Author(s)
David Ahmadian, BS
Nicholas A. Dewyer, MD
Affiliation(s)
University of Arizona College of Medicine;
Abstract:
Educational Objective: At the conclusion of this presentation, the participants should be aware of the potential utility of preoperative CT imaging for patients with presumed otosclerosis.
Objectives: Recently, increased attention has been on placed on identifying patients with superior semicircular canal dehiscence (SSCD) that is misdiagnosed as or occurs concurrently with otosclerosis. This study evaluated the utility of routine preoperative CT in patients with presumed otosclerosis.
Study Design: Retrospective cohort analysis.
Methods: A retrospective chart review was performed for patients treated by a single neurotologist at a tertiary academic medical center from 9/1/19 to 06/14/22. Inclusion criteria were patients who had a clinical diagnosis of otosclerosis and CT imaging. CT scans were reviewed for evidence of otosclerosis, SSCD, or other findings that may account for a conductive hearing loss. CT findings and clinical outcomes of interventions were described.
Results: Of 36 patients with presumed otosclerosis, 20 (56%) had imaging findings suggestive of otosclerosis. 2 (6%) were found to have SSCD, 1 with concurrent otospongiosis and 1 without. The patient with SSCD and concurrent otosclerosis was counseled on the additional risks of incomplete closure of his air bone gap and unmasking SSCD symptoms. He underwent uncomplicated laser stapedotomy with a good result and no unmasking of SSCD symptoms. The other patient with SSCD also had imaging findings of a tegmen dehiscence with temporal lobe meningoencephalocele resting on the heads of the ossicles. Audiologic evaluation showed absent acoustic reflexes bilaterally. The patient elected for treatment with a unilateral hearing aid.
Conclusions: 2 of 36 patients (6%) with presumed otosclerosis had findings on preoperative CT that changed management or counseling. Clinicians should consider obtaining routine preoperative CT before stapedectomy, although larger studies are needed to better quantify the cost and risk benefit tradeoffs.