Availability of audiological evaluation for the differential diagnosis of clinical otosclerosis

Kan, Taichi; Kishimoto, Mayuko; Tsuchiya, Yoshimasa; Ogawa, Tetsuya; Uchida, Yuzo

doi:10.1016/j.anl.2020.03.009

Cited by 6 publications

(3 citation statements)

References 16 publications

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“…As previous studies revealed, the Carhart notch is not exclusive to SF [Dirks and Malmquist, 1969;Dumich and Harner, 1983;Tuz et al, 2000;Linstrom et al, 2001;Kan et al, 2020]. The results of this study also indicated that the Carhart notch was present in only 42.9% patients of the SF group.…”

Section: Discussionsupporting

confidence: 75%

“…Given that the average IA admittance in healthy controls is 0.72 (range, 0.3-1.4) mmho, the admittance in both groups was beyond the reference range [Margolis and Heller, 1987;Wiley et al, 1996]. Almost similar results were presented by Kan et al [2020]; the static compliance in the otosclerosis group was 0.6 cc and that in the incudostapedial disconnection groups was 1.2 cc. These findings are also supported by the results of a study performed several decades ago [Jerger et al, 1974].…”

Section: Discussionmentioning

confidence: 76%

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Diagnostic Value of the Air-Bone Threshold Gap in Stapes Fixation

Cheon

Kim

et al. 2023

Audiol Neurotol

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Introduction: The Carhart notch is a well-known sign of stapes fixation. However, previous studies have reported that the Carhart notch is not specific to stapes fixation and is also present in other middle ear diseases. Therefore, this study investigated the diagnostic value of threshold gap between air conduction and bone conduction (ABG) for stapes fixation, instead of the bone conduction dip representing the Carhart notch. Methods: A total of 199 ears that underwent exploratory tympanotomy were enrolled in this retrospective study. They were categorized into three groups according to surgical findings: stapes fixation (SF), other ossicle fixation (OF), and chain disconnection (CD). Preoperative pure-tone audiograms and impedance audiograms were compared between the groups. Results: The incidence of the Carhart notch did not differ between the groups. The ABG at 2,000 Hz showed a good diagnostic performance for distinguishing between the SF and CD groups (area under the curve, AUC = 0.816, p < 0.001), but poor performance for distinguishing between the SF and OF groups (AUC = 0.662, p = 0.003). Bone conduction at 2,000 Hz showed a moderate performance for distinguishing between the SF and CD groups (AUC = 0.707, p < 0.001) and did not show statistically significant results for distinguishing between the SF and OF groups (AUC = 0.594, p = 0.080). The tympanic membrane compliance was significantly higher in the CD group than in the SF group (p = 0.001). Conclusions: The Carhart notch was not a specific finding of SF. The sensitivity and specificity of ABG ≤15 dB at 2,000 Hz for distinguishing between SF and CD were 60.4% and 89.2%, respectively. To prepare for surgical interventions in patients with conductive hearing loss but a normal tympanic membrane, clinicians should comprehensively consider these results.

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Section: Discussionsupporting

confidence: 75%

Section: Discussionmentioning

confidence: 76%

Diagnostic Value of the Air-Bone Threshold Gap in Stapes Fixation

Cheon

Kim

et al. 2023

Audiol Neurotol

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“…In otosclerosis, the affected ear will lack reflexes with both ipsilateral and contralateral stimulations. Conversely, present ARs in the affected ear indicate a mobile stapes footplate and ossicular chain, thus allowing practitioners to screen for other potential causes of conductive hearing loss (18,19). In their article on the use of AR to screen for TMW disorders in stapedectomy candidates, Hong et al (19) found that screening with AR combined with TMW symptoms yielded a 94% positive predictive value and a 71% negative predictive value for an ossicular etiology for hearing loss.…”

Section: Discussionmentioning

confidence: 99%

Preoperative Evaluation of Otosclerosis: A National Survey of Otologists

Doerfer

Sioshansi

et al. 2022

Otol Neurotol

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Main Outcome Measures: Percent of respondents performing preoperative testing with acoustic reflexes (ARs), electrocochleography, vestibular evoked myogenic potentials, and computed tomography (CT). Further analysis of those not ordering routine CT to determine whether imaging would be ordered for previous ear surgery, vestibular complaints, childhood hearing loss, AR inconsistent with otosclerosis, possible advanced otosclerosis, or atypical complaints, including autophony. Further subgroup analysis based on years in practice and practice setting (private versus academic). Results: Most respondents (56.5%) had practiced more than 15 years and worked in academic settings (69.4%). Rates of routine use of preoperative AR, vestibular evoked myogenic potential, and electrocochleography were 80, 4.7, and 0%, respectively. There were no significant differences based on time in practice or practice settings. For CT, 35.3% reported routine use with a statistically significant difference between academic and private practice respondents (42.4% versus 19.2%, p = 0.040). For CT contingent on specific clinical factors, only AR inconsistent with otosclerosis showed a statistically significant difference between academic and private practice providers (85.3% versus 57.1%, p = 0.020). Conclusion: Most otologists routinely obtain AR before stapedectomy. Academic providers more commonly order CT routinely and for AR inconsistent with otosclerosis. Most respondents not ordering routine CT ordered imaging in specific clinical scenarios. Overall, there is a high level of consistency in preoperative testing regardless of practice setting or time in practice.

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