Helical CT Findings in Patients Who Have Undergone Stapes Surgery for Otosclerosis
Marc T. Williams1,
Denis Ayache2,
Monique Elmaleh1,
Françoise Héran1,
Pierre Elbaz2 and
Jean-Daniel Piekarski1
1
Department of Medical Imaging, Fondation Ophtalmologique Adolphe de
Rothschild, 25 rue Manin, 75940 Paris, France.
2
Department of Otorhinolaryngology, Fondation Ophtalmologique Adolphe de
Rothschild, 75940 Paris, France.
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Fig. 1. —Incremental axial CT scan at level of oval window in 54-year-old
woman with bilateral conductive hearing loss caused by otosclerosis shows
otosclerotic focus as ill-defined hyperdense area (arrow) at anterior
margin of oval window and anterior part of stapes footplate.
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Fig. 2A. —Drawings show principles of surgical treatment of stapedovestibular
otosclerosis. Removal of stapedial arch after incudostapedial disarticulation.
Otosclerotic focus is left in place.
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Fig. 2B. —Drawings show principles of surgical treatment of stapedovestibular
otosclerosis. Stapedectomy with graft interposition. Stapes footplate is
completely removed. Oval window is sealed by a graft. Lateral ring-shaped end
of prosthesis is bound to long process of incus. Medial end of prosthesis is
set against graft and transmits vibrations to perilymphatic fluid.
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Fig. 2C. —Drawings show principles of surgical treatment of stapedovestibular
otosclerosis. Small fenestra stapedectomy with graft interposition.
Fenestration is created in stapes footplate and sealed by graft. Prosthesis is
then inserted as described in B.
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Fig. 2D. —Drawings show principles of surgical treatment of stapedovestibular
otosclerosis. Small fenestra stapedectomy without graft. Small circular
fenestration is performed in footplate. Fenestration is then sealed directly
by medial end of prosthesis.
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Fig. 3. —Coronal CT scout image in 51-year-old man shows correct plane for
oblique reconstructions along axis of prosthesis.
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Fig. 4A. —35-year-old woman with correctly positioned polytetrafluoroethylene
prosthesis. Conventional axial CT scan at level of oval window shows only tip
of prosthesis (arrowhead). It is impossible to know whether
prosthesis is in contact with stapes footplate or slightly separated from
it.
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Fig. 4B. —35-year-old woman with correctly positioned polytetrafluoroethylene
prosthesis. Oblique (B) axial and coronal (C) multiplanar
reconstructions show entire prosthesis (arrowhead). Device is
correctly inserted on long process of incus (arrow); no gap is seen
between footplate plane and tip of prosthesis.
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Fig. 4C. —35-year-old woman with correctly positioned polytetrafluoroethylene
prosthesis. Oblique (B) axial and coronal (C) multiplanar
reconstructions show entire prosthesis (arrowhead). Device is
correctly inserted on long process of incus (arrow); no gap is seen
between footplate plane and tip of prosthesis.
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Fig. 5A. —67-year-old woman with progressive conductive hearing loss occurring
4 years after stapedectomy for stapediovestibular otosclerosis. Conventional
axial CT scan shows tip of prosthesis (arrowhead) apparently in
contact with stapes footplate.
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Fig. 5B. —67-year-old woman with progressive conductive hearing loss occurring
4 years after stapedectomy for stapediovestibular otosclerosis. Oblique axial
reconstruction shows anterior displacement of prosthesis. Gap
(arrowhead) between tip of prosthesis (arrow) and footplate
is clearly visible.
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Fig. 6A. —59-year-old woman with sudden conductive hearing loss recurrence
after head trauma. Conventional axial CT scan shows prosthesis in incorrect
position; linear dense structure (arrow) oriented in sagittal plane
is seen in front of sinus tympani recess.
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Fig. 6B. —59-year-old woman with sudden conductive hearing loss recurrence
after head trauma. Oblique axial (B) and sagittal (C)
reconstructions show complete luxation of prosthesis from long process of
incus and from stapes footplate. Prosthesis (arrow) is located in
posterior part of tympanic cavity.
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Fig. 6C. —59-year-old woman with sudden conductive hearing loss recurrence
after head trauma. Oblique axial (B) and sagittal (C)
reconstructions show complete luxation of prosthesis from long process of
incus and from stapes footplate. Prosthesis (arrow) is located in
posterior part of tympanic cavity.
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Fig. 7. —43-year-old man presenting with conductive hearing loss caused by
postoperative intratympanic fibrosis 18 months after stapedectomy. Prosthesis
is correctly inserted. Oval window recess is filled by soft-tissue mass
(arrow) around medial end of prosthesis, causing hearing
impairment.
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Fig. 8A. —66-year-old woman with progressive conductive hearing loss 11 years
after stapedectomy and prosthesis placement performed because of obliterative
otosclerosis. Oblique axial (A) and coronal (B) reconstructions
show correct location of prosthesis (curved arrow). Oval window
recess is filled by proliferative otosclerotic focus (straight arrow)
that surrounds medial end of prosthesis.
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Fig. 8B. —66-year-old woman with progressive conductive hearing loss 11 years
after stapedectomy and prosthesis placement performed because of obliterative
otosclerosis. Oblique axial (A) and coronal (B) reconstructions
show correct location of prosthesis (curved arrow). Oval window
recess is filled by proliferative otosclerotic focus (straight arrow)
that surrounds medial end of prosthesis.
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Fig. 9A. —60-year-old man with persistent conductive hearing loss 6 months
after stapes surgery. Oblique axial reconstruction shows luxation of
prosthesis (straight arrow) posterior to handle of malleus
(curved arrow).
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Fig. 9B. —60-year-old man with persistent conductive hearing loss 6 months
after stapes surgery. Conventional axial CT scan shows incudomalleal
dislocation with enlargment of articular space (arrow).
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Fig. 10. —32-year-old woman with severe vertigo caused by postoperative
granuloma with resulting displacement of prosthesis. Granuloma presents as
soft-tissue mass (large arrow) in front of posterior part of oval
window. Prosthesis tip (small arrow) is displaced forward by
granuloma.
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Fig. 11A. —35-year-old woman with sensorineural hearing loss and vertigo caused
by intravestibular prostrusion of prosthesis 10 days after stapedectomy.
Oblique axial (A) and coronal (B) reconstructions show
protrusion of prosthesis shaft (arrow) in vestibule.
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Fig. 11B. —35-year-old woman with sensorineural hearing loss and vertigo caused
by intravestibular prostrusion of prosthesis 10 days after stapedectomy.
Oblique axial (A) and coronal (B) reconstructions show
protrusion of prosthesis shaft (arrow) in vestibule.
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