Tomographic diagnosis and relevant aspects of otosclerosis (original) (raw)
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Annals of Otology, Rhinology & Laryngology, 2005
Objectives: Computed tomographic (CT) scanning with slices of 1 mm or more has not been sufficient to demonstrate otosclerotic foci in most cases to date. Methods: We investigated the validity of CT scans with a 0.5-mm cubical scan technique, with and without planar reconstruction, and correlated these findings with audiological data. Forty-four temporal bone CT scans from 30 patients with conductive or mixed hearing loss were evaluated. Results: Otosclerotic foci were visualized in 74% of the cases. With reconstruction at the workstation, the sensitivity increased to 85%. Whereas in fenestral otosclerosis a correlation was found between the size of the focus and the air-bone gap, no correlation was seen between the size of the focus and bone conduction thresholds with cochlear involvement. Otosclerotic foci in patients treated with sodium fluoride were smaller than those in patients without treatment. This finding may indicate a beneficial effect of sodium fluoride on otosclerotic ...
EPIDEMIOLOGICAL AND RADIOLOGICAL PATTERNS OF OTOSCLEROSIS: A RETROSPECTIVE STUDY (Atena Editora)
EPIDEMIOLOGICAL AND RADIOLOGICAL PATTERNS OF OTOSCLEROSIS: A RETROSPECTIVE STUDY (Atena Editora), 2023
Otosclerosis is one of the main causes of deafness in adults, characterized by primary osteodystrophy of the otic capsule and sensorineural hearing loss. Even though Computed Tomography (CT) is the exam of choice, the findings can be subtle, since knowledge of radiological patterns can avoid underdiagnosis. Starting from patients with compatible clinics, a survey of the epidemiological and radiological behavior was carried out in a Brazilian public health institution, comparing it with available literature data, aiming to increase diagnostic accuracy. A total of 31 patients with compatible clinical and tomographic findings were selected, and all images and corresponding reports were reviewed. As otosclerosis was clinically suspected in both mastoids of the 31 individuals studied, even if the CT evidence was only unilateral, both petrosal bones (62 in total) were included. Parameters such as age, sex and laterality were evaluated. The disease was graded using the Symons and Fanning Classification: grade 1, exclusively fenestral; grade 2, patchy localized cochlear disease, with or without fenestral involvement, and extension to the basal cochlear gyrus or middle/apical gyrus or both basal and middle/apical gyri; grade 3, diffuse confluent cochlear involvement with or without fenestral involvement. There was a higher prevalence in females (65%), in addition to bilateral involvement (54%) and in patients in the 4th decade of life (36%), followed by patients in the 5th decade (23%) and 3rd decade (19%). Of the 62 CT scans evaluated, 48 had findings of primary osteodystrophy of the otic capsule, with grade 1 otosclerosis being the most common (62%), followed by grade 2 (24%) and, less common, grade 3 (12%). Such data are consistent with current literature. Considering that the findings of otosclerosis may be tenuous, despite clinically compatible, the study of the epidemiological and radiological profile proves to be a useful tool to improve diagnostic accuracy.
Value of Multislice Computed Tomography in the evaluation of early Otosclerosis
2016
Introducción: La otoesclerosis (OS) es una enfermedad de etiología desconocida, que presenta una transmisión autosómica dominante. Afecta más frecuentemente a mujeres entre 20 y 30 años, que consultan clínicamente por una hipoacusia de conducción. La OS se clasifica en fenestral (85%) y coclear (15%). La Tomografía Computada Multicorte (TCMC) es un método radiológico de elección en la valoración de la cápsula ótica. Ésta puede demostrar con precisión lesiones en la etapa inicial como focos hipodensos milimétricos, principalmente a nivel de la Fisula Ante Fenestram (FAF) y pueden corresponderse como un signo “precoz o inicial” de OS, aun cuando en la audiometría aparece un gap menor a 20 db. Revisión del tema: La OS es una enfermedad de etiología desconocida pero se sugiere una relación con las Abstract
Reliability of High-Resolution CT Scan in Diagnosis of Otosclerosis
Otology & Neurotology, 2009
Objective: To assess the reliability of high-resolution computed tomographic scan (HRCT scan) for the diagnosis of otosclerosis and to determine its usefulness to predict hearing deterioration and surgical difficulties. Study Design: Prospective study. Setting: Tertiary reference center. Patients: Two hundred nine ears (200 patients) presenting progressive conductive hearing loss with normal tympanic membrane, abnormal stapedial reflex, and scheduled for stapes surgery. The mean age was 47.3 years. Intervention: All patients underwent HRCT scan before surgery (slice thickness of 0.6 to 1 mm). Stapedotomy was performed in 99% of cases. Main Outcome Measures: High-resolution computed tomographic scan results were categorized as positive, doubtful, or negative. We classified a CT scan as positive for otosclerosis when a hypodense focus was seen around the otic capsule. Preoperative and postoperative air-and bone-conduction thresholds were collected. Results: Of 209 HRCT scans, 84.2% were classified positive, 8.6% doubtful, and 7.2% negative. In all patients with positive CT scan, otosclerosis was confirmed in surgery. Among 15
Hearing loss is the most prevalent chronic condition which can impact the quality of life not only of the individual who has hearing loss, but also their frequent communication partners, employers, family members, friends, and acquaintances. Otosclerosis is a localized hereditary disorder affecting endochondral bone of the otic capsule that is characterized by disordered resorption and deposition of bone. An otosclerotic lesion consists of areas of bone resorption, new bone formation, vascular proliferation and a connective tissue stroma. This present work has been undertaken to evaluate the patient of clinically suspected otosclerosis on the basis of patients history, clinical examination and audiological test (pure tone audiometry and impedence audiometry) who visited in the department
BACKGROUND AND PURPOSE: Otosclerosis is commonly identified on CT as a focus of hypodensity in the otic capsule anterior to the oval window. However, otosclerosis can have a sclerotic phase approximating the density of normal bone, making diagnosis challenging. This study assesses differences in otic capsule contour and thickness anterolateral to the anterior margin of the oval window in patients with otosclerosis compared with individuals with normal hearing. MATERIALS AND METHODS: Axial CT of 104 ears with clinically diagnosed otosclerosis and 108 consecutive ears of audiometrically normal individuals were retrospectively reviewed. Two radiologists independently evaluated the pattern of otosclerosis, otic capsule contour, and bone thickness on standardized axial images at the level of the oval window and cochleariform process. Measurements were made from the posterolateral margin of the cochlea to the apex of the otic capsule convex contour just anterolateral to the anterior margin of the oval window. In the absence of a convex contour, the sulcus between the oval window and the cochleariform process was identified, and measurement to the depth of the sulcus was used. Receiver operating characteristic analysis determined the best cutoff value of otic capsule thickness. RESULTS: Mean otic capsule thickness (2 SDs) was 3.08 (0.93) mm and 1.82 (0.31) mm in patients with otosclerosis and individuals with normal hearing, respectively (P Ͻ .001), with excellent interobserver agreement. Otic capsule thickness of Ͼ2.3 mm had 96.2% sensitivity, 100% specificity, 100% positive predictive value, and 96.4% negative predictive value for otosclerosis. A bulging/convex contour of the otic capsule had 68.3% sensitivity, 98.1% specificity, 97.3% positive predictive value, and 76.3% negative predictive value. CONCLUSIONS: Patients with otosclerosis have significantly thicker bone abutting the oval window than individuals with normal hearing.
Annals of Otology, Rhinology, and Laryngology, 1996
Otosclerotic cochlear involvement is a rather frequent disease that has not been clearly understood in terms of diagnosis and management. Objective evaluation methods are needed to confirm the clinical diagnosis, investigate the relationship with hearing impairment, and validate the results of treatment. In this study two ear groups with bone conduction hearing loss (BCHL) were investigated with audiometry and high-resolution computed tomography (HRCT). In the first group (n =22) the diagnosis of fenestral otosclerosis was confirmed at operation; the second group (n =9) was composed of ears clinically suspicious for purely cochlear involvement. Additionally, a control group (n = 14) of otologically normal ears was also studied. Foci of demineralization were demonstrated in 58% of the ears in the two groups; the sensorineural hearing loss (SNHL) in those ears was significantly worse than in those with normal radiologic findings. Three methods ofHRCT densitometry were used to determine the abnormal regions in the cochlear capsule; the results suggested that hypodense regions were consistent with a greater degree of SNHL. in contrast to the hyperdense ones in ears with better cochlear reserves. Agreement was found between the location of the density change and the frequency topography of the SNHL; densitometric values were correlated with the bone conduction thresholds for certain frequencies. It is concluded that the spongiotic foci are responsible for the SNHL. since there was a correlation between their location and the SNHL frequency. The determination of better hearing in those ears with sclerotic foci supports the hypothesis that the sclerotic phase may not be a healing process following the spongiotic phase, and that it can be the first stage of the disease. KEY WORDS-densitometry, high-resolution computed tomography, otosclerosis, sensorineural hearing loss.
Investigation of Vestibular Aqueduct in High-Resolution CT Scan in Patients with Otosclerosis
Journal of Babol University of Medical Sciences, 2023
Background and Objective: Otosclerosis is caused by abnormal bone remodeling in the middle ear, which is associated with dizziness and lightheadedness. An underlying cause of dizziness in this disease can be the presence of an enlarged vestibular aqueduct. In this study, the prevalence of enlarged vestibular aqueduct in these patients compared to the normal population has been investigated. Methods: In this cross-sectional study, 26 people with bilateral otosclerosis and 26 people with at least one healthy ear requiring a CT scan were compared. Vestibular aqueduct was tested by evaluating the two factors of the midpoint width between the external diaphragm and the common crus, and its width in the external diaphragm region and comparing the two groups. Bone conduction, speech detection threshold, and gap between bone conduction and air conduction were calculated and compared in otosclerosis patients with enlarged versus normal vestibular duct. Findings: The median width of the vestibular aqueduct in the area of the external aperture in patients with otosclerosis (1.2 mm) was significantly greater than that of healthy subjects (1 mm) (p=0.046). Regarding the size of the vestibular aqueduct in otosclerosis patients, 5 patients (9.6%) were found with enlarged vestibular aqueduct in radiological findings. However, this difference was not statistically significant. In otosclerosis patients, bone conduction threshold in all frequencies was significantly higher in people with enlarged vestibular aqueduct compared to other patients (p<0.001). Conclusion: Based on the results of this study, the prevalence of enlarged vestibular aqueduct in patients with otosclerosis is considerable, and it is better to pay enough attention to the CT scan of patients before surgery to prevent possible complications.
High resolution computed tomography of temporal bone in the evaluation of otologic diseases
International Journal of Otorhinolaryngology and Head and Neck Surgery, 2017
HRCT is particularly helpful in evaluating the anatomy and pathology of external auditory canal, middle ear cavity, vestibular aqueduct, tegmen tympani, sigmoid sinus plate, vertical segment of facial nerve canal, sinodural angle, carotid canal, jugular fossa, infra and supralabrynthine air cells and temporomandibular joint; both soft tissue extension and significantly sensitive ABSTRACT Background: Conventional radiological methods like X-ray mastoid have limited ability to delineate the details of the complex temporal bone and cochlea-vestibular anatomy and disease pathology. This can be overcome by the use of High resolution computed tomography (HRCT) evaluation of the temporal bone. HRCT is helpful in evaluating the anatomy and pathology type and extent of disease, thereby helps in preoperative planning. Methods: The CT scan of forty five patients attending the outpatient department of otorhinolaryngology in a tertiary care centre between August 2014 to August 2017 was evaluated in this study. Each CT scan was interpreted by an otolaryngologist and a radiologist and interpretation was by consensus. The data collected was evaluated and results are reported as rates and proportions (%). Results: The study evaluated CT scan of 45 patients of which 35 were male patients and 10 were female patients with age ranging from 5 years to 75 years. Most of these patients belonged to the 21-30, 31-40 age groups [9 (20%) in each group]. Infections of middle ear cleft (all with cholesteatoma), fractures of the temporal bone, anomalies and tumors of the external auditory canal and middle ear were the pathologies observed in these CT scans with infection (otomastoiditis) [23 (51.1%)] being the most common pathology observed. Conclusions: Pre-operative CT scan may not only help in identifying the nature, extent of infectious disease including ossicular, bony erosions; it may also identify anomalies in the temporal bone and surrounding structures. Thus, HRCT temporal bone will help the surgeon in planning effective surgical strategy, reducing morbidity during the surgery.