Efficacy of pre-operative computed tomography evaluation of the tympanic cavity for hearing improvement after stapes surgery for tympanosclerosis with stapes fixation

Kikkawa, Sayaka; Kubo, Keishi; Kawano, Hirokazu; Komune, Shizuo

doi:10.1017/s0022215114002345

Cited by 4 publications

(3 citation statements)

References 6 publications

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“…Kikkawa et al used the pneumatization status of tympanic mastoid cavities as a prognostic indicator in patients with tympanosclerosis and decided whether to perform staged surgery based on these findings. 22 We postulate that the CT value of the shadows around the ossicular chain in patients with tympanosclerosis would be higher than in patients without tympanosclerosis. However, the structure of the ossicular chain is too fine to segment, and we have not yet found a suitable and convenient measurement method for this analysis that can be used in clinical practice to do it.…”

Section: Discussionmentioning

confidence: 92%

“…This finding is very similar to the study by Kikkawa et al, who observed frequency-dependent hearing loss in patients with an immobile ossicular chain, which is more significant at lower frequencies and preserved better at 2000 Hz. 22 Therefore, we used frequency-specific ABGs as candidate variables because they are easy to assess and therefore easy to apply. We found that the variable of frequency-specific ABG at 250 Hz had the highest OR for tympanosclerosis, and we included it in the final model instead of the mean ABG.…”

Section: Discussionmentioning

confidence: 99%

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Development and Validation of a Clinical Score for Predicting the Risk of Tympanosclerosis Before Surgery

Dong

Zhou

et al. 2020

Ear Nose Throat J

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Objective: To develop and validate a clinical score to predict the risk of tympanosclerosis before surgery. Methods: A sample of 404 patients who underwent middle ear microsurgery for otitis media was enrolled. These patients were randomly divided into 2 cohorts: the training cohort (n = 243, 60%) and the validation cohort (n = 161, 40%). The preoperative predictors of tympanosclerosis were determined by multivariate logistic regression analysis and implemented using a clinical score tool. The predictive accuracy and discriminative ability of the clinical score were determined by the area under the curve (AUC) and the calibration curve. Results: The multivariate analysis in the training cohort (n = 243, 60%) identified independent factors for tympanosclerosis as the female sex (odds ratio [OR]: 3.83; 95% CI: 1.66-9.37), the frequency-specific air-bone gap at 250 Hz ≥ 45 dB HL (OR: 3.68; 95% CI: 1.68-8.57), aditus ad antrum blockage (OR: 3.29; 95% CI: 1.38-8.43), type I eardrum calcification (OR: 25.37; 95% CI: 8.41-88.91) or type II eardrum calcification (OR: 18.86; 95% CI: 6.89-58.77), and a history of otitis media ≥ 10 years (OR: 4.10; 95% CI: 1.58-11.83), which were all included in the clinical score tool. The AUC of the clinical score for predicting tympanosclerosis was 0.89 (95% CI: 0.85-0.93) in the training cohort and 0.89 (95% CI: 0.84-0.95) in the validation cohort. The calibration curve also showed good agreement between the predicted and observed probability. Conclusions: The clinical score achieved an optimal prediction of tympanosclerosis before surgery. The presence of calcification pearls on the promontorium tympani is a strong predictor of tympanosclerosis with stapes fixation.

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Section: Discussionmentioning

confidence: 92%

Section: Discussionmentioning

confidence: 99%

Development and Validation of a Clinical Score for Predicting the Risk of Tympanosclerosis Before Surgery

Dong

Zhou

et al. 2020

Ear Nose Throat J

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“…The surgical approach for a patient with CT showing limited myringosclerosis differs from a patient with intratympanic ossicular involvement which is further differs depending on the degrees, extent, and the ossicles or the complexes are affected. Kikkawa et al comment about the role of the middle ear and mastoid pneumatization in temporal CT in predicting the hearing outcome after stapes surgery for tympanosclerosis with stapes fixation; where they suggested that well‐aerated ears have good hearing results with single‐stage surgery, but for poor pneumatized ears a staged surgery is recommended to get a good hearing improvement 17 . For these reasons, temporal HRCT has a significant role in determining and planning the surgical intervention along with proper pre‐operative counseling for the patient.…”

Section: Discussionmentioning

confidence: 99%

Reliability of high‐resolution CT scan in diagnosis of ossicular tympanosclerosis

Larem

Altamimi

Aljariri

et al. 2021

Laryngoscope Investig Oto

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Objectives To evaluate the reliability of high‐resolution CT scans (HRCT scans) in the diagnosis of tympanosclerosis and to determine its benefit to predict the post‐surgical hearing outcome based on comparing radiological and surgical findings. Methods A retrospective study at a tertiary institute included 940 ears that underwent tyampanoplasty for chronic suppurative otitis media (CSOM) between January 2013 and March 2017. Preoperative temporal bone HRCT scans were analyzed to check for the prediction of tympanosclerosis and ossicular fixation. Intraoperatively, ossicular chain integrity was checked. Preoperative and postoperative audiometric evaluations using air‐bone gap (ABG) were compared. A postoperative pure‐tone ABG of 20 dB or less was considered as a successful hearing result. Results are compared with historical control groups, the study has been reviewed and approved by the IRB at the medical research center in Hamad Medical Corporation; however, it is a retrospective study so no informed consent was obtained from the patients. Results The study included 940 ears that underwent tympanoplasties due to CSOM, where 238 out of 940 (25.3%) of ears showed tympanosclerosis during tympanoplasty, intraoperatively, tympanosclerosis was localized to the eardrum in 174 of the 238 involved ears (73.1%), A 64 out of 238 (26.9%) of the ears with tympanosclerosis showed ossicular fixation, divided as 45 ears with Incudo‐malleal fixation, 14 ears with stapes fixation, and 5 ears with triple ossicular fixation. HRCT scan of the temporal bone was suggestive of ossicular chain fixation in 79 cases distributed as 55 incudo‐malleal fixations, 19 stapes fixation, and 5 complete ossicular fixations, with a sensitivity of 96.8%, and specificity of 98%. The audiological results were analyzed, with a patient follow‐up after 6 months. Conclusions Our study showed that CT scans when combined with the clinical findings can be an informative guide to otolaryngologists for preoperative evaluation and counseling of tympanosclerosis surgeries.

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Ossiculoplasty for Tympanosclerosis

Dedmon

O’Connell

Rivas

2020

Curr Otorhinolaryngol Rep

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Efficacy of pre-operative computed tomography evaluation of the tympanic cavity for hearing improvement after stapes surgery for tympanosclerosis with stapes fixation

Cited by 4 publications

References 6 publications

Development and Validation of a Clinical Score for Predicting the Risk of Tympanosclerosis Before Surgery

Development and Validation of a Clinical Score for Predicting the Risk of Tympanosclerosis Before Surgery

Reliability of high‐resolution CT scan in diagnosis of ossicular tympanosclerosis

Ossiculoplasty for Tympanosclerosis

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