medical University, Ministry of Health of the Russian Federation, Vladivostok, Russia, 690002
| | - S V Klimov
- Department of Computed Tomography, Regional state budgetary public health institution 'Vladivostok Clinical Hospital #1', Vladivostok, Russia, 690078
| | - I V Ivanets
- Department of Otorhinolaryngology, N.I Pirogov Russian National Research Medical University, Ministry of Health of the Russian Federation, Moscow, Russia, 117997; Medical Centre of the Far Eastern Federal University, Vladivostok, Russia, 960922
| | - L F Kislukhina
- 'Centre for Hearing Rehabilitation' a structural subdivision of the state autonomous public health institution 'Regional Clinical Centre for Specialized Types of Medical Care', Vladivostok, Russia, 690034
| | - E V Babushkina
- The 'Sail' Ear Hearing Clinic, Vladivostok, Russia, Vladivostok, Russia, 690002
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Kanzara T, Virk JS. Diagnostic performance of high resolution computed tomography in otosclerosis. World J Clin Cases 2017; 5:286-291. [PMID: 28798924 PMCID: PMC5535320 DOI: 10.12998/wjcc.v5.i7.286] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2017] [Revised: 05/02/2017] [Accepted: 05/31/2017] [Indexed: 02/05/2023] Open
Abstract
AIM To determine the sensitivity and specificity of high resolution computed tomography (HRCT) in the diagnosis of otosclerosis.
METHODS A systematic literature review was undertaken to include Level I-III studies (Oxford Centre for Evidenced based Medicine) that utilised HRCT to detect histology confirmed otosclerosis. Quantitative synthesis was then performed.
RESULTS Based on available level III literature, HRCT has a relatively low sensitivity of 58% (95%CI: 49.4-66.9), a high specificity, 95% (95%CI: 89.9-98.0) and a positive predictive value of 92% (95%CI: 84.1-95.8). HRCT is better at diagnosing the more prevalent fenestral form of otosclerosis but remains vulnerable to inframillimetre, retrofenestral and dense sclerotic lesions, despite the advent of more advanced CT scanners with improved collimation.
CONCLUSION Whilst the diagnosis of otosclerosis remains largely clinical, HRCT remains the gold standard imaging of choice for the middle ear and serves as a useful adjunct to the clinician, helping to delineate extent of disease and exclude other causes.
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Actualización en el diagnóstico radiológico de la otosclerosis. RADIOLOGIA 2016; 58:246-56. [DOI: 10.1016/j.rx.2016.04.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2015] [Revised: 04/26/2016] [Accepted: 04/30/2016] [Indexed: 12/28/2022]
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Gredilla Molinero J, Mancheño Losa M, Santamaría Guinea N, Arévalo Galeano N, Grande Bárez M. Update on the imaging diagnosis of otosclerosis. RADIOLOGIA 2016. [DOI: 10.1016/j.rxeng.2016.07.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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