Reliability of high-resolution CT scan in diagnosis of otosclerosis.
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.


METHODS
Prospective study.


METHODS
Tertiary reference center.


METHODS
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.


METHODS
All patients underwent HRCT scan before surgery (slice thickness of 0.6 to 1 mm). Stapedotomy was performed in 99% of cases.


METHODS
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 negative cases, we found 4 minor malformations and 1 fracture of the stapes. Footplate incidents (mobilized, floating, or fractured footplate; 5.3%) occurred significantly more frequently when an HRCT scan was negative or doubtful (p = 0.05). Mean preoperative air-bone gap was 27.7 dB (standard deviation, 10). Mean postoperative air-bone gap was within 10 dB in 65% and within 20 dB in 92% of cases. Greater than 10 dB deterioration of bone-conduction thresholds occurred in 2% of cases. Mean preoperative and postoperative bone-conduction thresholds were significantly lower in cases of round window obliteration, pericochlear, or internal auditory canal hypodensities (p < 0.005 and p < 0.0001, respectively).


CONCLUSIONS
In our series, the sensitivity of HRCT scan to otosclerosis was 95.1%. Hypodense otosclerotic foci were mostly localized at the anterior part of footplate. Negative or doubtful cases were associated with the highest incidence of stapes footplate complications. Foci involving otic capsule, internal auditory canal, or round window led to a significantly higher risk of sensorineural hearing loss.
Lagleyre
Sebastien
S
Department of Otology-Neurotology and Skull Base Surgery, Purpan University Hospital, Toulouse, France. lagleyre.s@chu-toulouse.fr
Sorrentino
Tommaso
T
Calmels
Marie-Noelle
MN
Shin
Young-Je
YJ
Escudé
Bernard
B
Deguine
Olivier
O
Fraysse
Bernard
B
D000293:Adolescent; D000328:Adult; D000368:Aged; D001299:Audiometry; D004432:Ear, Middle / Q000000981:diagnostic imaging / Q000601:surgery; D005260:Female; D007839:Functional Laterality / Q000502:physiology; D006309:Hearing / Q000502:physiology; D006314:Hearing Loss, Conductive / Q000000981:diagnostic imaging / Q000601:surgery; D006319:Hearing Loss, Sensorineural / Q000000981:diagnostic imaging / Q000601:surgery; D006801:Humans; D007431:Intraoperative Complications / Q000000981:diagnostic imaging / Q000517:prevention & control; D053685:Laser Therapy; D008297:Male; D008875:Middle Aged; D010040:Otosclerosis / Q000175:diagnosis* / Q000000981:diagnostic imaging* / Q000601:surgery; D011300:Preoperative Care; D011379:Prognosis; D015203:Reproducibility of Results; D012405:Round Window, Ear / Q000000981:diagnostic imaging / Q000601:surgery; D013199:Stapes / Q000000981:diagnostic imaging; D013201:Stapes Surgery; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D055815:Young Adult