| Objective: Temporal bone CT is highly sensitive to the radiological diagnosis of otosclerosis,which can indicate the location and extent of the lesion.The location and extent of the foci are related to the effect of stapes surgery for otosclerosis.This study retrospectively analyzes the HRCT imaging manifestations of otosclerosis.To study the correlation between the focal location and audiometry outcomes.Methods: Collected complete clinical data of 75 patients(86 ears)diagnosed as "otosclerosis" in the Department of Otorhinolaryngology Head and Neck Surgery of the First Affiliated Hospital of Guangxi Medical University from June 2012 to January 2021.Including all preoperative temporal bone HRCT(at 0.4mm,0.625 mm,0.8mm cuts),otoscope,acoustic immittance,and pure tone audiometry outcomes.By observing HRCT otosclerosis low-density lesions,we assess the reliability of HRCT in diagnosing otosclerosis,and analyze the impact of different lesions on surgery.Then,According to the Veillon classification method,the otosclerosis was classified by imaging and combined with the clinical characteristics.All patients were divided into four groups: no hypodensity location group,anterior fenestral hypodensity group,thickening of the footplate hypodensity group,and mixed hypodensity group,The preoperative and postoperative hearing of the patients in each group were compared and analyze the correlation between the lesion involved and the hearing.Results:The preoperative HRCT results showed that 78 ears had otosclerosis lesions,including spot,strip,or small low-density lesions in the anterior fissure,stapes floor,and around the cochlea.The positive rate was90.7%(78/86),Among them63 cases(84.0%,63/78)showed bilateral findings.Among the CT positive ears,the most common lesion involvedanterior fenestral hypodensities(92.3%,72/78),followed by thickening of the footplate(23.1%,18/78),pericochlear(19.2%,15/78),promontory(19.2%,15/78),round window(12.8%,10/78),facial nerve osseous canal(9.0%,9/78),internal auditory canal(9.0%,7/78).Preoperative HRCT combined with clinical characteristics were divided into groups: no hypodensity location group(8/86),anterior fenestral hypodensity group(48/86),thickening of the footplate hypodensity group(15/86),extensive hypodensity group(15/86).There was no significant difference in the average AC and BC threshold between the four groups before and after surgery,there was no statistical difference between preoperative ABG groups(p>0.05),the difference in postoperative ABG between the four groups was statistically significant(p<0.01).The postoperative ABG of the no hypodensity location group(p=0.038)and the anterior fenestral hypodensity group(p=0.000)was significantly lower than that of the extensive hypodensity group.The postoperative ABG of the anterior fenestral hypodensity group was significantly lower than that of thickening of the footplate hypodensity group(p<0.05).Compared with no hypodensity location group and the anterior fenestral hypodensity group,the thickening of the footplate hypodensity group and the extensive hypodensity group had higher air and bone conduction thresholds before and after the operation of the affected ear.The incidence of postoperative SNHL was1 patient in anterior fenestral hypodensity group.All other patients had improved hearing to varying degrees.None of the patients experienced severe complications such as intractable vertigo or permanent facial paralysis after the operation.Conclusion:1.HRCT has high sensitivity for the diagnosis of otosclerosis(90.7%),which can accurately display the location and shape of most otosclerosis lesions,and provide important information for preoperative evaluation and surgical scheme selection.2.Preoperative HRCT showed that the ears with thickening of the footplate and extensive otosclerosis are associated with poorer preoperative hearing thresholds and postoperative hearing impovement. |
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