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Purohit B, Op de Beeck K, Hermans R. Role of MRI as first-line modality in the detection of previously undiagnosed otosclerosis: a single tertiary institute experience. Insights Imaging 2020; 11:71. [PMID: 32430577 PMCID: PMC7237555 DOI: 10.1186/s13244-020-00878-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2020] [Accepted: 04/23/2020] [Indexed: 12/26/2022] Open
Abstract
Background Otosclerosis causes conductive, sensorineural and mixed hearing loss (CHL, SNHL, MHL) and tinnitus in young adults. It is best diagnosed on high-resolution CT (HRCT). Occasionally, patients presenting with SNHL and/or tinnitus may undergo temporal bone MRI as the first investigation. In this study, we have described the role of MRI as the first-line modality in the detection of previously undiagnosed otosclerosis. Using search words ‘MRI otosclerosis’ we found 15 cases in the PACS of our institute, (University Hospitals, KU Leuven, Belgium) from 2003 to 2018. Of these, 2 were known cases of otosclerosis, hence excluded from the study. The remaining 13 patients underwent MRI as first-line investigation for unilateral SNHL (8/13), bilateral SNHL (3/13), unilateral MHL (1/13) and bilateral pulsatile tinnitus (1/13). All MRI studies were reported by the same senior radiologist. Results Of these 13 cases, 12 were reported as showing MRI features suspicious for otosclerosis. The typical positive findings in these cases were intermediate T1 signal and post-contrast enhancement in the perilabyrinthine/pericochlear regions. Out of 13 patients, 9 underwent subsequent HRCT, confirming otosclerosis in all. The single MRI which was reported as normal initially showed otosclerosis on HRCT. Retrospective evaluation of this MRI study showed subtle positive findings of otosclerosis. Conclusion The end point of this study was to validate the subtle findings of otosclerosis on MRI, by comparison to the gold-standard modality HRCT. Our hypothesis is that in the appropriate clinical setting, familiarity with MRI features of otosclerosis would increase the diagnostic ‘catch’ in the first ‘net’ itself i.e. first-line MRI.
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Affiliation(s)
- Bela Purohit
- Department of Radiology, University Hospitals, KU Leuven, Leuven, Belgium. .,Department of Neuroradiology, National Neuroscience Institute, Singapore, Singapore.
| | - Katya Op de Beeck
- Department of Radiology, University Hospitals, KU Leuven, Leuven, Belgium
| | - Robert Hermans
- Department of Radiology, University Hospitals, KU Leuven, Leuven, Belgium
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Abstract
Many bone dysplasias, some common and others rare, may involve the temporal bone causing conductive, sensorineural, or mixed hearing loss, vestibular dysfunction, or skull base foraminal narrowing, potentially affecting quality of life. Some conditions may affect only the temporal bone, whereas others may be more generalized, involving different regions of the body. High-resolution computed tomography may detect subtle osseous changes that can help define the type of dysplasia, and MR imaging can help define the degree of activity of lesions and potential associated complications.
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Jan TA, Remenschneider AK, Halpin C, Seton M, McKenna MJ, Quesnel AM. Third-generation bisphosphonates for cochlear otosclerosis stabilizes sensorineural hearing loss in long-term follow-up. Laryngoscope Investig Otolaryngol 2017; 2:262-268. [PMID: 29094069 PMCID: PMC5655565 DOI: 10.1002/lio2.91] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2017] [Revised: 06/12/2017] [Accepted: 07/01/2017] [Indexed: 12/22/2022] Open
Abstract
Objective To assess long‐term hearing outcomes in patients treated with third‐generation bisphosphonates for otosclerosis‐related progressive sensorineural hearing loss (SNHL). Study Design Retrospective case series review Methods We performed a retrospective case series review of patients with otosclerosis and progressive SNHL. Patients were treated with either risedronate or zoledronate after a diagnosis of otosclerosis with a significant SNHL component. Bone conduction pure tone threshold averages (BC‐PTAs) and word recognition scores (WRS) before and after bisphosphonate administration in long‐term follow‐up was analyzed. Significant change in BC‐PTA was defined as greater than 10dB or between 4% and 18% in WRS based on binomial variance. Results Seven patients were identified and 14 ears met inclusion criteria. Three patients were female and the mean age was 48.3 ± 10.3 years. The mean duration between treatment with bisphosphonate administration and long‐term post‐treatment follow‐up audiometry was 87.6 ± 18.3 months, with a range of 61.6 to 109.1 months and median of 89.2 months. Analysis using BC‐PTA and WRS demonstrated that 11 ears remained stable while 2 improved and 1 worsened. No patient experienced any major complication as the result of bisphosphonate therapy. Conclusion Treatment with third‐generation bisphosphonates is associated with stability in otosclerosis‐related sensorineural hearing over 5‐ to 9‐year period. These results suggest that such medications may prevent the progression of SNHL in patients with otosclerosis. Level of Evidence 4 (Case series).
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Affiliation(s)
- Taha A Jan
- Department of Otolaryngology , Massachusetts Eye and Ear Harvard Medical School Boston Massachusetts U.S.A
| | - Aaron K Remenschneider
- Department of Otolaryngology , Massachusetts Eye and Ear Harvard Medical School Boston Massachusetts U.S.A
| | - Christopher Halpin
- Department of Otolaryngology , Massachusetts Eye and Ear Harvard Medical School Boston Massachusetts U.S.A
| | - Margaret Seton
- Department of Medicine , Brigham and Women's Hospital Harvard Medical School Boston Massachusetts U.S.A
| | - Michael J McKenna
- Department of Otolaryngology , Massachusetts Eye and Ear Harvard Medical School Boston Massachusetts U.S.A
| | - Alicia M Quesnel
- Department of Otolaryngology , Massachusetts Eye and Ear Harvard Medical School Boston Massachusetts U.S.A
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Abstract
OBJECTIVE To evaluate the diagnostic value of computed tomography (CT) in detecting otosclerosis in patients with conductive hearing loss and a clinical suspicion of otosclerosis. DATA SOURCES PubMed, Embase, and the Cochrane Library. STUDY SELECTION A systematic search was conducted. Studies reporting original study data were included. DATA EXTRACTION Relevance and risk of bias of the selected articles were assessed. Studies with low relevance, high risk of bias, or both were excluded. Prevalences, sensitivities, specificities, and post-test probabilities were extracted from the included articles. DATA SYNTHESIS Seven studies characterized by a moderate to high relevance and moderate to low risk of bias were included for data extraction. The prevalence of otosclerosis was high (up to 100%) in the majority of the included studies. In those studies with a high prevalence of disease, both positive and negative post-test probabilities were (relatively) high: 99% and between 51% and 67% respectively. In one study with a low prevalence of disease (9%), both positive and negative post-test probabilities were low (23% and 3% respectively). Overall, reported sensitivities ranged between 60% and 95%. CONCLUSION Preoperative CT has little to add in establishing otosclerosis and may not be necessary to confirm the diagnosis. We would recommend reserving CT for those patients with suspected additional abnormalities, for specific preoperative planning, or out of legal necessity.
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Abstract
OBJECTIVE This article presents an approach to imaging conductive hearing loss in patients with normal tympanic membranes and discusses entities that should be checked as the radiologist evaluates this potentially complicated issue. CONCLUSION Conductive hearing loss in a patient with a normal tympanic membrane is a complicated condition that requires a careful imaging approach. Imaging should focus on otosclerosis, and possible mimics and potential surgical considerations should be evaluated. The radiologist should examine the ossicular chain and the round window and keep in mind that a defect in the superior semicircular canal can disturb the hydraulic integrity of the labyrinth.
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de Oliveira Vicente A, Chandrasekhar SS, Yamashita HK, Cruz OLM, Barros FA, Penido NO. Magnetic resonance imaging in the evaluation of clinical treatment of otospongiosis: a pilot study. Otolaryngol Head Neck Surg 2015; 152:1119-26. [PMID: 25791707 DOI: 10.1177/0194599815574698] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2014] [Accepted: 02/04/2015] [Indexed: 11/15/2022]
Abstract
OBJECTIVES To evaluate the applicability of magnetic resonance imaging (MRI) as a method for monitoring the activity of otospongiotic lesions before and after clinical treatment. STUDY DESIGN Prospective, randomized, controlled, double-blind study. SETTING One single tertiary care institution in a large, cosmopolitan city. METHODS Twenty-six patients (n = 42 ears) with clinical, audiometric, and tomographic diagnosis of otosclerosis were enrolled. If computed tomography (CT) demonstrated active lesions, these patients underwent MRI to detect otospongiotic foci, seen as areas of gadolinium enhancement. Patients were divided into 3 groups and received treatment with placebo, sodium alendronate, or sodium fluoride for 6 months. After this period, clinical and audiometric evaluations and a second MRI were performed. Each MRI was evaluated by both a neuroradiologist and an otolaryngologist in a subjective (visual) and objective (using specific eFilm Workstation software) manner. RESULTS Otospongiosis was most predominantly identified in the region anterior to the oval window, and this site was reliable for comparing pre- and posttreatment scans. The patients in the alendronate and sodium fluoride groups had MRI findings that suggested a decrease in activity of otospongiotic lesions, more relevant in the alendronate group. These findings were statistically significant for both subjective and objective MRI evaluations. CONCLUSIONS MRI shows higher sensitivity than clinical or audiometric assessment for detecting reduction in activity of otospongiosis. The objective MRI evaluation based on software analysis was the most accurate method of monitoring clinical treatment response in otospongiosis.
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Affiliation(s)
- Andy de Oliveira Vicente
- Department of Otorhinolaryngology and Head and Neck Surgery and the Department of Imaging Diagnosis, Universidade Federal de São Paulo-Escola Paulista de Medicina, São Paulo, Brazil
| | | | - Helio K Yamashita
- Department of Otorhinolaryngology and Head and Neck Surgery and the Department of Imaging Diagnosis, Universidade Federal de São Paulo-Escola Paulista de Medicina, São Paulo, Brazil
| | - Oswaldo Laercio M Cruz
- Department of Otorhinolaryngology and Head and Neck Surgery and the Department of Imaging Diagnosis, Universidade Federal de São Paulo-Escola Paulista de Medicina, São Paulo, Brazil
| | - Flavia A Barros
- Department of Otorhinolaryngology and Head and Neck Surgery and the Department of Imaging Diagnosis, Universidade Federal de São Paulo-Escola Paulista de Medicina, São Paulo, Brazil
| | - Norma O Penido
- Department of Otorhinolaryngology and Head and Neck Surgery and the Department of Imaging Diagnosis, Universidade Federal de São Paulo-Escola Paulista de Medicina, São Paulo, Brazil
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In response to letter to the editor: "Correlation of computed tomography with histopathology in otoslcerosis", Quesnel et al. Otol Neurotol 2013; 34(1):22-8. Otol Neurotol 2014; 34:22-8. [PMID: 24026031 DOI: 10.1097/mao.0b013e318277a1f7] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
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Virk JS, Singh A, Lingam RK. The role of imaging in the diagnosis and management of otosclerosis. Otol Neurotol 2014; 34:e55-60. [PMID: 23921926 DOI: 10.1097/mao.0b013e318298ac96] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
OBJECTIVE To examine the evidence for the role of radiologic imaging in the diagnosis and management of otosclerosis. DATA SOURCES A review of contemporary (1990 to present) English medical literature via MedLine using the terms imaging, otosclerosis, otospongiosis, stapes surgery, computed tomography, magnetic resonance, CT, and MRI was performed. STUDY SELECTION Abstracts were reviewed independently by 2 authors and relevant articles were then evaluated. Exclusion criteria included editorials, non-English language, comments, and letters. DATA EXTRACTION Level of evidence was assigned in accordance with the Oxford Centre for Evidence-based Medicine guidance (Levels I-V). RESULTS Thirty-seven articles met the inclusion criteria, of which, 11 were of Level III, 22 of Level IV, and 4 of level V evidence. High-resolution computed tomography (CT) of the temporal bones is the imaging technique of choice in the diagnosis of otosclerosis with newer multidetector scanners demonstrating a sensitivity and specificity in excess of 90%. There is Level III evidence that CT densitometry and extent of disease on CT correlates with hearing thresholds. Extensive and multifocal disease on CT has a poorer prognosis (Level III/IV). The potential use of CT in staging classifications, surgical planning, predicting surgical outcomes and risk of complications has also been described and evaluated. CONCLUSION This systematic review indicates that imaging has a useful role in both the diagnosis and management of otosclerosis, supported principally by Level III/IV evidence.
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Affiliation(s)
- Jagdeep Singh Virk
- ENT Department, Northwick Park Hospital, North West London NHS Trust, Harrow, UK
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Thomson S, Madani G. The windows of the inner ear. Clin Radiol 2014; 69:e146-52. [DOI: 10.1016/j.crad.2013.10.020] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2013] [Revised: 10/22/2013] [Accepted: 10/30/2013] [Indexed: 12/01/2022]
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Berrettini S, Ravecca F, Volterrani D, Neri E, Forli F. Imaging Evaluation in Otosclerosis: Single Photon Emission Computed Tomography and Computed Tomography. Ann Otol Rhinol Laryngol 2010; 119:215-24. [DOI: 10.1177/000348941011900402] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objectives: The aim of our study was to demonstrate the utility of diphosphonate bone single photon emission computed tomography (SPECT) in diagnosing otosclerosis and to correlate the findings from SPECT with age, gender, and sensorineural hearing loss. We also evaluated the ability of high-resolution computed tomography (HR-CT) in detecting otospongiotic and otosclerotic foci and correlated the HR-CT findings with the SPECT results. Methods: Seventy-three subjects with surgically confirmed otosclerosis underwent SPECT, and 45 of the 73 patients also underwent HR-CT of the petrous bones. Results: In the patient sample examined in this study, SPECT demonstrated a sensitivity of 95.2% and a specificity of about 96.7%. By correlating the SPECT findings, we found an inverse relationship between bone radioactivity and age (ie, greater disease activity in younger patients) and a direct relationship between bone radioactivity and the severity of sensorineural impairment in younger patients. In the 45 patients who also underwent HR-CT, the sensitivity of HR-CT (58%) was lower than that of SPECT, and the comparison between SPECT activity and the HR-CT findings (fenestral or retrofenestral type) demonstrated a statistically significant correlation between the morphological finding of bone demineralization (pericochlear foci) and a high uptake index. Conclusions: The use of SPECT seems to be highly effective in differentiating normal from pathological petrous bone. It also provides a quantitative evaluation of disease activity and shows a significant correlation with bone demineralization revealed by HR-CT.
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Kawase S, Naganawa S, Sone M, Ikeda M, Ishigaki T. Relationship between CT densitometry with a slice thickness of 0.5 mm and audiometry in otosclerosis. Eur Radiol 2006; 16:1367-73. [PMID: 16532357 DOI: 10.1007/s00330-005-0128-7] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2005] [Revised: 10/09/2005] [Accepted: 12/13/2005] [Indexed: 11/28/2022]
Abstract
The appropriate cutoff Hounsfield unit (HU) value for the diagnosis of otosclerosis was determined and the correlation between the bone conduction threshold and the findings of computed tomography (CT) densitometry investigated. CT images, 0.5-mm thick, were evaluated in 24 ears with otosclerosis and 19 control ears. Eight regions of interest were set around the otic capsule. The mean HU values in the area anterior to the oval window (A-OW) and anterior to the internal auditory canal (A-IAC) were significantly lower in otosclerosis than in controls. Based on receiver operating characteristic (ROC) analysis, the cutoff HU value in A-OW was determined to be 2,187.3 HU. The mean HU value in retrofenestral otosclerosis was significantly lower in the area A-OW, A-IAC and around the cochlea than in controls. Based on ROC analysis, the cutoff HU value in the latter was determined to be 2,045 HU. A statistically significant correlation was found between the density of the area A-OW and the hearing level at 500 and 1,000 Hz, and between the density of the area around the cochlea and the hearing level at most frequencies. These results suggest the semi-automated diagnosis of otosclerosis may be possible.
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Affiliation(s)
- Setsuko Kawase
- Department of Radiology, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Nagoya, Japan.
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Tringali S, Bertholon P, Pouget JF, Timoshenko AP, Faye M, Veyret C, Martin C. Otospongiose cochléaire et pseudo-quatrième tour de cochlée. ACTA ACUST UNITED AC 2004; 121:373-6. [PMID: 15711476 DOI: 10.1016/s0003-438x(04)95535-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
OBJECTIVE To describe different sequences on magnetic resonance imaging (MRI) in otosclerosis with peri-cochlear involvement. METHOD MRI T1 and T2 sequences with T1 gadolinium injection and computed tomography (CT) scans with millimetric slices on axial and coronal views were obtained. The diagnosis of bilateral otosclerosis was confirmed by surgical exploration. RESULTS On the CT scan, there was a fourth turn of the cochlea which appeared on the MRI T1 sequence with an intermediate signal and on the T2 sequences with a high intensity signal. After gadolinium injection, there was signal enhancement, suggestive of active otospongiosis. On the CT scan, there was another lesion in front of the cochlea with endosteal involvement. This was no however visible on the MRI, even after gadolinium infusion, in accordance with inactive otospongiosis. DISCUSSION We reviewed the literature concerning MRI and results in otosclerosis. CONCLUSION MRI of the labyrinth with T1 sequences and gadolinium injection can be contributive to the diagnosis of otosclerosis to differentiate inactive from inactive otospongiosis. However, prospective studies must be conducted to confirm this hypothesis.
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Affiliation(s)
- S Tringali
- Service d'ORL et de Chirurgie Cervico-faciale, Hôpital Bellevue, boulevard Pasteur 42055 Saint-Etienne Cedex 02
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Berrettini S, Ravecca F, Volterrani D, Forli F, Boni G, Neri E, Franceschini SS. Single photon emission computed tomography in otosclerosis: diagnostic accuracy and correlation with age, sex, and sensorineural involvement. Otol Neurotol 2002; 23:431-8. [PMID: 12170140 DOI: 10.1097/00129492-200207000-00006] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To evaluate the accuracy of single photon emission computed tomography (SPECT) in detecting otospongiotic foci of the labyrinthine capsule in otosclerotic patients and to correlate the metabolic patterns detected by SPECT with age, sex, and sensorineural hearing loss. PATIENTS AND METHODS Thirty-six patients with surgically confirmed otosclerosis and a control group of 12 subjects with normal hearing; each subject underwent SPECT study of the skull with (99m)technetium-diphosphonate ((99m)Tc-medronate). Statistical analysis of the results was performed by use of the Mann-Whitney U test. RESULTS SPECT seemed to be very sensitive in differentiating otospongiotic bone from normal bone; in the affected group, only 2 of 72 ears yielded false-negative results (sensitivity 97.2%). Moreover, in the otosclerotic patients, the mean petrosa uptake value was higher than in the control group, a difference that was statistically significant (p < 0.0001). MAIN OUTCOME MEASURES Regarding uptake in relation to patient age, an inverse relationship was observed between increased metabolic activity and age: the mean uptake index in the younger patients was significantly higher than that in the older patients (p < 0.0001). By contrast, no statistically significant differences were found between men and women (p = 0.1519). Comparison of SPECT alterations with bone conduction thresholds revealed a statistically significant correlation (p = 0.0002 and p = 0.0010) between increased metabolic bone activity and sensorineural involvement only in the younger group of otosclerotic patients. CONCLUSIONS Diphosphonate bone SPECT is the only functional method that allows in vivo evaluation of disease activity, and it was highly sensitive in detecting otosclerosis. SPECT can be considered useful in the diagnosis of otosclerosis that is difficult to recognize, such as cochlear otosclerosis and far-advanced otosclerosis, and it could also find a place in evaluating the efficacy of medical therapy for otosclerosis.
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Affiliation(s)
- Stefano Berrettini
- Ear Nose and Throat (ENT) Unit, Neuroscience Department, and Oncology Department, University of Pisa, Via Savi 10, 56100 Pisa, Italy.
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