Imaging Studies in Otosclerosis: An Up-to-date Comprehensive Review

Abstract

Introduction Otosclerosis is a primary osteodystrophy of the otic capsule, frequently responsible for acquired hearing loss in adults. Although the diagnostic value of imaging investigations in otosclerosis is debatable, they might still be employed with different goals within the context of the disease. Objectives The present paper aims to review the most recent literature on the use of imaging studies in otosclerosis for the most varied purposes, from routine application and differential diagnosis to prognostic prediction and investigation of surgical failure. Data Synthesis The diagnosis of otosclerosis is usually clinical, but computed tomography (CT) is paramount in particular cases for the differential diagnosis. The routine use, however, is not supported by strong evidence. Even so, there is growing evidence of the role of this method in surgical planning and prediction of postoperative prognosis. In specific scenarios, for example when superior semicircular canal dehiscence (SSCD) syndrome is suspected or in surgical failure, CT is crucial indeed. Magnetic resonance imaging (MRI), however, has limited – although important – indications in the management of individuals with otosclerosis, especially in the evaluation of postoperative complications and in the follow-up of medical treatment in active ostosclerosis. Conclusion Imaging studies have a broad range of well-established indications in otosclerosis. Besides, although the routine use of CT remains controversial, the most recent papers have shed light into new potential benefits of imaging prior to surgery.

Stapes surgery for otosclerosis: Comparison of two techniques

“…The therapeutic approach of patients with otosclerosis is aimed at limiting the clinical-symptomatic progression of the disease 5 . There is no curative medical therapy 6 .…”

Increased Petrous Bone Uptake on 18F-PSMA-1007 PET/CT Due to Otospongiosis

“…This unique pathology affecting only the petrous part of the temporal bone is a primary progressive osteodystrophy of the bony inner ear labyrinth. Histology initially shows osteoclastic destruction of the normal lamellar bone around preexisting blood vessels followed by formation of new spongy bone, which is highly vascular and decalcified 4,5. Mineralization then leads to the formation of otosclerotic lesions.…”

“…The disease commonly starts at the oval window and can progress to surround the cochlea and the vestibule. 1,4 On CBCT, otospongiotic lesions present as osteolytic foci involving the bony labyrinth, whereas contrast enhancement on MRI reflects active bone remodeling. 6 Very extensive temporal bone involvement can mimic Paget disease and osteogenesis imperfecta.…”

“…Histology initially shows osteoclastic destruction of the normal lamellar bone around preexisting blood vessels followed by formation of new spongy bone, which is highly vascular and decalcified. 4,5 Mineralization then leads to the formation of otosclerotic lesions. The disease commonly starts at the oval window and can progress to surround the cochlea and the vestibule.…”

“…On CBCT, otospongiotic lesions present as osteolytic foci involving the bony labyrinth, whereas contrast enhancement on MRI reflects active bone remodeling 6 . Very extensive temporal bone involvement can mimic Paget disease and osteogenesis imperfecta 1,3,4 . 18 F-PSMA-1007 PET/CT is routinely used to assess dissemination of prostate cancer 7,8 .…”