title: Discontinuity of the incudo-stapedial joint within a fully aerated middle ear and mastoid on computed tomography: A clinico-radiological study of its aetiology and clinical consequence.
abstract: OBJECTIVE
  To investigate the aetiology and clinical consequences of incudo-stapedial (IS) discontinuity when it is demonstrated on computed tomography (CT) within a fully aerated middle ear and mastoid.
  
  
  METHODS
  Patients with CT evidence of IS discontinuity within a fully aerated middle ear and mastoid were prospectively identified. Clinical history, otoscopic findings, audiometry, and CT data were evaluated. Predefined criteria were used to determine the likely aetiology of IS discontinuity, whether it was diagnosed prior to the CT study, and the clinical consequences in terms of degree of conductive hearing loss and requirement for surgical correction. The range of CT appearances was evaluated.
  
  
  RESULTS
  The IS discontinuity in 34/36 ears was felt to be due to incus erosion secondary to chronic otitis, on the basis of clinical history and otoscopic findings. The IS discontinuity was rarely evident prior to CT with long-process deficiency being identified in only 5/36 cases. The mean air bone gap was only 22.5 dB. The ossicular defect was surgically addressed in only four cases. The incus deficiency was confined to the lower-third on CT in 19/36 cases.
  
  
  CONCLUSIONS
  When IS discontinuity is demonstrated within a fully aerated middle ear and mastoid, the most likely aetiology is of acquired incus erosion due to chronic otitis media. The IS discontinuity on CT is usually not evident otoscopically. It usually results in only mild conductive hearing loss and the ossicular discontinuity was rarely surgically addressed in the present series.
authors.affiliation: Department of Radiology, Guy's and St Thomas' Hospital, London, UK. steve.connor@nhs.net
authors.forename: S E J
authors.initials: SE
authors.lastname: Connor
authors.forename: I
authors.initials: I
authors.lastname: Pai
authors.forename: D
authors.initials: D
authors.lastname: Jiang
authors.forename: A J D
authors.initials: AJ
authors.lastname: Spiers
authors.forename: A
authors.initials: A
authors.lastname: Fitzgerald-O'Connor
mesh_terms: D000293:Adolescent; D000328:Adult; D004429:Ear Ossicles / Q000002:abnormalities* / Q000000981:diagnostic imaging*; D005260:Female; D006314:Hearing Loss, Conductive / Q000175:diagnosis / Q000209:etiology*; D006801:Humans; D004204:Joint Dislocations / Q000150:complications* / Q000000981:diagnostic imaging*; D008297:Male; D008416:Mastoid / Q000002:abnormalities* / Q000000981:diagnostic imaging*; D008875:Middle Aged; D011859:Radiography; D055815:Young Adult