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In an era of insidiously reducing thresholds for investigating patients, Maxwell and colleagues pose an important question: is high-resolution computed tomography (HRCT) prior to stapes surgery for otosclerosis worthwhile? Their practice typically considers HRCT for cases of suspected otosclerosis presenting somewhat inconclusively (such as present stapedial reflexes, a significant sensorineural component to the hearing loss or vestibular symptoms) and for revision cases. During the five-year window studied, their team performed 708 stapes operations. Of these, 54 (8%) patients underwent HRCT preoperatively. This group then had a total of 68 primary stapedotomies. Following HRCT, local radiology reports identified otosclerosis in 20/68 (29.4%) cases. As might be expected, HRCT-confirmed cases showed more extensive otosclerosis at surgery, including bipolar foci (30%, 6/20) and diffuse footplate involvement (20%, 4/20). Contrastingly, in cases not preoperatively confirmed by HRCT, by far the most common location of otosclerotic focus was the anterior crus (39.1%, 18/48). However, in 9/48 cases there was no report of location of otosclerotic involvement. When the HRCTs were additionally reviewed by the surgeon and/or a neuroradiologist preoperatively, the diagnosis of otosclerosis was confirmed in a further 12 (17.6%) cases, giving an overall HRCT sensitivity of 47.1%. In conclusion, this paper tells us two important things: first, for patients with suspected otosclerosis who present somewhat atypically, HRCT will confirm the diagnosis in just under half of the cases. For the remainder of patients, clinical judgement will dictate whether to offer surgery or not. Secondly, when experts (the operating surgeon and/or neuroradiologist) read HRCTs in cases of suspected otosclerosis, they identify more cases than a general radiology service alone.

Sensitivity of High-Resolution Computed Tomography in Otosclerosis Patients undergoing Primary Stapedotomy.
Maxwell AK, Shokry MH, Master A, Slattery WH.
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Lucy Dalton

University Hospitals Birmingham, UK.

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