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Int Arch Otorhinolaryngol 2016; 20(02): 094-098
DOI: 10.1055/s-0036-1579743
Original Research
Thieme Publicações Ltda Rio de Janeiro, Brazil

Obliquity of the Stapes in Otosclerosis: A New Radiological Sign

Veluswamy Anand
1   Department of Otorhinolaryngology and Head and Neck Surgery, MCV Memorial ENT Trust Hospital, Pollachi, Tamil Nadu, India
,
H. N. Udayabhanu
1   Department of Otorhinolaryngology and Head and Neck Surgery, MCV Memorial ENT Trust Hospital, Pollachi, Tamil Nadu, India
,
B. Siva Subramaniam
2   Department of Radiology, SRL, Diagnostic-Hitech Scan Center, Coimbatore, Tamil Nadu, India
› Author Affiliations
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Publication History

10 December 2015

16 December 2015

Publication Date:
09 March 2016 (online)

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Abstract

Introduction Observing the obliquity of stapes by closely scrutinizing the HRCT temporal bone in otosclerosis revealed a reliable and consistent finding. This finding can add to the existing radiological criteria in diagnosis of otosclerosis.

Objective The objective of this study is to establish the obliquity of stapes in otosclerosis by radiological measurements using HRCT temporal bone by comparing: (a) the distance between the horizontal (tympanic) segment of facial nerve and stapes head in otosclerotic ears (study group) with non-otosclerotic ears (control group); and (b) the angle subtended by stapes with promontory in the study and control groups.

Methods This is a prospective study performed after the institutional Ethics Committee clearance (IEC 3/2013).

Results An increased mean distance between the horizontal segment of facial nerve and stapes head in otosclerotic patients (i.e., 2.49mm +/− 0.24mm SD), when compared with the non-otosclerotic patients (i.e., 1.46mm +/− 0.16mm SD) is noted. There is a change in angle (i.e., 64.550 +/− 7.190 SD) subtended by the stapes toward the promontory in otosclerotic ears when compared with that of controls (i.e., 99.700 +/− 40 SD). We applied the Mann-Whitney U non-parametric test and considered p value of < 0.0001 highly significant.

Conclusions Obliquity of stapes in otosclerosis referred to as a “Pisa” sign by the senior author has diagnostic value as a new radiological sign in imaging of otosclerosis. This obliquity explains the torsional effect of otosclerosis on the ossicular chain. The findings correlate with late complications and failures in stapes surgery.

Keywords

obliquity - otosclerosis - stapes - temporal bone
 

  • References

  • 1 Politzer A. Uber primare Erkrankung der Knocheren Labyrinth-Kapsel. Johrenheilk 1894; 25: 309-327
    Google Scholar
  • 2 Anson BJ, Cauldwell EW, Bast TH. The fissula ante fenestram of the human otic capsule; developmental and normal adult structure. Ann Otol Rhinol Laryngol 1947; 56 (4) 957-985
    CrossrefGoogle Scholar
  • 3 Bast TH. Development of otic capsule. Residual cartilages and defective ossification and their relation to otosclerotic foci. Arch Otolaryngol 1940; 32: 771-782
    CrossrefGoogle Scholar
  • 4 Anson BJ, Cauldwell EW, Bast TH. The fissula ante fenestram of the human otic capsule; aberrant form and contents. Ann Otol Rhinol Laryngol 1948; 57 (1) 103-128
    CrossrefGoogle Scholar
  • 5 Swartz DJ, Loevener AL. Imaging of the Temporal bone. 4th ed. New York, USA: Thieme; 2009
    Google Scholar
  • 6 Shea Jr JJ, Shea PF. Stapedectomy for otosclerosis. In: Glasscock ME, Gulya AJ, eds. Surgery of the ear. Ontario, Canada: Elsevier; 2003: 517-531
    Google Scholar
  • 7 Ruedi L. Pathogenesis of otosclerosis. Arch Otolaryngol 1963; 78: 469-477
    CrossrefGoogle Scholar
  • 8 Valvassori GE. Otodystrophies. In: Berrett A, Brunner S, Valvassori GE, eds. Modern Thin Section Tomography. Illinois, USA: Springfield; 1973: 109-117
    Google Scholar
  • 9 Valvassori GE. Radiologic diagnosis of cochlear otosclerosis. Laryngoscope 1965; 75 (10) 1563-1571
    CrossrefGoogle Scholar
  • 10 Gulya AJ. Developmental anatomy of the temporal bone and skull base. In: Glasscock ME, Gulya AJ, eds. Surgery of the ear. Ontario, Canada: Elsevier; 2003: 3-33
    Google Scholar
  • 11 Iruela-Arispe ML, Vernon RB, Wu H, Jaenisch R, Sage EH. Type I collagen-deficient Mov-13 mice do not retain SPARC in the extracellular matrix: implications for fibroblast function. Dev Dyn 1996; 207 (2) 171-183
    CrossrefGoogle Scholar
  • 12 Myers EN, Carrau RL , Eds. Operative otolaryngology: Head and Neck surgery. 2nd ed. Philadelphia: Elsevier; 2008
    Google Scholar
  • 13 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 (6) 1367-1373
    CrossrefPubMedGoogle Scholar
  • 14 Zhu F, Sun M, Zhang J, Sun D, Jiang Y. [Location of tympanic segment and mastoid segment of facial nerve and prevention of prosopoplegia in operations]. Lin Chung Er Bi Yan Hou Tou Jing Wai Ke Za Zhi 2011; 25 (7) 314-316
    Google Scholar
  • 15 Măru N, Cheiţă AC, Mogoantă CA, Prejoianu B. Intratemporal course of the facial nerve: morphological, topographic and morphometric features. Rom J Morphol Embryol 2010; 51 (2) 243-248
    Google Scholar
  • 16 Purohit B, Hermans R, Op de Beeck K. Imaging in otosclerosis: A pictorial review. Insights Imaging 2014; 5 (2) 245-252
    CrossrefPubMedGoogle Scholar
  • 17 Naumann IC, Porcellini B, Fisch U. Otosclerosis; incidence of positive findings on high resolution computed tomography and their correlation with audiological test data. Ann Otol Rhinol Laryngol 2005; 114 (9) 709-716
    CrossrefPubMedGoogle Scholar
  • 18 Mafee MF, Henrikson GC, Valvassori GE et al. Use of CT in stapedial otosclerosis. Radiology 1985; 156: 709-714
    CrossrefGoogle Scholar
  • 19 Belden CJ, Weg N, Minor LB, Zinreich SJ. CT evaluation of bone dehiscence of the superior semicircular canal as a cause of sound and/or pressure induced vertigo. Radiology 2003; 226: 337-343
    CrossrefPubMedGoogle Scholar
  • 20 JuusoKujala. Modern Surgical treatment of otosclerosis [dissertation]. Helsinki, Finalnd: Helsinki University Printing House; 2009: 24
    Google Scholar
  • 21 Maier T, Strauss G, Bauer F, Grasser A, Hata N, Lueth TC. Distance measurement in middle ear surgery using a telemanipulator. Med Image Comput Comput Assist Interv 2011; 14 (Pt 1): 41-48
    Google Scholar