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 Table of Contents  
REVIEW ARTICLE
Year : 2020  |  Volume : 5  |  Issue : 4  |  Page : 341-345

Role of multislice computed tomographic scan in management of otosclerosis


1 Department of Ear, Nose and Throat(ENT), Faculty of Medicine, Assiut University, Assiut, Egypt
2 Department of Diagnostic Radiology, Faculty of Medicine, Assiut University, Assiut, Egypt

Date of Submission22-Feb-2016
Date of Decision27-Aug-2018
Date of Acceptance08-Sep-2018
Date of Web Publication20-Nov-2020

Correspondence Address:
Hoda Abd Elkader Mohammed
Department of Ear, Nose and Throat (ENT), Faculty of Medicine, Assiut University, Assiut
Egypt
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/JCMRP.JCMRP_61_18

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  Abstract 


Otosclerosis is the abnormal growth of bone of the middle ear affects endochondral bone of the otic capsule that prevents structures within the ear from working properly and causes hearing loss. To assess the radiological findings in patients with otosclerosis using high-resolution multislice computed tomographic (CT) scan. This prospective study was done at Assiut University hospital during the period from June 2016 to August 2017. Thirty patients were enrolled in this study; 11 (36.7%) males and 19 (63.3%) females. CT was efficient in the diagnosis of otosclerotic foci, showing a high rate of positivity. The multislice CT findings were bilateral in 45 ears and this evidence was statistically significant. Preoperative high-resolution CT scan may serve as a valuable imaging method in the planning of stapes surgery. It helps to avoid serious complications and unnecessary stapes surgeries by the detection of several abnormalities in the middle or inner ear CT density of otosclerotic lesions in any of the CT grades was significantly correlated with hearing loss.

Keywords: conductive hearing loss, high-resolution computed tomographic scan, otosclerosis


How to cite this article:
ElWafa Abdel-Jalil AA, Sayed SA, Othman MM, Elkader Mohammed HA. Role of multislice computed tomographic scan in management of otosclerosis. J Curr Med Res Pract 2020;5:341-5

How to cite this URL:
ElWafa Abdel-Jalil AA, Sayed SA, Othman MM, Elkader Mohammed HA. Role of multislice computed tomographic scan in management of otosclerosis. J Curr Med Res Pract [serial online] 2020 [cited 2020 Dec 1];5:341-5. Available from: http://www.jcmrp.eg.net/text.asp?2020/5/4/341/301052




  Introduction Top


Otosclerosis is the abnormal growth of bone of the middle ear that affects endochondral bone of the otic and capsule causing hearing loss[1]. High-resolution computed tomographic (HRCT) scan could detect very fine architectural changes in the otic capsule and surrounding bone structures[2]. Preoperative detection of otosclerosis specific hypodense lesions has great clinical significance, since it might correspond to the type, severity, and progression of hearing loss[3],[4],[5],[6].

Some studies suggested that, there is a relationship between otosclerosis and CT findings. The present study aimed to assess the radiological findings in patients with otosclerosis using high-resolution multislice CT scan.


  Patients and Methods Top


Ethical considerations

This prospective randomized cohort study was done after obtaining an Institutional Review Board approval from the Committee of Medical Ethics, Faculty of Medicine, Assiut University. It was conducted in Otorhinolaryngology Department, Assiut University Hospital during the period from June 2016 and August 2017. Before including participants in the study, the purpose and nature of the study were explained to all patients.

They were free to ask about the nature of the study. They agreed that they understand the investigational nature of the study benefits. They were free to terminate participation in this study without affection of clinical service or management. A written informed consent including the explanation was obtained from the patient.

The collected and disseminated data of the patients were confidential. The study and all interventions and investigations including audiological evaluation and radiological studies were done by scientifically qualified and trained personnel.

Inclusion criteria

  1. All patients with conductive or mixed hearing loss with intact tympanic membrane with provisional diagnosis of otosclerosis.
  2. Age group 18–55 years.


Exclusion criteria

  1. Pateint with age group less than 18 or more than 55 years old.
  2. Pregnant patients.
  3. Previous ear surgery.


Methodology

This study was carried out on 30 patients complaining of hearing loss±tinnitus diagnosed clinically, audiologically, radiologically, and confirmed intraoperative as otosclerosis.

All the patients included in the study were subjected to:

  1. Full general history taking: including personal history, family history, complaint, history of present illness, especially symptom of hearing affection
  2. Complete otolaryngologic, head and neck examination: to exclude other causes of conductive hearing loss, otoscopic examination
  3. Full audiological assessment at the time of diagnosis including pure-tone audiometry, tympanometry
  4. High-resolution multislice CT scanning: very thin (0.1 mm) thickness axial sections were obtained on multidetector CT scanner, followed by axial and coronal reformats, respectively in the plane, and perpendicular to the lateral semicircular canal. All cases were examined without contrast injection


  5. CT grading for otosclerosis[7]:

    Grade 1: solely fenestral, either spongiotic or sclerotic lesions, evident as a thickened stapes footplate

    Grade 2: patchy localized cochlear disease

    Grade 3: diffuse cochlear involvement of the otic capsule

  6. Assessment of ossicular chain intraoperative.


Operative details

Exploratory tympanostomy was done under general anesthesia through endotracheal intubation through an incision of the external canal with Rosen knife elevation of the tympanomeatal flap, exploration of the middle ear, testing of the mobility of ossicles fixed stapes was found in all cases, stapedectomy was done, and Teflon piston applied.

All cases operated in our department by experienced surgeons. The operation was done microscopically in some cases and endoscopically in the others.

Statistical analyses

The data were entered and edited using the statistical package for the social science (SPSS, version 22; SPSS Inc., Chicago, Illinois, USA). Results were expressed as the mean ± SD or frequency (%). The χ2 test was used to analyze differences among categorical variables.


  Results Top


The study included 30 patients (26 of them with bilateral hearing loss, four patients with unilateral hearing loss, and four of them operated bilaterally), recruited from the Otolaryngology Department in Assiut University. Age ranged from 18 to 55 years, with a mean of 29.27 ± 3.2 years. [Table 1] showed basic patient's characteristics. Clinical presentation of patients was summarized in [Figure 1]. Otoscopic examination results were summarized in [Figure 2].
Table 1 Patient characteristic

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Figure 1: Clinical presentation.

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Figure 2: Otoscopic examination results.

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Audiological evaluation

Basic audiological evaluation characteristics are composed of pure-tone audiometry results which included in [Table 2] and tympanometry results that are shown in [Figure 3].
Table 2: Pure-tone audiogram evaluation results

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Figure 3: Tympanogram evaluation results.

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CT findings are summarized in [Table 3], and Figs. 4–7 represent CT findings in our study. CT grading is summarized in [Table 4] with grade 1 represents narrowed or enlarged the round or oval window, grade 2 characterizes patchy localized cochlear disease (with or without fenestral involvement), and grade 3 denotes diffuse confluent cochlear involvement of the otic capsule (with or without fenestral involvement).
Table 3: Computed tomographic findings

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Table 4: Computed tomographic grading

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Audiological and computed tomographic findings correlation

Patients with normal findings include 15 (25%) ears and their main conductive gap 22.59 ± 13.18, while patients with grade 1 include 13 (21.7%) ears and their main conductive gap 27.14 ± 8.09 and patient with grade 2 include 13 (21.7%) ears with main conductive gap 26.25 ± 9.54 with P value of 0.148. Finally, patients with grade 3 include 19 (31.7%) ears with main conductive gap 32.78 ± 7.32. A significant relationship was detected between the CT findings and audiological findings of all grades with P value of 0.029 as shown in [Table 5].
Table 5: Audiological and computed tomographic findings correlation

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Intraoperative and CT findings correlation are explained in [Table 6].
Table 6: Intraoperative and computed tomographic findings correlation

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  Discussion Top


A suspicion of otosclerosis is evoked by a combination of history and audiometric findings. Confirmation of the diagnosis typically requires surgical middle ear exploration. The objective of this study is to review the usefulness and the role of HRCT imaging for the diagnosis of otosclerosis to decrease the surgical risk.

Several factors were found to be involved in the prediction of the outcome of the otoslerotic patient that includes a clinical presentation with particular concern to the presence of tinnitus, hearing loss, or combination of both. In addition, audiometric findings playing a pivotal role through pure-tone audiometry, that can demonstrate the type of hearing loss whether conductive hearing loss, sensorineural hearing loss, or mixed hearing loss. Finally, CT findings that can show the status of the oval window, round window, cochlea, mastoid, facial nerve canal, middle ear pathology, ossicular chain integrity, other inner ear pathology, sinus plate, and jugular bulb. In our study, we found that otosclerotic patients presented at the mean age of 29.27 years. This finding is in agreement with studies done by Virk et al.[8] and Rudic et al.[9] who found that most otosclerotic patients are presented between second and fourth decade.

Regarding sex, our data revealed that otosclerosis showed slight female predominance with a female to male ratio of 1.7: 1 which is in agreement with other studies[3],[10] who found a female predominance with a female to male ratio of 1.4: 1 and 1.3: 1, respectively. This finding could be attributed to genetic factors, hormonal imbalance, immune system disorder and autoantibodies that are more common among females.

Our work detected grade 1 otosclerosis in 21.7%, grade 2 in 21.7%, and grade 3 in 31.7%, so grade 3 was the predominant form. This is in agreement with Wycherly et al.[5] who found that 76% of their cases were grade 3. This also agrees with Marx et al.[6] who found that 79.8% of their cases were grade 3. Our findings were in controversy to study done by Lee et al.[11] that studied a number of cases, 82% of them was grade 2. This difference could be attributed to the genotypic variation between our population sample and other groups.

Our study showed that significant association presents between CT findings of the otosclerotic patient and audiological finding (pure-tone audiometry and tympanometry) with P value 0.029. This agrees with Shin et al.[3] who found preoperative and postoperative bone conduction thresholds significantly lower (P < 0.05) in patients with pericochlear foci on the CT scan. Gredilla Molinero et al.[12] found that HRCT is the modality of choice for radiological diagnosis of patients with otosclerosis and it allows us to perform differential diagnosis with other conditions of similar symptomatology. It provides us with prognostic information and allows us to identify cases with higher surgical risk.

Vicente Ade et al.[13] who stated that CT was efficient in the diagnosis of otosclerotic foci, showing a high rate of positivity, especially for fenestral lesions. Moreover, their data showed that tomographic findings were bilateral in most patients and this evidence was statistically significant and agreed with our results.

Finally, our study showed an evident association between the CT findings and intraoperative diagnosis of otosclerosis as 82.4% of the operated patient have positive CT findings. Negative finding does not exclude the involvement of stapes footplate by otosclerotic foci as Shin et al.[3] found a significant association between doubtful or negative CT scan with the risk of complications of the stapes footplate. Thus, in cases of negative or doubtful HRCT scan otosclerosis, the surgeons have to be alerted to the higher risk of encountering a stapes footplate problem. That there are several middle and inner ear disorders that must be distinguished from stapes fixations to avoid unnecessary stapes surgery or serious intraoperative complications, such as large vestibular aqueduct, enlarged cochlear canaliculus, superior semicircular canal dehiscence syndrome, embryonic disorders of the hearing ossicles, stapes malformations, persisting stapedial artery, or prolapsing facial nerve into the oval window niche[14],[15],[16].

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Politzer A. Primary disease of the knocked labyrinth capsule. J Otolaryngol 1894; 25:309–327.  Back to cited text no. 1
    
2.
Lagleyre S, Sorrentino T, Calmels MN, Shin YJ, Escudé B, Deguine O, et al. Reliability of high-resolution CT scan in the diagnosis of otosclerosis. Otol Neurotol 2009; 30:1152–1159.  Back to cited text no. 2
    
3.
Shin YJ, Fraysse B, Deguine O, Cognard C, Charlet JP, Sévely A. Sensorineural hearing loss and otosclerosis: a clinical and radiologic survey of 437 cases. Acta Otolaryngol 2001; 121:200–204.  Back to cited text no. 3
    
4.
Naumann IC, Porcellini B, Fisch U. Otosclerosis: incidence of positive findings on high-resolution computed tomography and their correlation to audiological test data. Ann Otol Rhinol Laryngol 2005; 114:709–716.  Back to cited text no. 4
    
5.
Wycherly BJ, Berkowitz F, Noone AM, Kim HJ. Computed tomography and otosclerosis: a practical method to correlate the sites affected to hearing loss. Ann Otol Rhinol Laryngol 2010; 119:789–794.  Back to cited text no. 5
    
6.
Marx M, Lagleyre S, Escudé B, Demeslay J, Elhadi T, Deguine O, et al. Correlations between CT scan findings and hearing thresholds in otosclerosis. Acta Otolaryngol 2011; 131:351–357.  Back to cited text no. 6
    
7.
Marshall AH, Fanning N, Symons S, Shipp D, Chen JM, Nedzelski JM. Cochlear implantation in cochlear otosclerosis. Laryngoscope 2005; 115:1728–1733.  Back to cited text no. 7
    
8.
Virk JS, Singh A, Lingam RK. The role of imaging in the diagnosis and management of otosclerosis. Otol Neurotol 2013; 34:55–60.  Back to cited text no. 8
    
9.
Rudic M, Keogh I, Wagner R, Wilkinson E, Kiros N, Ferrary E. The pathophysiology of otosclerosis: review of current research. Hear Res 2015; 330:51–56.  Back to cited text no. 9
    
10.
Curtin HD. Imaging of conductive hearing loss with a normal tympanic membrane. Am J Roentgenol 2016; 206:49–56.  Back to cited text no. 10
    
11.
Lee TC, Aviv RI, Chen JM, Nedzelski JM, Fox AJ, Symons SP. CT grading of otosclerosis. Am J Neuroradiol 2009; 30:1435–1439.  Back to cited text no. 11
    
12.
Gredilla Molinero J, Mancheño Losa M, Santamaría Guinea N, Arévalo Galeano N, Grande Bárez M. Update on the imaging diagnosis of otosclerosis. Radiologia 2016; 55:246–256.  Back to cited text no. 12
    
13.
Vicente Ade O, Hic Y, Albernaz Pl, Pendio Nde O. Computed tomography in the diagnosis of otosclerosis, Otolaryngol Head Neck Surg 2006; 134:685.92.  Back to cited text no. 13
    
14.
Merchant SN, Rosowski JJ, McKenna MJ. Superior semicircular canal dehiscence mimicking otosclerotic hearing loss. Adv Otorhinolaryngol 2007; 65:137–145.  Back to cited text no. 14
    
15.
Sugimoto H, Ito M, Hatano M, Yoshizaki T. Persistent stapedial artery with stapes ankylosis. Auris Nasus Larynx 2014; 6:582–585.  Back to cited text no. 15
    
16.
Moskowitz HS. Review of otosclerosis diagnosis, evaluation, pathology, surgical techniques, and outcomes. Ann Otol Rhinol Laryngol 2015; 3:250–251.  Back to cited text no. 16
    


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5], [Figure 6], [Figure 7]
 
 
    Tables

  [Table 1], [Table 2], [Table 3], [Table 4], [Table 5], [Table 6]



 

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