Can High-Resolution Computed Tomography Detect a Therapeutic Response to Medical Treatment in a Patient With Otosclerosis?

Jung, Matthew; WippoldII, Franz J.; Goebel, Joel A.

doi:10.1097/mao.0000000000000863

Cited by 2 publications

(3 citation statements)

References 5 publications

(5 reference statements)

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“…While the two sequential scans were performed using different techniques (high‐resolution CT vs. cone beam CT) the post‐treatment images were judged to represent a clear change in bone density by senior neuroradiology staff. These scans confirm the findings by Jung and colleagues who recently reported a similar case of radiologic improvement in mineralization in a patient with otosclerosis treated with bisphosphonates …”

Section: Discussionsupporting

confidence: 90%

“…While panels C and D show axial cuts demonstrating lucencies around the cochlea in 2005 (white arrow heads), these same areas appear more mineralized post treatment (D and D') in 2012. A similar effect was reported recently in a case by Jung et al33…”

supporting

confidence: 91%

“…These scans confirm the findings by Jung and colleagues who recently reported a similar case of radiologic improvement in mineralization in a patient with otosclerosis treated with bisphosphonates. 33 The shortcomings of this study are multifold, including the limited number of patients treated, its retrospective nature, and lack of true controls. It does, however, build upon results from our previous publication 7 and extends the follow-up period to up to 9 years.…”

Section: Discussionmentioning

confidence: 98%

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Third‐generation bisphosphonates for cochlear otosclerosis stabilizes sensorineural hearing loss in long‐term follow‐up

Jan

Remenschneider

Halpin

et al. 2017

Laryngoscope Investig Oto

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ObjectiveTo assess long‐term hearing outcomes in patients treated with third‐generation bisphosphonates for otosclerosis‐related progressive sensorineural hearing loss (SNHL).Study DesignRetrospective case series reviewMethodsWe performed a retrospective case series review of patients with otosclerosis and progressive SNHL. Patients were treated with either risedronate or zoledronate after a diagnosis of otosclerosis with a significant SNHL component. Bone conduction pure tone threshold averages (BC‐PTAs) and word recognition scores (WRS) before and after bisphosphonate administration in long‐term follow‐up was analyzed. Significant change in BC‐PTA was defined as greater than 10dB or between 4% and 18% in WRS based on binomial variance.ResultsSeven patients were identified and 14 ears met inclusion criteria. Three patients were female and the mean age was 48.3 ± 10.3 years. The mean duration between treatment with bisphosphonate administration and long‐term post‐treatment follow‐up audiometry was 87.6 ± 18.3 months, with a range of 61.6 to 109.1 months and median of 89.2 months. Analysis using BC‐PTA and WRS demonstrated that 11 ears remained stable while 2 improved and 1 worsened. No patient experienced any major complication as the result of bisphosphonate therapy.ConclusionTreatment with third‐generation bisphosphonates is associated with stability in otosclerosis‐related sensorineural hearing over 5‐ to 9‐year period. These results suggest that such medications may prevent the progression of SNHL in patients with otosclerosis.Level of Evidence4 (Case series).

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Section: Discussionsupporting

confidence: 90%

supporting

confidence: 91%

Section: Discussionmentioning

confidence: 98%

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Third‐generation bisphosphonates for cochlear otosclerosis stabilizes sensorineural hearing loss in long‐term follow‐up

Jan

Remenschneider

Halpin

et al. 2017

Laryngoscope Investig Oto

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Four-point impedance as a biomarker for bleeding during cochlear implantation

Bester

Razmovski

Collins

et al. 2020

Sci Rep

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Cochlear implantation has successfully restored the perception of hearing for nearly 200 thousand profoundly deaf adults and children. More recently, implant candidature has expanded to include those with considerable natural hearing which, when preserved, provides an improved hearing experience in noisy environments. But more than half of these patients lose this natural hearing soon after implantation. To reduce this burden, biosensing technologies are emerging that provide feedback on the quality of surgery. Here we report clinical findings on a new intra-operative measurement of electrical impedance (4-point impedance) which, when elevated, is associated with high rates of postoperative hearing loss and vestibular dysfunction. In vivo and in vitro data presented suggest that elevated 4-point impedance is likely due to the presence of blood within the cochlea rather than its geometry. Four-point impedance is a new marker for the detection of cochlear injury causing bleeding, that may be incorporated into intraoperative monitoring protocols during CI surgery. The preservation of cochlear structure and residual functional hearing has become the standard of care for cochlear implantation (CI). Hearing preservation is important to facilitate combined electrical and acoustic stimulation of the cochlea, as this improves speech recognition in noise and music appreciation 1-4. Cochlear structural preservation will ensure that the ear is ready for future, regenerative therapies 5,6. Structural and functional preservation of the cochlea depends not only upon the electrode design, but also the surgery. Electrodes must be introduced into the cochlea without causing injury. Until recently, technologies have not existed to guide the surgeon during the implant procedure; the operation has been conducted "blind" without the provision of feedback. Over recent years, we and others have begun to monitor cochlear function during cochlear implantation 7-10 , using the CI's own electrodes to monitor the electrophysiological response of the ear to acoustic stimulation. This technique, known as electrocochleography, has provided valuable information to guide surgeons during the operation; if the electrophysiological response is preserved during surgery, residual hearing is better after implantation 7-10. This paper is motivated by a desire to increase the scope of intraoperative monitoring during CI surgery. Current methods allow real-time detection of cochlear dysfunction, but these do not assess cochlear injury directly. Here we report on a method that has this potential. We have monitored "four-point" electrical impedance (4PI) from the implant's intracochlear electrodes during CI surgery. This impedance measurement is acquired by passing current between two outer electrodes whilst the voltage (from which the impedance may be inferred) is measured between two inner electrodes (Fig. 1A). The method is believed to assess the bulk impedance between the two inner electrodes, and has been used to differentiate between tissue and fluid ...

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Can High-Resolution Computed Tomography Detect a Therapeutic Response to Medical Treatment in a Patient With Otosclerosis?

Cited by 2 publications

References 5 publications

Third‐generation bisphosphonates for cochlear otosclerosis stabilizes sensorineural hearing loss in long‐term follow‐up

Third‐generation bisphosphonates for cochlear otosclerosis stabilizes sensorineural hearing loss in long‐term follow‐up

Four-point impedance as a biomarker for bleeding during cochlear implantation

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