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Stability of computed tomography densitometry in patients with otosclerosis:a two-year follow-up

Journal of Otology 2022年第1期17卷 39-45页

作者： Yanqing Fang Wei Chen Liu-Jie Ren Sebastian Kiehn Yilai Shu Bing Chen ENT Institute and Otorhinolaryngology Department of the Affiliated Eye and ENT Hospital State Key Laboratory of Medical NeurobiologyFudan UniversityShanghai200031China NHC Key Laboratory of Hearing Medicine Fudan UniversityShanghai200031PR China Department of Radiology Eye and ENT HospitalFudan UniversityShanghai200031China Laryngeal Physiology Laboratory University of Wisconsin e MadisonMadisonWIUnited States Institutes of Biomedical Sciences Fudan UniversityNO.83 Fenyang RoadXuhui DistrictShanghai200031China

Objectives:To quantify the progression of otosclerosis in the unoperated ear between two stapedotomy procedures for patients with bilateral otosclerosis which can help to determine whether a HRCT scan should be re-performed before the second surgery for patients who already received HRCT imaging before the initial surgery.Methods:35 patients who underwent bilateral stapedotomy were included.Two rounds of HRCT examination and audiometry were performed at the time of the first surgery and second surgery on the ear that was not operated on during the initial surgery.The relationship between the changes in HRCT densitometry and audiometry over time was analyzed.Results:The second round of HRCT did not add significant information about the changes to the otosclerosis lesions in either the imaging diagnosis or the HRCT density values except for small changes in the HRCT densitometry readings at the area anterior to the inner auditory(P=0.01).While the changes in HRCT manifestation are small,changes near the fissula ante fenestram(FAF)were still positively correlated with the air bone gap(ABG)of patients(p=0.031,r=0.388).Conclusions:The progression of lesions in otosclerosis is slow resulting in small and insignificant changes to the HRCT features.Therefore,a repeat HRCT evaluations prior to surgery is not necessary for patients who have had a previous HRCT evaluation within 2 years of the operation.The small changes in HRCT manifestation near the FAF were still correlated with negative effects on the ABG which could cause worsened hearing thresholds over this timeframe。

关键词： otosclerosis Fissula ante fenestram(FAF) High reconstruction-computed tomography (HRCT) Auditory CT densitometry

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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?

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Journal of Otology 2022年第2期17卷 84-89页

作者： Lucas Resende Lucinda Mangia Gabriel Lucca de Oliveira Salvador Bettina Carvalho Rogerio Hamerschmidt Department of Otolaryngology Head and Neck SurgeryHospital de Clínicas da Universidade Federal do ParanaGeneral Carneiro st181CuritibaBrazil Department of Imaging and Radiology Head and Neck SurgeryHospital de Clínicas da Universidade Federal do ParanaGeneral Carneiro st181CuritibaBrazil

Introduction:The role of objective parameters in terms of improvement of the accuracy of highresolution 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-valueotosclerosis(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.

关键词： otosclerosis Computed tomography Imaging diagnosis

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Does bilateral otosclerosis make pre-operative bone conduction more inaccurate?

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Journal of Otology 2021年第1期16卷 1-5页

作者： Fiona McClenaghan Jeremy Lavy The Royal National Throat Nose and Ear Hospital 330 Grays Inn RoadLondonWC1X 8DAUnited Kingdom

Objectives:To assess whether bilateral otosclerosis renders pre-operative bone conduction more inaccurate by increasing the Carhart effect.Methods:Retrospective review of a database of pre and post-operative audiograms of 745 ears with otosclerosis treated with stapedectomy from 2013 to 2020 in a tertiary centre.Main outcome measures:Change in bone conduction after stapedectomy for otosclerosis in:unilateral otosclerosis(U1);bilateral otosclerosis undergoing first side surgery(B1);bilateral otosclerosis undergoing second side surgery(B2).The magnitude of change in bone conduction post-operatively within and between each group.Results:The average difference in pre and post-operative bone conduction was significant within in all groups(T-stat>2 and P-valueotosclerosis.There is no evidence that pre-operative bone conduction in bilateral otosclerosis is more inaccurate than in unilateral disease.In order to assess accuracy of pre-operative bone conduction in otosclerosis a reliable method of assessing post-operative bone conduction is required,without assumption of its equivalence to cochlear reserve.

关键词： otosclerosis Stapedectomy Hearing loss Bone conduction

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Diagnostic performance of high resolution computed tomography in otosclerosis

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世界临床病例杂志 2017年第7期5卷 286-291页

作者： Todd Kanzara Jagdeep Singh Virk ENT Department Countess of Chester Hospital ENT Department Royal National ThroatNose and Ear Hospital

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.

关键词： otosclerosis High resolution computed tomography Otospongiosis Retrofenestral Sensitivity Specificity Fenestral Computed tomography

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Malleostapedotomy for otosclerosis,our experience of nitinol piston on twelve patients

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Journal of Otology 2020年第4期15卷 129-132页

作者： Stephane Gargula Mary Daval Nicolas Arej Mathieu Veyrat Alain Corre Denis Ayache Department of Otorhinolaryngology Rothschild Foundation HospitalParisFrance Clinical Research Department Rothschild Foundation HospitalParisFrance

Objective:Malleostapedotomy allows to completely by-pass the incus in otosclerosis surgery.Recently its use has been rivaled by hydroxyapatite cement for cases of mild and moderate necrosis of the incus.However,it remains gold standard for cases of extensive necrosis,incus dislocation,or epitympanic fixation.Modern heat-crimping pistons make surgery easier and safer.This study focuses on our experience with this technique.Methods:Retrospective analysis of patient’s files and pre-and post-operative audiograms,for cases of surgically treated otosclerosis with malleostapedotomy.Results:Twelve patients underwent malleostapedotomy for otosclerosis between 2011 and 2019.Amongst them there were 10 revision surgeries and 2 primary cases.75%had incus long-process necrosis,17%had epitympanic fixation and one had a history of incus transposition.Nine patients(75%)had closure of air-bone gap(ABG)of<10 dB(p<0.001)and 11(92%)had a threshold of 20 dB(p<0.001).Mean pre-operative ABG was 31 dB(15 dBe55 dB),and mean post-operative ABG was 7 dB(0 dBe21 dB;p<0.001).There was no sensorineural hearing loss nor any other post-operative complication.Conclusions:Malleostapedotomy is a safe and reliable technique,allowing an ABG closure comparable to conventional incus to vestibule prosthesis.It remains the preferred technique whenever the incus cannot be used.

关键词： Malleus Stapes otosclerosis Conductive hearing loss Chronic otitis media Hydroxyapatite

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The distance between stapedial footplate and incus in otosclerosis surgery

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Journal of Otology 2015年第1期10卷 18-20页

作者： Ali Eftekharian Navid Ahmady Roozbahany Somayeh Shomali Department of Otolaryngology Shahid Beheshti University of Medical Sciences Hearing Disorders Research Center Shahid Beheshti University of Medical Sciences

Background: The measurement of the piston length during stapedotomy is important and it may have significant effects on the surgical outcome.Objective: To determine the piston length in a group of otosclerosis patients who underwent primary stapedotomy.Material and methods: Between Sep 2013 and Sep 2014, 85 patients with diagnosed otosclerosis underwent primary stapedotomy. Teflon prosthesis of 0.6 mm of diameter was used in all patients. The distance between medial surface of the long process of incus and center point of the stapedial footplate measured. The piston length calculated by adding 0.25 mm for the thickness of footplate and 0.50 mm for placement of the prosthesis into the vestibule.Results: The distance between stapedial foot plate and incus ranged from 3.50 to 4.50 mm. The mean distance was 3.95 ± 0.16 mm. In majority of cases(74.1%) piston length was 4.75 mm followed by 4.50 mm in 15.3% and 5.00 mm in 5.9%. Piston length was 4.25 mm in 3.5% and5.25 mm in only 1.2% of patients. There was no significant post-operative complication and air bone gap closure obtained in all patients.Conclusion: The most common distance between foot plate and incus is 4.00 mm. No case needed a piston longer than 5.25 mm or shorter than4.25 mm.

关键词： otosclerosis Footplate to incus distance Piston le

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otosclerosis: Contribution of Computed Tomography and Radio-Anatomical Correlations

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Open Journal of Clinical Diagnostics 2015年第2期5卷 74-80页

作者： Khaled Khamassi Madiha Mahfoudhi Hejer Mbarek Farah Hedhili Ayoub Ben Yahia Lobna Bougacha Jihen Ben Hafdhallah Najla Mnif Rim Lahiani Mamia Ben Salah Department of Otorhinolaryngology—Head and Neck Surgery Charles Nicolle Hospital Tunis Tunisia Department of Internal Medicine A Charles Nicolle Hospital Tunis Tunisia Department of Radiology Charles Nicolle Hospital Tunis Tunisia

otosclerosis is an osteodystrophia of the otic capsule, responsible for hearing loss by blocking of the stapes footplate. The purpose of this study was to evaluate the reliability of computed tomography (CT) in the positive diagnosis of otosclerosis, to compare the radiological findings to those intraoperatively, and to seek a correlation between imaging data and postoperative audiometric results. This is a retrospective study of 60 patients having otosclerosis, treated in our department between 2009 and 2011. All patients underwent an otoscopic examination, pure tone and vocal audiometry, impedancemetry and petrous CT scan. At petrous CT scan, a footplate thickening was found in 9 cases. Labyrinthine bone hypodensity was noted in 51 cases. Sensitivity of CT in the diagnosis of otosclerosis was 100%. Regarding the operative findings and their correlation with imaging, we found that among the 7 facial canal procidences reported intraoperatively, CT had identified 6, with a sensitivity of 86%. Of the 53 facial nerve in normal position intraoperatively, CT had only identified 34, with a specificity of 64%. Regarding the ossicles, there were 6 cases of abnormalities of the incus, among them 3 were identified on CT, with a sensitivity of 50%. The 54 patients with normal ossicular chain intraoperatively were all identified as such on CT, with a specificity of 100% (p = 0.001). For correlation between imaging and postoperative results, it was found that patients with extended otosclerosis had lower postoperative audiometric improvement than those having localized disease (p otosclerosis. It also helps, with good sensitivity and specificity, seeking for anatomical variants that the surgeon could possibly encounter during surgical procedure. Finally, there is a statistically significant correlation between imaging data and postoperative audiometric results, allowing establishing a functional prognosis even before surgery.

关键词： otosclerosis Computed Tomography Hearing Loss Audiometry

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Revision surgery for otosclerosis:An overview

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World Journal of Otorhinolaryngology 2015年第1期5卷 21-29页

作者： Sertac Yetiser Department of ORL and HNS Anadolu Medical Center

Stapes surgery for otosclerosis has been proved to be a very satisfying procedure. However, the condition is difficult for the patients with no or little hearing gain after surgery and for those who had sudden or gradual hearing loss after a successful air-bone gap closure in the follow-up period. The issue of re-exploring the middle ear is challenging. A general review of this subject from several points of view remains lacking. In this study, articles related with the revision surgery for otosclerosis have been reviewed after a Pub Med research and common and/or contradictory points were documented. The aim of this study is to give an insight to diagnostic and therapeutic approaches forthe clinicians in patients who need a revision surgery. In conclusion, prosthesis problems, loose prosthesis in stapedotomy and migrated prosthesis in stapedectomy are the most common causes for revision surgery. Most important indicators which effect better hearing outcome following revision surgery are those ears with the presence of incus, with no obliteration of oval window, with small fenestra stapedotomy and the experience of surgeon. The risk of neurosensorial hearing loss in revision cases is not high but the hearing gain is limited as compared to primary cases. The rate of 10 d B air-bone gap closure is around 60%-70% at most and even less promising results have been reported. Patient's demands and expectations have to be clarified in a realistic way.

关键词： otosclerosis Stapedotomy Stapedectomy Revision

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Hyperacusis and stapes surgery:An observation in fifty patients after stapedotomy

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Journal of Otology 2021年第1期16卷 18-21页

作者： Mariline Santos Angela Reis Rego Joao Lino Miguel Coutinho Cecília Almeida Sousa Department of Otolaryngology Head and Neck SurgeryCentro Hospitalar Universitario do PortoPortugal

Objective:To assess hyperacusis after stapedotomy and its possible influencing factors.Study design:Prospective,interventional,and longitudinal study.Setting:A tertiary referral center.Patients:Fifty consecutive patients(35 females,mean age=46.8 years).Intervention:All patients underwent stapedotomy.The validated Portuguese version of the“Hyperacusis Questionnaire”(HQ)was administered before and two weeks and one month after surgery.Results:No hyperacusis was reported by any patient before surgery.At two weeks after surgery,all patients experienced hyperacusis,with a mean HQ at 16.88±6.54(range 4e25).One month after surgery,hyperacusis had already resolved in most patients.Gender,preoperative presentation or surgeon had no influence on HQ scores(p>0.05).Patients with previous contralateral stapedotomy showed lower HQ scores(p=0.001).Audiological parameters improvement measured at one month after surgery(PTA,SRT and contralateral SRT)were associated with HQ higher scores.Conclusion:This study confirms that hyperacusis is a common complaint after stapedotomy that usually resolves in one month after surgery.The HQ highest scores were registered among patients with the highest audiological gain after surgery.This suggests that hyperacusis may be a positive prognostic factor for audiological success after stapedotomy.

关键词： Hyperacusis Stapes otosclerosis Middle ear Surgery

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CT EVALUATION OF MALFORMED EXTERNAL AND MIDDLE EAR AND ITS SURGICAL CORRELATION

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中华医学杂志(英文版) 1992年第6期105卷 490-493页

作者：冷同嘉宫娟兰宝森 100730 Beijing Beijing Tongren Hospital 00730 Beijing Beijing Tongren Hospital

This study evaluated the diagnostic value of highresolution CT(HRCT)for atresia of the externalauditory meatus(EAM)and isolated middle ear mal-formation.CT scan of the temporal bone was done in33 patients with such disorders and 5 patients withotosclerosis etc.were studied in the same way for com-parison.Coronal HRCT clearly showed conditions ofthe atresia plate and malformation of the malleus,incus,abnormal course of facial canal and changes inthe vestibular window.The axial HRCT is useful todemonstrate the articulations in between the malleus,incus,stapes and the cochlear window.All the HRCTfindings were confirmed during operation.Axial andcoronal HRCT for external and middle eardeformation is highly valuable for decision making andsurgical planning.

关键词： otosclerosis

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