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Berendt K, Jen H, Liu R, Jeffery D. Incidentally Discovered 99mTc-MDP Uptake on Bone Scan in Otosclerosis. Laryngoscope 2024; 134:4763-4765. [PMID: 38837225 DOI: 10.1002/lary.31552] [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: 03/29/2024] [Accepted: 05/21/2024] [Indexed: 06/07/2024]
Abstract
Otosclerosis is a poorly understood clinical entity causing progressive conductive hearing loss. Here we present the first known evidence of otosclerosis demonstrating 99mTc-MDP uptake on bone scan. This presents an opportunity to explore the role of nuclear medicine imaging in early detection, staging, and even informing treatment and prognosis of this condition. Laryngoscope, 134:4763-4765, 2024.
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Affiliation(s)
- Karl Berendt
- Faculty of Medicine and Dentistry, Department of Radiology and Diagnostic Imaging, University of Alberta, Edmonton, Alberta, Canada
| | - Ho Jen
- Faculty of Medicine and Dentistry, Department of Radiology and Diagnostic Imaging, University of Alberta, Edmonton, Alberta, Canada
| | - Richard Liu
- Faculty of Medicine and Dentistry, Department of Surgery, Division of Otolaryngology, University of Alberta, Edmonton, Alberta, Canada
| | - Dean Jeffery
- Faculty of Medicine and Dentistry, Department of Radiology and Diagnostic Imaging, University of Alberta, Edmonton, Alberta, Canada
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Pinto JV, Almeida AI, Andrade A, Vales F, Moura CP, Marques P. Comparison Between the Veillon and the Symons-Fanning CT Classification Systems for Otosclerosis. Otol Neurotol 2024; 45:e618-e623. [PMID: 39264917 DOI: 10.1097/mao.0000000000004311] [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: 09/14/2024]
Abstract
OBJECTIVE To analyze the correlation between outcomes of stapes surgery and preoperative and postoperative audiometric results with different radiological staging classifications such as the Veillon classification (VC) and the Symons-Fanning classification (SFC). STUDY DESIGN Retrospective observational study. SETTING One tertiary hospital center. PATIENTS Adult patients submitted to stapes surgery due to otosclerosis from January 2017 to December 2022. INTERVENTION Evaluation of different radiological classifications such as the VC and SFC. MAIN OUTCOME MEASURES Preoperative and postoperative pure-tone audiometric data, outcomes of stapes surgery success (closure of the ABG, rates of AC threshold less than or equal to 30 dB), and postoperative sensorineural hearing loss. RESULTS A total of 87 patients and 97 operated ears were included. The SFC was associated with preoperative BC (p = 0.041) and AC (p = 0.018) and postoperative BC (p = 0.026) with an increase in thresholds with higher radiological stages. The VC was associated with postoperative AC (p = 0.045) with an increase in AC thresholds with increasing radiological stages. Lastly, both the VC (p = 0.032) and the SFC (p = 0.023) were associated with a decrease in rates of postoperative AC thresholds ≤30 dB with higher radiological stages. CONCLUSIONS The SFC seems to be more useful to predict preoperative AC and BC and postoperative BC. On the contrary, the VC was more useful to predict postoperative AC. Both scales were similarly associated with the rate of AC thresholds ≤30 dB.
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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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Puiggrós IV, Moreno EG, Dotu CO, Agustí MQI, Díaz FL. Diagnostic Efficacy of High-Resolution Computed Tomography Densitometry for Diagnosing Otosclerosis. Otol Neurotol 2023; 44:e697-e701. [PMID: 37733986 DOI: 10.1097/mao.0000000000004012] [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: 09/23/2023]
Abstract
OBJECTIVES The purpose of this study is to evaluate the reliability of temporal bone density measurements for diagnosing otosclerosis. MATERIALS AND METHODS A retrospective case-control study is presented. Bone density was measured in Hounsfield units (HUs) by using high-resolution computed tomography in eight regions of interest (ROI) where otosclerotic foci are usually localized. The density of 113 otosclerotic ears was compared with that of 33 nonotosclerotic ears to determine sensitivity and specificity. Furthermore, the binormal receiver operating characteristic curve of each ROI's density was calculated to estimate the diagnostic value for osteosclerosis. In addition, the radiological density of seven cases-where radiological visual examination exhibited no findings but surgery confirmed stapes fixation-was compared with nonotosclerotic controls. RESULTS ROI densities were significantly lower in otosclerotic patients compared with nonotosclerotic controls. The area under the curve of the fissula ante fenestram (FAF) presented the highest diagnostic performance: 1,871 HU cut-off value (area under the curve = 0.986), 96.64% sensitivity, and 100% specificity. Significantly lower densities in the FAF area were observed in the seven cases with negative radiology but intraoperatively confirmed otosclerosis. CONCLUSION The high-resolution computed tomography density of the FAF is a reliable measurement for diagnosing otosclerosis. A value less than 1,871 HU exhibited the highest sensitivity and specificity in a European Caucasian population.
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Affiliation(s)
- Ignacio Viza Puiggrós
- Department of Otorhinolaryngology-Head and Neck Surgery, Hospital Clinic de Barcelona
| | | | - César Orús Dotu
- Division of Otology, Department of Otolaryngology, Hospital de la Santa Creu i Sant Pau
| | - Miquel Quer I Agustí
- Division of Otology, Department of Otolaryngology, Hospital de la Santa Creu i Sant Pau
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Silva VAR, Pauna HF, Lavinsky J, Guimarães GC, Abrahão NM, Massuda ET, Vianna MF, Ikino CMY, Santos VM, Polanski JF, Silva MNLD, Sampaio ALL, Zanini RVR, Lourençone LFM, Denaro MMDC, Calil DB, Chone CT, Castilho AM. Brazilian Society of Otology task force - Otosclerosis: evaluation and treatment. Braz J Otorhinolaryngol 2023; 89:101303. [PMID: 37647735 PMCID: PMC10474207 DOI: 10.1016/j.bjorl.2023.101303] [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: 07/21/2023] [Accepted: 08/06/2023] [Indexed: 09/01/2023] Open
Abstract
OBJECTIVES To review and provide evidence-based recommendations for the diagnosis and treatment of otosclerosis. METHODS Task force members were educated on knowledge synthesis methods, including electronic database search, review and selection of relevant citations, and critical appraisal of selected studies. Articles written in English or Portuguese on otosclerosis were eligible for inclusion. The American College of Physicians' guideline grading system and the American Thyroid Association's guideline criteria were used for critical appraisal of evidence and recommendations for therapeutic interventions. RESULTS The topics were divided into 2 parts: 1) Diagnosis - audiologic and radiologic; 2) Treatment - hearing AIDS, pharmacological therapy, stapes surgery, and implantable devices - bone-anchored devices, active middle ear implants, and Cochlear Implants (CI). CONCLUSIONS The pathophysiology of otosclerosis has not yet been fully elucidated, but environmental factors and unidentified genes are likely to play a significant role in it. Women with otosclerosis are not at increased risk of worsening clinical condition due to the use of contraceptives or during pregnancy. Drug treatment has shown little benefit. If the patient does not want to undergo stapedotomy, the use of hearing aids is well indicated. Implantable systems should be indicated only in rare cases, and the CI should be indicated in cases of profound deafness.
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Affiliation(s)
- Vagner Antonio Rodrigues Silva
- Universidade Estadual de Campinas (Unicamp), Faculdade de Ciências Médicas (FCM), Departamento de Otorrinolaringologia, Cirurgia de Cabeça e Pescoço, Campinas, SP, Brazil
| | - Henrique Furlan Pauna
- Hospital Universitário Cajuru, Departamento de Otorrinolaringologia, Curitiba, PR, Brazil
| | - Joel Lavinsky
- Universidade Federal do Rio Grande do Sul (UFRGS), Departamento de Ciências Morfológicas, Porto Alegre, RS, Brazil
| | - Guilherme Corrêa Guimarães
- Universidade Estadual de Campinas (Unicamp), Faculdade de Ciências Médicas (FCM), Departamento de Otorrinolaringologia, Cirurgia de Cabeça e Pescoço, Campinas, SP, Brazil
| | - Nicolau Moreira Abrahão
- Universidade Estadual de Campinas (Unicamp), Faculdade de Ciências Médicas (FCM), Departamento de Otorrinolaringologia, Cirurgia de Cabeça e Pescoço, Campinas, SP, Brazil
| | - Eduardo Tanaka Massuda
- Universidade de São Paulo (USP), Faculdade de Medicina de Ribeirão Preto, Departamento de Oftalmologia, Otorrinolaringologia e Cirurgia de Cabeça e Pescoço, Ribeirão Preto, SP, Brazil
| | - Melissa Ferreira Vianna
- Irmandade Santa Casa de Misericordia de São Paulo, Departamento de Otorrinolaringologia, São Paulo, SP, Brazil
| | - Cláudio Márcio Yudi Ikino
- Universidade Federal de Santa Catarina, Departamento de Cirurgia e Hospital Universitário, Florianópolis, SC, Brazil
| | - Vanessa Mazanek Santos
- Universidade Federal do Paraná, Hospital de Clínicas, Departamento de Otorrinolaringologia e Cirurgia de Cabeça e Pescoço, Curitiba, PR, Brazil
| | - José Fernando Polanski
- Universidade Federal do Paraná, Hospital de Clínicas, Departamento de Otorrinolaringologia e Cirurgia de Cabeça e Pescoço, Curitiba, PR, Brazil; Faculdade Evangélica Mackensie do Paraná, Curitiba, PR, Brazil
| | | | - André Luiz Lopes Sampaio
- Universidade de Brasília (UnB), Faculdade de Medicina, Laboratório de Ensino e Pesquisa em Otorrinolaringologia, Brasília, DF, Brazil
| | | | - Luiz Fernando Manzoni Lourençone
- Universidade de São Paulo, Faculdade de Odontologia de Bauru, Bauru, SP, Brazil; Universidade de São Paulo, Hospital de Reabilitação de Anomalias Craniofaciais, Bauru, SP, Brazil
| | | | - Daniela Bortoloti Calil
- Universidade Estadual de Campinas (Unicamp), Faculdade de Ciências Médicas (FCM), Departamento de Otorrinolaringologia, Cirurgia de Cabeça e Pescoço, Campinas, SP, Brazil
| | - Carlos Takahiro Chone
- Universidade Estadual de Campinas (Unicamp), Faculdade de Ciências Médicas (FCM), Departamento de Otorrinolaringologia, Cirurgia de Cabeça e Pescoço, Campinas, SP, Brazil
| | - Arthur Menino Castilho
- Universidade Estadual de Campinas (Unicamp), Faculdade de Ciências Médicas (FCM), Departamento de Otorrinolaringologia, Cirurgia de Cabeça e Pescoço, Campinas, SP, Brazil.
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Hiremath SB, Biswas A, Mndebele G, Schramm D, Ertl-Wagner BB, Blaser SI, Chakraborty S. Cochlear Implantation: Systematic Approach to Preoperative Radiologic Evaluation. Radiographics 2023; 43:e220102. [PMID: 36893052 DOI: 10.1148/rg.220102] [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: 03/10/2023]
Abstract
Sensorineural hearing loss results from abnormalities that affect the hair cells of the membranous labyrinth, inner ear malformations, and conditions affecting the auditory pathway from the cochlear nerve to the processing centers of the brain. Cochlear implantation is increasingly being performed for hearing rehabilitation owing to expanding indications and a growing number of children and adults with sensorineural hearing loss. An adequate understanding of the temporal bone anatomy and diseases that affect the inner ear is paramount for alerting the operating surgeon about variants and imaging findings that can influence the surgical technique, affect the choice of cochlear implant and electrode type, and help avoid inadvertent complications. In this article, imaging protocols for sensorineural hearing loss and the normal inner ear anatomy are reviewed, with a brief description of cochlear implant devices and surgical techniques. In addition, congenital inner ear malformations and acquired causes of sensorineural hearing loss are discussed, with a focus on imaging findings that may affect surgical planning and outcomes. The anatomic factors and variations that are associated with surgical challenges and may predispose patients to periprocedural complications also are highlighted. © RSNA, 2023 Quiz questions for this article are available through the Online Learning Center. Online supplemental material and the slide presentation from the RSNA Annual Meeting are available for this article.
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Affiliation(s)
- Shivaprakash B Hiremath
- From the Department of Radiology, Division of Neuroradiology (S.B.H., S.C.), and Department of Otolaryngology-Head and Neck Surgery (D.S.), University of Ottawa, The Ottawa Hospital, 1053 Carling Ave, Ottawa, ON, Canada K1Y 4E9; Division of Neuroradiology, Great Ormond Street Hospital for Children, London, England (A.B.); Department of Diagnostic Imaging, The Hospital for Sick Children, Toronto, ON, Canada (G.M., B.B.E.W., S.I.B.); and Department of Medical Imaging, University of Toronto, Toronto, ON, Canada (S.B.H., G.M., B.B.E.W., S.I.B.)
| | - Asthik Biswas
- From the Department of Radiology, Division of Neuroradiology (S.B.H., S.C.), and Department of Otolaryngology-Head and Neck Surgery (D.S.), University of Ottawa, The Ottawa Hospital, 1053 Carling Ave, Ottawa, ON, Canada K1Y 4E9; Division of Neuroradiology, Great Ormond Street Hospital for Children, London, England (A.B.); Department of Diagnostic Imaging, The Hospital for Sick Children, Toronto, ON, Canada (G.M., B.B.E.W., S.I.B.); and Department of Medical Imaging, University of Toronto, Toronto, ON, Canada (S.B.H., G.M., B.B.E.W., S.I.B.)
| | - Gopolang Mndebele
- From the Department of Radiology, Division of Neuroradiology (S.B.H., S.C.), and Department of Otolaryngology-Head and Neck Surgery (D.S.), University of Ottawa, The Ottawa Hospital, 1053 Carling Ave, Ottawa, ON, Canada K1Y 4E9; Division of Neuroradiology, Great Ormond Street Hospital for Children, London, England (A.B.); Department of Diagnostic Imaging, The Hospital for Sick Children, Toronto, ON, Canada (G.M., B.B.E.W., S.I.B.); and Department of Medical Imaging, University of Toronto, Toronto, ON, Canada (S.B.H., G.M., B.B.E.W., S.I.B.)
| | - David Schramm
- From the Department of Radiology, Division of Neuroradiology (S.B.H., S.C.), and Department of Otolaryngology-Head and Neck Surgery (D.S.), University of Ottawa, The Ottawa Hospital, 1053 Carling Ave, Ottawa, ON, Canada K1Y 4E9; Division of Neuroradiology, Great Ormond Street Hospital for Children, London, England (A.B.); Department of Diagnostic Imaging, The Hospital for Sick Children, Toronto, ON, Canada (G.M., B.B.E.W., S.I.B.); and Department of Medical Imaging, University of Toronto, Toronto, ON, Canada (S.B.H., G.M., B.B.E.W., S.I.B.)
| | - Birgit B Ertl-Wagner
- From the Department of Radiology, Division of Neuroradiology (S.B.H., S.C.), and Department of Otolaryngology-Head and Neck Surgery (D.S.), University of Ottawa, The Ottawa Hospital, 1053 Carling Ave, Ottawa, ON, Canada K1Y 4E9; Division of Neuroradiology, Great Ormond Street Hospital for Children, London, England (A.B.); Department of Diagnostic Imaging, The Hospital for Sick Children, Toronto, ON, Canada (G.M., B.B.E.W., S.I.B.); and Department of Medical Imaging, University of Toronto, Toronto, ON, Canada (S.B.H., G.M., B.B.E.W., S.I.B.)
| | - Susan I Blaser
- From the Department of Radiology, Division of Neuroradiology (S.B.H., S.C.), and Department of Otolaryngology-Head and Neck Surgery (D.S.), University of Ottawa, The Ottawa Hospital, 1053 Carling Ave, Ottawa, ON, Canada K1Y 4E9; Division of Neuroradiology, Great Ormond Street Hospital for Children, London, England (A.B.); Department of Diagnostic Imaging, The Hospital for Sick Children, Toronto, ON, Canada (G.M., B.B.E.W., S.I.B.); and Department of Medical Imaging, University of Toronto, Toronto, ON, Canada (S.B.H., G.M., B.B.E.W., S.I.B.)
| | - Santanu Chakraborty
- From the Department of Radiology, Division of Neuroradiology (S.B.H., S.C.), and Department of Otolaryngology-Head and Neck Surgery (D.S.), University of Ottawa, The Ottawa Hospital, 1053 Carling Ave, Ottawa, ON, Canada K1Y 4E9; Division of Neuroradiology, Great Ormond Street Hospital for Children, London, England (A.B.); Department of Diagnostic Imaging, The Hospital for Sick Children, Toronto, ON, Canada (G.M., B.B.E.W., S.I.B.); and Department of Medical Imaging, University of Toronto, Toronto, ON, Canada (S.B.H., G.M., B.B.E.W., S.I.B.)
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Bassiouni M, Bauknecht HC, Muench G, Olze H, Pohlan J. Missed Radiological Diagnosis of Otosclerosis in High-Resolution Computed Tomography of the Temporal Bone-Retrospective Analysis of Imaging, Radiological Reports, and Request Forms. J Clin Med 2023; 12:jcm12020630. [PMID: 36675559 PMCID: PMC9860545 DOI: 10.3390/jcm12020630] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Revised: 01/09/2023] [Accepted: 01/11/2023] [Indexed: 01/15/2023] Open
Abstract
Objectives: Several studies reported low detection rates of otosclerosis in high-resolution computed tomography (HRCT), especially when the scans were reviewed by non-specialized general radiologists. In the present study, we conducted a retrospective review of the detection of otosclerosis in HRCT by general radiologists and the impact of inadequately filled radiological request forms on the detection rate. Methods: Retrospective analysis of hospital records, HRCT reports, and radiological referral notes of 40 patients who underwent stapedotomy surgery for otosclerosis. HRCT imaging data sets were retrospectively reviewed by a blinded experienced neuroradiologist, whose reading served as the gold standard. Results: General radiologists reading HRCT scans had an overall detection rate of otosclerosis of 36.1% in this cohort (13 of 36 available HRCT reports). The neuroradiologist had a much higher detection rate of 82.5% (33 of 40 cases). Interobserver agreement between the general radiologists and the subspecialist neuroradiologist was poor (Cohen’s kappa κ = 0.26). General radiologists missed the diagnosis in 15 of the 33 CT-positive scans, corresponding to a missed diagnosis rate of 45.4%. There was a highly significant association between a missed diagnosis and the lack of an explicitly mentioned clinical suspicion of otosclerosis in the request forms (Pearson’s chi-squared test, p < 0.005). Conclusion: The diagnosis of otosclerosis is frequently missed by radiologists on HRCT scans of the temporal bone in a clinical setting. Possible reasons include a relative lack of experience of general radiologists with temporal bone imaging as well as the failure of clinicians to unambiguously communicate their suspicion of otosclerosis.
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Affiliation(s)
- Mohamed Bassiouni
- Department of Otorhinolaryngology, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, 10117 Berlin, Germany
| | - Hans-Christian Bauknecht
- Institute of Neuroradiology, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, 10117 Berlin, Germany
| | - Gloria Muench
- Department of Diagnostic Radiology, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, 10117 Berlin, Germany
| | - Heidi Olze
- Department of Otorhinolaryngology, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, 10117 Berlin, Germany
| | - Julian Pohlan
- Department of Diagnostic Radiology, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, 10117 Berlin, Germany
- Berlin Institute of Health, Charité—Universitätsmedizin Berlin, 10117 Berlin, Germany
- Correspondence:
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Radiological parameters and audiometric findings in otosclerosis: is there any relationship? J Laryngol Otol 2023; 137:68-75. [PMID: 34823621 DOI: 10.1017/s0022215121003947] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
OBJECTIVE The role of high-resolution computed tomography scans in otosclerosis remains uncertain. There is a debate over the relationship between radiological and audiometric findings among patients. METHOD Pre-operative audiometry and high-resolution computed tomography findings from 40 ears with surgically confirmed otosclerosis were compared. High-resolution computed tomography scan data regarding the characteristics of the disease foci, the endosteal extension and the occurrence of internal auditory canal diverticula were obtained. The influence of each radiological variable on the simple pure tone average, the high-frequency pure tone average and the bone-conduction pure tone average were investigated. RESULTS Cases with endosteal extension (p = 0.047) and a higher number of affected sites within the otic capsule had a worse bone-conduction pure tone average, although it was only significant for the latter (p = 0.006). Those without concomitant retrofenestral disease (p = 0.019) had better simple pure tone average. CONCLUSION The number of sites of involvement and concomitant retrofenestral disease seem to significantly impact audiometric findings in otosclerosis.
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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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O'Toole Bom Braga G, Zboray R, Parrilli A, Bulatović M, Caversaccio MD, Wagner F. Otosclerosis under microCT: New insights into the disease and its anatomy. FRONTIERS IN RADIOLOGY 2022; 2:965474. [PMID: 37492684 PMCID: PMC10365283 DOI: 10.3389/fradi.2022.965474] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Accepted: 07/13/2022] [Indexed: 07/27/2023]
Abstract
Purpose Otospongiotic plaques can be seen on conventional computed tomography (CT) as focal lesions around the cochlea. However, the resolution remains insufficient to enable evaluation of intracochlear damage. MicroCT technology provides resolution at the single micron level, offering an exceptional amplified view of the otosclerotic cochlea. In this study, a non-decalcified otosclerotic cochlea was analyzed and reconstructed in three dimensions for the first time, using microCT technology. The pre-clinical relevance of this study is the demonstration of extensive pro-inflammatory buildup inside the cochlea which cannot be seen with conventional cone-beam CT (CBCT) investigation. Materials and Methods A radiological and a three-dimensional (3D) anatomical study of an otosclerotic cochlea using microCT technology is presented here for the first time. 3D-segmentation of the human cochlea was performed, providing an unprecedented view of the diseased area without the need for decalcification, sectioning, or staining. Results Using microCT at single micron resolution and geometric reconstructions, it was possible to visualize the disease's effects. These included intensive tissue remodeling and highly vascularized areas with dilated capillaries around the spongiotic foci seen on the pericochlear bone. The cochlea's architecture as a morphological correlate of the otosclerosis was also seen. With a sagittal cut of the 3D mesh, it was possible to visualize intense ossification of the cochlear apex, as well as the internal auditory canal, the modiolus, the spiral ligament, and a large cochleolith over the osseous spiral lamina. In addition, the oval and round windows showed intense fibrotic tissue formation and spongiotic bone with increased vascularization. Given the recently described importance of the osseous spiral lamina in hearing mechanics and that, clinically, one of the signs of otosclerosis is the Carhart notch observed on the audiogram, a tonotopic map using the osseous spiral lamina as region of interest is presented. An additional quantitative study of the porosity and width of the osseous spiral lamina is reported. Conclusion In this study, structural anatomical alterations of the otosclerotic cochlea were visualized in 3D for the first time. MicroCT suggested that even though the disease may not appear to be advanced in standard clinical CT scans, intense tissue remodeling is already ongoing inside the cochlea. That knowledge will have a great impact on further treatment of patients presenting with sensorineural hearing loss.
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Affiliation(s)
| | - Robert Zboray
- Center for X-ray Analytics, Swiss Federal Laboratories for Materials Science and Technology (Empa), Dübendorf, Switzerland
| | - Annapaola Parrilli
- Center for X-ray Analytics, Swiss Federal Laboratories for Materials Science and Technology (Empa), Dübendorf, Switzerland
| | - Milica Bulatović
- ARTORG Center for Biomedical Engineering Research, University of Bern, Bern, Switzerland
| | - Marco Domenico Caversaccio
- Department of Otorhinolaryngology, Head and Neck Surgery, Inselspital, University Hospital Bern, Bern, Switzerland
| | - Franca Wagner
- Department of Diagnostic and Interventional Neuroradiology, Inselspital, University Hospital Bern, Bern, Switzerland
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Role of HRCT Temporal Bone in Predicting Surgical Difficulties Encountered in Fenestral Otosclerosis Surgery. Indian J Otolaryngol Head Neck Surg 2022; 74:581-588. [PMID: 36032908 PMCID: PMC9411290 DOI: 10.1007/s12070-021-02428-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Accepted: 01/25/2021] [Indexed: 11/27/2022] Open
Abstract
To study spectrum of high resolution computed tomography (HRCT) imaging findings in otosclerosis, to predict approximate length of prosthesis required from pre-operative HRCT measurements and to correlate between oval window niche (OWN) height preoperatively and difficulty in introducing foot plate perforator during surgery. A cross sectional study was conducted on 23 patients with a clinical diagnosis of otosclerosis from September 2018 to July 2020. Sensitivity of HRCT in detecting otosclerosis, correlation between pre-operative incudo-stapedial length (ISL) and intra operative prosthesis length, and correlation between OWN height and difficulty in introducing perforator were sought. The mean age of 23 patients studied was 39.9 years with a female preponderance of 56.5%. 17 out of 19 patients with foci of otosclerosis during surgery had HRCT findings of otosclerosis providing a sensitivity of 89.5%. Mean OWN height obtained was 1.29 mm preoperatively and a cut off value of 1.325 mm found using receiver operating characteristic curve method classifying OWN height as narrow or normal. Mean ISL measured pre operatively was 4.25 mm and mean length of prosthesis used was 4.56 mm with significant positive correlation using intraclass correlation coefficient method with correlation coefficient = 0.879. HRCT is an invaluable modality aiding the surgeon to detect otosclerotic foci with high sensitivity, identify thick obliterative otosclerotic foci requiring additional drilling, to predict the length of prosthesis used and to predict difficulties in approaching footplate when OWN height is below 1.325 mm.
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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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Casselman JW, Vanden Bossche S, De Foer B, Bernaerts A, Dekeyzer S. Temporal Bone. Clin Neuroradiol 2022. [DOI: 10.1007/978-3-319-61423-6_90-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/16/2023]
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16
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Deng F, Touska P, Reinshagen KL, Curtin HD, Juliano AF. Diagnostic Performance of Conebeam CT Pixel Values in Active Fenestral Otosclerosis. AJNR Am J Neuroradiol 2021; 42:1667-1670. [PMID: 34140277 DOI: 10.3174/ajnr.a7192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Accepted: 04/16/2021] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Quantitative bone densitometry on multidetector CT of the temporal bone is a diagnostic adjunct for otosclerosis in its active (spongiotic) phase, but translating this technique to conebeam CT is limited by the technical variability of conebeam CT pixel values. The purpose of this study was to evaluate the performance of internally calibrated conebeam CT pixel value measurements that can enable the determination of active fenestral otosclerosis (otospongiosis). MATERIALS AND METHODS This study included 37 ears in 22 patients with a clinical diagnosis of otospongiosis in those ears and 35 ears in 22 control patients without the diagnosis. Temporal bone conebeam CT was performed. ROIs were set anterior to the oval window, in the lateral semicircular canal bone island, and in a nearby aerated space. Mean conebeam CT pixel values in these regions determined the relative attenuation ratio of the area anterior to the oval window normalized to normal otic capsule bone and air. RESULTS The relative attenuation ratio for cases of otospongiosis was significantly lower than that for controls (P < .001). Based on receiver operating characteristic analysis, the optimal cutoff relative attenuation ratio was 0.876, which had an accuracy of 97.2% for the diagnosis of otospongiosis. CONCLUSIONS Internally calibrated pixel value ratios in temporal bone conebeam CT can feasibly help diagnose active/spongiotic-phase fenestral otosclerosis in an objective manner.
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Affiliation(s)
- F Deng
- From the Department of Radiology (F.D.), Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - P Touska
- Department of Radiology (P.T), Guy's Hospital, Guy's and St. Thomas' Hospitals National Health Service Foundation Trust, London, UK
| | - K L Reinshagen
- Department of Radiology (K.L.R, H.D.C., A.F.J.), Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts
| | - H D Curtin
- Department of Radiology (K.L.R, H.D.C., A.F.J.), Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts
| | - A F Juliano
- Department of Radiology (K.L.R, H.D.C., A.F.J.), Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts.
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Nie L, Li C, Marzani F, Wang H, Thibouw F, Grayeli AB. Classification of Wideband Tympanometry by Deep Transfer Learning with Data Augmentation for Automatic Diagnosis of Otosclerosis. IEEE J Biomed Health Inform 2021; 26:888-897. [PMID: 34181561 DOI: 10.1109/jbhi.2021.3093007] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Otosclerosis is a common disease of the middle ear leading to stapedial fixation. Its rapid and non-invasive diagnosis could be achieved through wideband tympanometry (WBT), but the interpretation of the raw data provided by this tool is complex and time-consuming. Convolutional neural networks (CNN) could potentially be applied to this situation to help the clinicians categorize WBT data. A dataset containing 135 samples from 80 patients with otosclerosis and 55 controls was obtained. We designed a lightweight CNN to categorize samples into the otosclerosis and control. Receiver operating characteristic (ROC) analysis showed an area under the curve (AUC) of 0.95 0.011, and the F1-score was 0.89 0.031 (r=10). The performance was further improved by data augmentation schemes and transfer learning strategies (AUC: 0.97 0.010, F1-score: 0.94 0.016, p<0.05, ANOVA). Finally, the most relevant diagnostic features employed by the CNN were assessed via the activation pattern heatmaps. These results are crucial for the visual interpretation of WBT graphic outputs which clinicians use in routine, and for a better understanding of the WBT signal in relation to the ossicular mechanics.
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Tan W, Guan P, Wu L, Chen H, Li J, Ling Y, Fan T, Wang Y, Li J, Yan B. The use of explainable artificial intelligence to explore types of fenestral otosclerosis misdiagnosed when using temporal bone high-resolution computed tomography. ANNALS OF TRANSLATIONAL MEDICINE 2021; 9:969. [PMID: 34277769 PMCID: PMC8267294 DOI: 10.21037/atm-21-1171] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Accepted: 05/28/2021] [Indexed: 12/15/2022]
Abstract
Background The purpose of this study was to explore the common characteristics of fenestral otosclerosis (OS) which are misdiagnosed, and develop a deep learning model for the diagnosis of fenestral OS based on temporal bone high-resolution computed tomography scans. Methods We conducted a study to explicitly analyze the clinical performance of otolaryngologists in diagnosing fenestral OS and developed an explainable deep learning model using 134,574 temporal bone high-resolution computed tomography (HRCT) slices collected from 1,294 patients for the automatic diagnosis of fenestral OS. We prospectively created an external test set with 31,774 CT slices from 144 patients, which contained 86 fenestral OS ears and 202 normal ears and used it to evaluate the performance of our otosclerosis-Logical Neural Network (LNN) model to assess its potential clinical utility. In addition, we compared the diagnostic acumen of seven otolaryngologists with the otosclerosis-LNN approach in the clinical test set, which was mixed with 78 fenestral OS and 62 normal ears. Finally, to evaluate the assisting value of the model, the seven participants were again invited to classify all cases in the clinical test set after referring to the diagnostic results of the model, to which they were blinded. Results The diagnostic performance of otologists was not satisfactory, and those CT samples which were misdiagnosed had similar characteristics. Based on this finding, we defined three subtypes of fenestral OS lesions that are suitable for clinical diagnosis guidance: “focal”, “transitional”, and “typical” fenestral OS. The most encouraging result is that the model achieved an area under the curve (AUC) of 99.5% (per-ear-sensitivity of 96.4%, per-ear-specificity of 98.9%) on the prospective unknown external test. Furthermore, we used this model to assist otologists and observed a consistent and significant improvement in diagnostic performance, especially for the newly defined focal and transitional fenestral OS, which led to the initial high misdiagnosis rate. Conclusions Our findings of the fine-grained classification of fenestral OS could have implications for future diagnosis and prevention programs. In addition, our deep OS localization network is an effective approach providing assistance to otologists to deal with the significant challenge of the misdiagnosis of fenestral OS.
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Affiliation(s)
- Weimin Tan
- School of Computer Science, Shanghai Key Laboratory of Intelligent Information Processing, Fudan University, Shanghai, China
| | - Pengfei Guan
- ENT Institute and Otorhinolaryngology Department of Affiliated Eye and ENT Hospital, State Key Laboratory of Medical Neurobiology, Fudan University, Shanghai, China
| | - Lingjie Wu
- ENT Institute and Otorhinolaryngology Department of Affiliated Eye and ENT Hospital, State Key Laboratory of Medical Neurobiology, Fudan University, Shanghai, China
| | - Hedan Chen
- School of Computer Science, Shanghai Key Laboratory of Intelligent Information Processing, Fudan University, Shanghai, China
| | - Jichun Li
- School of Computer Science, Shanghai Key Laboratory of Intelligent Information Processing, Fudan University, Shanghai, China
| | - Yu Ling
- School of Computer Science, Shanghai Key Laboratory of Intelligent Information Processing, Fudan University, Shanghai, China
| | - Ting Fan
- ENT Institute and Otorhinolaryngology Department of Affiliated Eye and ENT Hospital, State Key Laboratory of Medical Neurobiology, Fudan University, Shanghai, China
| | - Yunfeng Wang
- ENT Institute and Otorhinolaryngology Department of Affiliated Eye and ENT Hospital, State Key Laboratory of Medical Neurobiology, Fudan University, Shanghai, China
| | - Jian Li
- Clinical Laboratory Center, Children's Hospital of Fudan University, Shanghai, China
| | - Bo Yan
- School of Computer Science, Shanghai Key Laboratory of Intelligent Information Processing, Fudan University, Shanghai, China
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Burd C, Pai I, Pinto M, Dudau C, Connor S. Morphological comparison of internal auditory canal diverticula in the presence and absence of otospongiosis on computed tomography and their impact on patterns of hearing loss. Neuroradiology 2021; 63:431-437. [PMID: 33210164 PMCID: PMC7880953 DOI: 10.1007/s00234-020-02606-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Accepted: 11/12/2020] [Indexed: 01/22/2023]
Abstract
PURPOSE The association of internal auditory canal (IAC) fundal diverticula with otospongiosis (OS) and their clinical significance remain unclear. We explored whether isolated IAC diverticula were morphologically different from those with additional CT features of OS, and whether IAC diverticula morphology influenced patterns of hearing loss. METHODS Consecutive temporal bone CT studies with (n = 978) and without (n = 306) features of OS were retrospectively assessed. Two independent observers evaluated the presence of IAC diverticula morphological features (depth, neck:depth ratio, definition of contour and angulation of shape), and these were correlated with the presence of fenestral and pericochlear OS. Audiometric profiles were analysed for the isolated IAC diverticula and those with fenestral OS alone. Continuous data was compared using Wilcoxon rank sum tests and categorical data with chi-squared and Fisher's exact tests. RESULTS Ninety-five isolated IAC diverticula were demonstrated in 54/978 patients (5.5%) without CT evidence of OS (31M, 23F, mean age 46), and 119 IAC diverticula were demonstrated in 71/306 patients (23%) with CT evidence of OS (23M, 48F, mean age 55). Reduced neck:depth ratio, ill definition and angulation were all significantly associated with the presence of pericochlear OS (p < 0.001), whilst only ill definition was associated with the presence of fenestral OS alone (p < 0.05). No morphological feature was associated with conductive hearing loss in isolated diverticula or with sensorineural hearing loss in diverticula with fenestral OS alone. CONCLUSION IAC diverticula associated with pericochlear OS demonstrate different morphological features from isolated IAC diverticula. There are no clear audiometric implications of these morphological features.
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Affiliation(s)
- Christian Burd
- Department of Radiology, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Irumee Pai
- Department of Otolaryngology, Guy's and St. Thomas' Hospital NHS Foundation Trust, London, UK
- School of Biomedical Engineering & Imaging Sciences Clinical Academic Group, King's College London, London, SE1 9RT, UK
| | - Melisha Pinto
- Department of Oral Medicine and Radiology, Coorg Institute of Dental Sciences, Virajpet, Karnataka, India
| | - Cristina Dudau
- Department of Radiology, Guy's and St Thomas' NHS Foundation Trust, London, UK
- Department of Neuroradiology, King's College Hospital NHS Foundation Trust, London, UK
| | - Steve Connor
- Department of Radiology, Guy's and St Thomas' NHS Foundation Trust, London, UK.
- School of Biomedical Engineering & Imaging Sciences Clinical Academic Group, King's College London, London, SE1 9RT, UK.
- Department of Neuroradiology, King's College Hospital NHS Foundation Trust, London, UK.
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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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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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Purohit B, Op de Beeck K, Hermans R. Role of MRI as first-line modality in the detection of previously undiagnosed otosclerosis: a single tertiary institute experience. Insights Imaging 2020; 11:71. [PMID: 32430577 PMCID: PMC7237555 DOI: 10.1186/s13244-020-00878-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2020] [Accepted: 04/23/2020] [Indexed: 12/26/2022] Open
Abstract
Background Otosclerosis causes conductive, sensorineural and mixed hearing loss (CHL, SNHL, MHL) and tinnitus in young adults. It is best diagnosed on high-resolution CT (HRCT). Occasionally, patients presenting with SNHL and/or tinnitus may undergo temporal bone MRI as the first investigation. In this study, we have described the role of MRI as the first-line modality in the detection of previously undiagnosed otosclerosis. Using search words ‘MRI otosclerosis’ we found 15 cases in the PACS of our institute, (University Hospitals, KU Leuven, Belgium) from 2003 to 2018. Of these, 2 were known cases of otosclerosis, hence excluded from the study. The remaining 13 patients underwent MRI as first-line investigation for unilateral SNHL (8/13), bilateral SNHL (3/13), unilateral MHL (1/13) and bilateral pulsatile tinnitus (1/13). All MRI studies were reported by the same senior radiologist. Results Of these 13 cases, 12 were reported as showing MRI features suspicious for otosclerosis. The typical positive findings in these cases were intermediate T1 signal and post-contrast enhancement in the perilabyrinthine/pericochlear regions. Out of 13 patients, 9 underwent subsequent HRCT, confirming otosclerosis in all. The single MRI which was reported as normal initially showed otosclerosis on HRCT. Retrospective evaluation of this MRI study showed subtle positive findings of otosclerosis. Conclusion The end point of this study was to validate the subtle findings of otosclerosis on MRI, by comparison to the gold-standard modality HRCT. Our hypothesis is that in the appropriate clinical setting, familiarity with MRI features of otosclerosis would increase the diagnostic ‘catch’ in the first ‘net’ itself i.e. first-line MRI.
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Affiliation(s)
- Bela Purohit
- Department of Radiology, University Hospitals, KU Leuven, Leuven, Belgium. .,Department of Neuroradiology, National Neuroscience Institute, Singapore, Singapore.
| | - Katya Op de Beeck
- Department of Radiology, University Hospitals, KU Leuven, Leuven, Belgium
| | - Robert Hermans
- Department of Radiology, University Hospitals, KU Leuven, Leuven, Belgium
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Yueniwati Y, Apprianisa A. The Correlation Between Petrous Part of the Temporal Bone Density and the Internal Auditory Canal Diameter in Sensorineural Hearing Loss Patients with Chronic Renal Failure. Indian J Otolaryngol Head Neck Surg 2019; 71:1652-1657. [PMID: 31750231 PMCID: PMC6841789 DOI: 10.1007/s12070-019-01722-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2019] [Accepted: 07/23/2019] [Indexed: 11/25/2022] Open
Abstract
Patients with chronic renal failure often suffer from hearing loss and the most common cause is sensorineural hearing loss. Sensorineural hearing loss can be caused by cochlear otosclerosis with early symptoms such as decreased petrous part of the temporal bone density due to narrowing of the internal auditory canal. Finding a correlation between the petrous part of the temporal bone density and the anteroposterior diameter of the internal auditory canal in sensorineural hearing loss in patients with chronic renal failure. An observational analytic, cross-sectional study, using a consecutive sampling technique. The petrous part of the temporal bone density decreased in patients with chronic renal failure. The anteroposterior diameter of the internal auditory canal remained normal, there was no association with sensorineural loss. There is a significant correlation between the petrous part of the temporal bone density and sensorineural hearing loss in patients with chronic renal failure. High-resolution CT scans of the mastoid can assist clinicians in determining cochlear otosclerosis and the subsequent detection of the early presence of sensorineural hearing loss.
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Affiliation(s)
- Yuyun Yueniwati
- Radiology Department, Faculty of Medicine, Universitas Brawijaya, Jl Veteran Malang, Malang, 65145 Indonesia
| | - Andica Apprianisa
- Radiology Department, Faculty of Medicine, Universitas Brawijaya, Jl Veteran Malang, Malang, 65145 Indonesia
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Bilateral Cochlear Otosclerosis; Clinic and Radiologic Findings. ANADOLU KLINIĞI TIP BILIMLERI DERGISI 2019. [DOI: 10.21673/anadoluklin.453418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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Ali HI, Khater NH. Otosclerosis and complications of stapedectomy: CT and MRI correlation. ALEXANDRIA JOURNAL OF MEDICINE 2019. [DOI: 10.1016/j.ajme.2017.07.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Affiliation(s)
- Heba Ibrahim Ali
- Ain Shams University Hospital, Radiology Department, Egypt Egypt
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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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Buch K, Baylosis B, Fujita A, Qureshi MM, Takumi K, Weber PC, Sakai O. Etiology-Specific Mineralization Patterns in Patients with Labyrinthitis Ossificans. AJNR Am J Neuroradiol 2019; 40:551-557. [PMID: 30792250 DOI: 10.3174/ajnr.a5985] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2018] [Accepted: 01/05/2019] [Indexed: 12/20/2022]
Abstract
BACKGROUND AND PURPOSE Our aim was to identify whether specific patterns of ossification in labyrinthitis ossificans are associated with the known risk factors. Labyrinthitis ossificans has been described as sequela of prior temporal bone trauma, prior infection, and other disorders including sickle cell disease. Specific patterns of mineralization in the membranous labyrinth associated with these risk factors has not been previously described. MATERIALS AND METHODS This was a retrospective study evaluating temporal bone CT scans at our institution from November 2005 to May 2018 in patients with labyrinthitis ossificans. Membranous labyrinthine structures evaluated for ossification included the following: basal, middle, and apical cochlear turns; lateral, posterior, and superior semicircular canals; and the vestibule for both ears in all patients. These structures were assigned a severity score, 0-4, based on degree of mineralization. Clinical records were reviewed for potential labyrinthitis ossificans risk factors. Basic descriptive statistics and a mixed model were used to correlate the degree and patterns of ossification with clinical history. RESULTS Forty-four patients (58 ears) with labyrinthitis ossificans were identified and evaluated. The most common risk factors were chronic otomastoiditis (n = 18), temporal bone surgery (n = 9), temporal bone trauma (n = 6), sickle cell disease (n = 5), and meningitis (n = 4). For all etiologies, the semicircular canals were most severely affected, and the vestibule was the least. In patients with prior temporal bone surgery, significantly greater mineralization was seen in the basal turn of the cochlea (P = .027), the vestibule (P = .001), and semicircular canals (P < .001-.008). No significant pattern was identified in patients with meningitis, sickle cell disease, or trauma. CONCLUSIONS Significant patterns of mineralization in labyrinthitis ossificans were observed in patients with prior temporal bone surgery. For all etiologies, the semicircular canals were most severely affected. No significant mineralization pattern was observed in patients with chronic otomastoiditis, meningitis, sickle cell disease, or prior temporal bone trauma.
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Affiliation(s)
- K Buch
- From the Departments of Radiology (K.B., B.B., A.F., M.M.Q., K.T., O.S.)
| | - B Baylosis
- From the Departments of Radiology (K.B., B.B., A.F., M.M.Q., K.T., O.S.)
| | - A Fujita
- From the Departments of Radiology (K.B., B.B., A.F., M.M.Q., K.T., O.S.)
- Department of Radiology (A.F.), Jichi Medical University, Shimotsuke, Tochigi, Japan
| | - M M Qureshi
- From the Departments of Radiology (K.B., B.B., A.F., M.M.Q., K.T., O.S.)
- Radiation Oncology (M.M.Q., P.C.W., O.S.)
| | - K Takumi
- From the Departments of Radiology (K.B., B.B., A.F., M.M.Q., K.T., O.S.)
| | - P C Weber
- Radiation Oncology (M.M.Q., P.C.W., O.S.)
| | - O Sakai
- From the Departments of Radiology (K.B., B.B., A.F., M.M.Q., K.T., O.S.)
- Radiation Oncology (M.M.Q., P.C.W., O.S.)
- Otolaryngology-Head and Neck Surgery (O.S.), Boston Medical Center, Boston University School of Medicine, Boston, Massachusetts
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Nguyen T, Pulickal G, Singh A, Lingam R. Conductive hearing loss with a "dry middle ear cleft"-A comprehensive pictorial review with CT. Eur J Radiol 2019; 110:74-80. [PMID: 30599877 DOI: 10.1016/j.ejrad.2018.11.024] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2018] [Revised: 09/07/2018] [Accepted: 11/20/2018] [Indexed: 11/18/2022]
Abstract
Conductive hearing loss (CHL) commonly results from middle ear fluid and inflammation (otitis media). Less commonly in patients with CHL, the middle ear cleft is well aerated or 'dry' with absence of soft tissue or fluid clinically and on imaging. There are numerous causes for this but they can be clinically challenging to diagnose. This pictorial review aims to illustrate and discuss the CT features of both common and less common causes of CHL in patients with a "dry middle ear cavity".
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Affiliation(s)
- Thi Nguyen
- Benson Radiology, 120 Greenhill Road, Unley, South Australia, 5061, Australia; Department of Medical Imaging, Flinders Medical Centre, Bedford Park, 5042, South Australia, Australia.
| | - Geoiphy Pulickal
- Department of Diagnostic Radiology at Khoo Teck Puat Hospital, 90 Yishun Central, 768828, Singapore.
| | - Arvind Singh
- Department of ENT Surgery, Northwick Park Hospital, Watford Road, Harrow, HA1 3UJ, United Kingdom.
| | - Ravi Lingam
- Department of Radiology, Northwick Park Hospital, Watford Road, London, HA1 3UJ, United Kingdom.
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Wang F, Yoshida T, Shimono M, Sugimoto S, Teranishi M, Naganawa S, Sone M. Significance of internal auditory canal diverticula in ears with otosclerosis. Acta Otolaryngol 2018; 138:1066-1069. [PMID: 30682901 DOI: 10.1080/00016489.2018.1521526] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND Diverticula in the internal auditory canal (IAC) have been reported in ears with otosclerosis. OBJECTIVE We evaluated hearing levels and vascular activity in ears with otosclerosis with and without IAC diverticula and clarify the significance of IAC diverticula. MATERIALS AND METHODS Sixty-one ears from 54 patients who underwent stapes surgery for otosclerosis [fenestral (48 ears) and retrofenestral (13 ears) groups] were included in the present study. Preoperative hearing levels on pure tone audiometry (PTA) and intraoperative measurements of blood flow were compared between the groups. RESULTS A total of 24 of 61 ears (39.3%) showed IAC diverticula, significantly higher than the frequency in ears without otosclerosis (3.7%). No significant differences in air- and bone-conduction thresholds on PTA were evident between ears with and without IAC diverticula in each group. Ears without IAC diverticula tended to show higher blood flow in the area anterior to the oval window than ears with IAC diverticula, but the difference was not significant. CONCLUSIONS The incidence of the IAC diverticula in otosclerosis was significantly higher than in cases without otosclerosis. The existence of IAC diverticula was not evidently related to the severity of the disease from the perspective of hearing level and vascular activity.
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Affiliation(s)
- Fei Wang
- Department of Otorhinolaryngology, Nagoya University Graduate School of Medicine, Nagoya, Japan
- Department of Otorhinolaryngology, The First Affiliated Hospital of China Medical University, Otorhinolaryngology, Shenyang, China
| | - Tadao Yoshida
- Department of Otorhinolaryngology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Mariko Shimono
- Department of Otorhinolaryngology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Satofumi Sugimoto
- Department of Otorhinolaryngology, Nagoya Univerisity Hospital, Nagoya, Japan
| | - Masaaki Teranishi
- Department of Otorhinolaryngology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Shinji Naganawa
- Department of Radiology, Nagoya University, Graduate School of Medicine, Nagoya, Japan
| | - Michihiko Sone
- Department of Otorhinolaryngology, Nagoya University Graduate School of Medicine, Nagoya, Japan
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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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Abstract
Many bone dysplasias, some common and others rare, may involve the temporal bone causing conductive, sensorineural, or mixed hearing loss, vestibular dysfunction, or skull base foraminal narrowing, potentially affecting quality of life. Some conditions may affect only the temporal bone, whereas others may be more generalized, involving different regions of the body. High-resolution computed tomography may detect subtle osseous changes that can help define the type of dysplasia, and MR imaging can help define the degree of activity of lesions and potential associated complications.
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Abstract
The use of imaging in otosclerosis for diagnosis, preoperative assessment, and follow-up has the potential to give the clinician an additional tier of patient evaluation and validation of diagnosis. Before stapes surgery, imaging may help avoid unnecessary middle ear explorations in nonotosclerotic cases, prevent potential complications, and assist in appropriate patient counseling regarding management expectations. Postoperatively, following unsuccessful air-bone gap closure in stapes surgery or conductive hearing deterioration following initial successful closure of the air bone gap, imaging can be used to determine the prosthesis position in the middle ear.
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Berrettini S, Lombardo F, Bruschini L, Ciabotti A, Raffaello C, De Cori Sara, De Marchi Daniele, Forli F. 3D fluid attenuated inversion recovery (FLAIR) magnetic resonance imaging at different stages of otosclerosis. Eur Arch Otorhinolaryngol 2018; 275:2643-2652. [PMID: 30191304 DOI: 10.1007/s00405-018-5093-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2018] [Accepted: 08/10/2018] [Indexed: 12/14/2022]
Abstract
PURPOSE The aim of this work is to study otosclerotic patients by 3D-FLAIR (fluid attenuated inversion recovery) sequence magnetic resonance imaging (MRI) with and without Gadolinium administration (-/+ Gd), to understand whether there is a direct relationship between radiological findings at 3D FLAIR MRI sequences and some clinical features of otosclerosis, such as the presence and entity of sensorineural involvement, duration of disease, patient gender, and other factors. METHODS 38 patients affected by different stages of unilateral or bilateral otosclerosis underwent 3D FLAIR MRI+/- Gd. 11 subjects with normal hearing, previously submitted to 3T MRI for other minor diseases, unrelated with otosclerosis, had been retrospectively enrolled as control group. RESULTS We found significant correlations between 3D FLAIR MRI findings and some clinical features of otosclerosis, such as severity of cochlear damage (in terms of entity of sensorineural loss) and duration of disease. These findings indicate that at 3D-FLAIR MRI different patterns may depend on the level of blood labyrinth barrier damage in the cochlea, and be related to different stages of cochlear involvement in otosclerotic patients. CONCLUSIONS We believe that our findings may contribute in understanding the pathogenesis of cochlear damage in otosclerosis and may have further prognostic value. Our results led us to consider the possible use of 3D-FLAIR sequences in monitoring the effectiveness of any medical therapy of otosclerosis and in selecting the patients eligible for treatment.
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Affiliation(s)
- Stefano Berrettini
- ENT Audiology and Phoniatrics Unit, Department of Surgical, Medical, Molecular Pathology and Emergency Medicine, University of Pisa, Via Paradisa 2, 56100, Pisa, Italy. .,Division of ENT Diseases, Karolinska Institutet, Stockholm, Sweden.
| | - Francesco Lombardo
- Neuroradiology Unit, Fondazione CNR Regione Toscana "G. Monasterio", Pisa, Italy
| | - Luca Bruschini
- ENT Audiology and Phoniatrics Unit, Department of Surgical, Medical, Molecular Pathology and Emergency Medicine, University of Pisa, Via Paradisa 2, 56100, Pisa, Italy
| | - Annalisa Ciabotti
- ENT Audiology and Phoniatrics Unit, Department of Surgical, Medical, Molecular Pathology and Emergency Medicine, University of Pisa, Via Paradisa 2, 56100, Pisa, Italy
| | - Canapicchi Raffaello
- Neuroradiology Unit, Fondazione CNR Regione Toscana "G. Monasterio", Pisa, Italy
| | - De Cori Sara
- Neuroradiology Unit, Fondazione CNR Regione Toscana "G. Monasterio", Pisa, Italy
| | - De Marchi Daniele
- Neuroradiology Unit, Fondazione CNR Regione Toscana "G. Monasterio", Pisa, Italy
| | - Francesca Forli
- ENT Audiology and Phoniatrics Unit, Department of Surgical, Medical, Molecular Pathology and Emergency Medicine, University of Pisa, Via Paradisa 2, 56100, Pisa, Italy
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Juliano AF. Cross Sectional Imaging of the Ear and Temporal Bone. Head Neck Pathol 2018; 12:302-320. [PMID: 30069846 PMCID: PMC6081284 DOI: 10.1007/s12105-018-0901-y] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2017] [Accepted: 02/24/2018] [Indexed: 12/16/2022]
Abstract
CT and MR imaging are essential cross-sectional imaging modalities for assessment of temporal bone anatomy and pathology. The choice of CT versus MR depends on the structures and the disease processes that require assessment, delineation, and characterization. A thorough knowledge of the two imaging modalities' capabilities and of temporal bone anatomy greatly facilitates imaging interpretation of pathologic conditions.
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Affiliation(s)
- Amy F. Juliano
- Massachusetts Eye and Ear Infirmary, Boston, MA USA ,Harvard Medical School, Boston, MA USA
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Puac P, Rodríguez A, Lin HC, Onofrj V, Lin FC, Hung SC, Zamora C, Castillo M. Cavitary Plaques in Otospongiosis: CT Findings and Clinical Implications. AJNR Am J Neuroradiol 2018; 39:1135-1139. [PMID: 29622557 DOI: 10.3174/ajnr.a5613] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2017] [Accepted: 02/03/2018] [Indexed: 12/17/2022]
Abstract
BACKGROUND AND PURPOSE Cavitary plaques have been reported as a manifestation of otospongiosis. They have been related to third window manifestations, complications during cochlear implantation, and sensorineural hearing loss. However, their etiology and clinical implications are not entirely understood. Our purpose was to determine the prevalence, imaging findings, and clinical implications of cavitary plaques in otospongiosis. MATERIALS AND METHODS We identified patients with otospongiosis at a tertiary care academic medical center from January 2012 to April 2017. Cross-sectional CT images and clinical records of 47 patients (89 temporal bones) were evaluated for the presence, location, and imaging features of cavitary and noncavitary otospongiotic plaques, as well as clinical symptoms and complications in those who underwent cochlear implantation. RESULTS Noncavitary otospongiotic plaques were present in 86 (97%) temporal bones and cavitary plaques in 30 (35%). Cavitary plaques predominated with increasing age (mean age, 59 years; P = .058), mostly involving the anteroinferior wall of the internal auditory canal (P = .003), and their presence was not associated with a higher grade of otospongiosis by imaging (P = .664) or with a specific type of hearing loss (P = .365). No patients with cavitary plaques had third window manifestations, and those with a history of cochlear implantation (n = 6) did not have complications during the procedure. CONCLUSIONS Cavitary plaques occurred in one-third of patients with otospongiosis. Typically, they occurred in the anteroinferior wall of the internal auditory canal. There was no correlation with the degree of otospongiosis, type of hearing loss, or surgical complications. Cavitary plaques tended to present in older patients.
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Affiliation(s)
- P Puac
- From the Division of Neuroradiology (P.P., A.R., V.O., S.-C.H., C.Z., M.C.), Department of Radiology, University of North Carolina School of Medicine, Chapel Hill, North Carolina
| | - A Rodríguez
- From the Division of Neuroradiology (P.P., A.R., V.O., S.-C.H., C.Z., M.C.), Department of Radiology, University of North Carolina School of Medicine, Chapel Hill, North Carolina
| | - H-C Lin
- Radiology Department (H.-C.L.), Cathay General Hospital, Taipei, Taiwan
| | - V Onofrj
- From the Division of Neuroradiology (P.P., A.R., V.O., S.-C.H., C.Z., M.C.), Department of Radiology, University of North Carolina School of Medicine, Chapel Hill, North Carolina
| | - F-C Lin
- Department of Biostatistics and North Carolina Translational and Clinical Sciences Institute (F.-C.L.), University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - S-C Hung
- From the Division of Neuroradiology (P.P., A.R., V.O., S.-C.H., C.Z., M.C.), Department of Radiology, University of North Carolina School of Medicine, Chapel Hill, North Carolina
| | - C Zamora
- From the Division of Neuroradiology (P.P., A.R., V.O., S.-C.H., C.Z., M.C.), Department of Radiology, University of North Carolina School of Medicine, Chapel Hill, North Carolina
| | - M Castillo
- From the Division of Neuroradiology (P.P., A.R., V.O., S.-C.H., C.Z., M.C.), Department of Radiology, University of North Carolina School of Medicine, Chapel Hill, North Carolina
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Subramanian M, Chawla A, Chokkappan K, Lim T, Shenoy JN, Chin Guan Peh W. High-Resolution Computed Tomography Imaging in Conductive Hearing Loss: What to Look for? Curr Probl Diagn Radiol 2018. [DOI: 10.1067/j.cpradiol.2017.05.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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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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Dudau C, Salim F, Jiang D, Connor SEJ. Diagnostic efficacy and therapeutic impact of computed tomography in the evaluation of clinically suspected otosclerosis. Eur Radiol 2016; 27:1195-1201. [PMID: 27364152 DOI: 10.1007/s00330-016-4446-8] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2016] [Accepted: 05/23/2016] [Indexed: 12/21/2022]
Abstract
OBJECTIVE To assess the diagnostic efficacy and therapeutic impact of CT in evaluating patients with clinically suspected otosclerosis. METHODS CT scans performed over a 5-year period for clinically suspected otosclerosis were retrospectively reviewed. CT diagnoses were correlated with subsequent surgical management. For otosclerosis positive cases, clinically significant extensions of otosclerosis were correlated with audiometry and the diagnosis was correlated with surgical findings. RESULTS Of 259 CT studies, 46 % of patients were positive, 49 % negative and 5 % equivocal for otosclerosis. A relevant alternative CT diagnosis was evident in 33 % of the negative studies. One targeted surgery was performed for every four CT studies. CT outcome influenced the decision to perform stapedectomy in 41 % CT-positive versus 4 % CT-negative patients. CT-positive ears for otosclerosis could not be predicted from baseline clinical or audiometric criteria. Those with endosteal extension demonstrated lower bone conduction thresholds presurgically. The positive predictive value of CT diagnosis of otosclerosis was 100 %. CONCLUSIONS CT demonstrated a high rate of clinically relevant diagnoses in both CT-positive and -negative for otosclerosis patients, and this frequently influenced surgical management. CT also added value by demonstrating relevant extensions of the otosclerotic foci, some of which were predictive of audiometric parameters. KEY POINTS • CT demonstrates a high rate of alternative diagnoses in suspected otosclerosis, 1:3. • CT results in a high rate of targeted surgery in suspected otosclerosis, 1:4. • CT prevents exploratory surgery in suspected otosclerosis. • Endosteal extension of otosclerosis is predictive of lower bone conduction tresholds presurgically. • The PPV of CT diagnosis of otosclerosis was 100 %.
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Affiliation(s)
- Cristina Dudau
- Department of Neuroradiology, King's College Hospital NHS Foundation Trust, Ruskin Wing, Denmark Hill, London, SE5 9RS, UK.
| | - Fakhruddin Salim
- Department of Otolaryngology, Head and Neck Surgery, Auditory Implantation Centre, Guy's and St. Thomas Hospital, London, UK
| | - Dan Jiang
- Department of Otolaryngology, Head and Neck Surgery, Auditory Implantation Centre, Guy's and St. Thomas Hospital, London, UK
| | - Steve E J Connor
- Department of Radiology, Guy's and St Thomas' NHS Foundation Trust, London, UK
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Lombardo F, De Cori S, Aghakhanyan G, Montanaro D, De Marchi D, Frijia F, Fortunato S, Forli F, Chiappino D, Berrettini S, Canapicchi R. 3D-Flair sequence at 3T in cochlear otosclerosis. Eur Radiol 2016; 26:3744-51. [PMID: 26747254 DOI: 10.1007/s00330-015-4170-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2015] [Revised: 09/16/2015] [Accepted: 12/14/2015] [Indexed: 01/01/2023]
Abstract
PURPOSE To assess the capability of three-dimensional fluid-attenuated inversion recovery (3D-FLAIR) sequences in detecting signal alterations of the endolabyrinthine fluid in patients with otosclerosis. MATERIALS AND METHODS 3D-FLAIR before and after (-/+) gadolinium (Gd) administration was added to the standard MR protocol and acquired in 13 patients with a clinical/audiological diagnosis of severe/profound hearing loss in otosclerosis who were candidates for cochlear implantation and in 11 control subjects using 3-T magnetic resonance imaging (MRI) equipment. The MRI signal of the fluid-filled cochlea was assessed both visually and calculating the signal intensity ratio (SIR = signal intensity cochlea/brainstem). RESULTS We revealed no endocochlear signal abnormalities on T1-weighted -/+ Gd images for either group, while on 3D-FLAIR we found bilateral hyperintensity with enhancement after Gd administration in eight patients and bilateral hyperintensity without enhancement in one patient. No endocochlear signal abnormalities were detected in other patients or the control group. CONCLUSION Using 3-T MRI equipment, the 3D-FLAIR -/+ Gd sequence is able to detect the blood-labyrinth barrier (BLB) breakdown responsible for alterations of the endolabyrinthine fluid in patients with cochlear otosclerosis. We believe that 3D-FLAIR +/- Gd is an excellent imaging modality to assess the intra-cochlear damage in otosclerosis patients. KEY POINTS • Gd-enhanced T1-weighted MRI has limited application to detect intra-cochlear damage. • 3D-FLAIR is less sensitive to flux artefacts and allows multiplanar reconstruction. • Post-Gd 3D-FLAIR is advantageous as it may highlight the BLB breakdown. • Using 3D-FLAIR -/+ Gd, we were able to identify intra-cochlear signal hyperintensities. • 3D-FLAIR might be applied for monitoring disease progression and treatment response.
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Affiliation(s)
- Francesco Lombardo
- Fondazione CNR Regione Toscana "G. Monasterio", Neuroradiology Unit, Via Moruzzi, 1, 56124, Pisa, Italy.
| | - Sara De Cori
- Fondazione CNR Regione Toscana "G. Monasterio", Neuroradiology Unit, Via Moruzzi, 1, 56124, Pisa, Italy
| | - Gayane Aghakhanyan
- Fondazione CNR Regione Toscana "G. Monasterio", Neuroradiology Unit, Via Moruzzi, 1, 56124, Pisa, Italy
| | - Domenico Montanaro
- Fondazione CNR Regione Toscana "G. Monasterio", Neuroradiology Unit, Via Moruzzi, 1, 56124, Pisa, Italy
| | - Daniele De Marchi
- Fondazione CNR Regione Toscana "G. Monasterio", Neuroradiology Unit, Via Moruzzi, 1, 56124, Pisa, Italy
| | - Francesca Frijia
- Fondazione CNR Regione Toscana "G. Monasterio", Neuroradiology Unit, Via Moruzzi, 1, 56124, Pisa, Italy
| | - Susanna Fortunato
- ENT Audiology Phoniatry Unit, Department of Neuroscience, University of Pisa, Pisa, Italy
| | - Francesca Forli
- ENT Audiology Phoniatry Unit, Department of Neuroscience, University of Pisa, Pisa, Italy
| | - Dante Chiappino
- Fondazione CNR Regione Toscana "G. Monasterio", Department of Radiology, Massa, Italy
| | - Stefano Berrettini
- ENT Audiology Phoniatry Unit, Department of Neuroscience, University of Pisa, Pisa, Italy
| | - Raffaello Canapicchi
- Fondazione CNR Regione Toscana "G. Monasterio", Neuroradiology Unit, Via Moruzzi, 1, 56124, Pisa, Italy
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Juliano AF, Ginat DT, Moonis G. Imaging Review of the Temporal Bone: Part II. Traumatic, Postoperative, and Noninflammatory Nonneoplastic Conditions. Radiology 2015; 276:655-72. [PMID: 26302389 DOI: 10.1148/radiol.2015140800] [Citation(s) in RCA: 49] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
The first part of this review of the temporal bone discussed anatomy of the temporal bone as well as inflammatory and neoplastic processes in the temporal bone region (1). This second part will first discuss trauma to the temporal bone and posttraumatic complications. The indications for common surgical procedures performed in the temporal bone and their postoperative imaging appearance are then presented. Finally, a few noninflammatory nonneoplastic entities involving the temporal bone are reviewed. They are relatively uncommon diagnoses compared with infectious or inflammatory diseases. However, because patients present with symptoms that are either common (hearing loss) or distinctive (sensorineural hearing loss in a child), they are important for the radiologist to be aware of and recognize.
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Affiliation(s)
- Amy F Juliano
- From the Department of Radiology, Massachusetts Eye and Ear Infirmary, 243 Charles St, Boston, MA 02114 (A.F.J.); Department of Radiology, The University of Chicago Medicine, Chicago, Ill (D.T.G.); and Department of Radiology, Beth Israel Deaconess Medical Center, Boston, Mass (G.M.)
| | - Daniel T Ginat
- From the Department of Radiology, Massachusetts Eye and Ear Infirmary, 243 Charles St, Boston, MA 02114 (A.F.J.); Department of Radiology, The University of Chicago Medicine, Chicago, Ill (D.T.G.); and Department of Radiology, Beth Israel Deaconess Medical Center, Boston, Mass (G.M.)
| | - Gul Moonis
- From the Department of Radiology, Massachusetts Eye and Ear Infirmary, 243 Charles St, Boston, MA 02114 (A.F.J.); Department of Radiology, The University of Chicago Medicine, Chicago, Ill (D.T.G.); and Department of Radiology, Beth Israel Deaconess Medical Center, Boston, Mass (G.M.)
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Pont E, Mazón M, Montesinos P, Sánchez MÁ, Más-Estellés F. Imaging Diagnostics: Congenital Malformations and Acquired Lesions of the Inner Ear. ACTA OTORRINOLARINGOLOGICA ESPANOLA 2015. [DOI: 10.1016/j.otoeng.2014.07.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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47
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Opacification of the middle ear and mastoid: imaging findings and clues to differential diagnosis. Clin Radiol 2015; 70:e1-e13. [DOI: 10.1016/j.crad.2014.11.014] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2014] [Revised: 11/19/2014] [Accepted: 11/26/2014] [Indexed: 11/17/2022]
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48
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Decisive Criteria Between Stapedotomy and Cochlear Implantation in Patients with Far Advanced Otosclerosis. Otol Neurotol 2015; 36:e73-8. [DOI: 10.1097/mao.0000000000000692] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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49
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Comparative analysis of preoperative diagnostic values of HRCT and CBCT in patients with histologically diagnosed otosclerotic stapes footplates. Eur Arch Otorhinolaryngol 2015; 273:63-72. [DOI: 10.1007/s00405-015-3490-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2014] [Accepted: 12/30/2014] [Indexed: 01/20/2023]
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