Postinflammatory ossicular fixation: CT analysis with surgical correlation.

Abstract

Postinflammatory ossicular fixation is a common problem encountered by the otologic surgeon upon exploration because of conductive hearing loss in patients with chronic otitis media. These nonotosclerotic noncongenital lesions take three pathologic forms: fibrous tissue fixation (chronic adhesive otitis media), hyalinization of collagen (tympanosclerosis), and new bone formation (fibro-osseous sclerosis). Fibrous tissue fixation appears on CT as nonbony, noncalcific soft-tissue debris encasing some or all of the ossicular chain. Tympanosclerosis appears as unifocal or multifocal punctate or weblike calcifications in the middle ear cavity or on the tympanic membrane. This debris may be in direct apposition to the ossicular chain or may replace the suspensory ligaments in symptomatic patients. New bone formation has been identified only in the attic and is the least common manifestation. Thick bony webs or generalized bony encasement may be present at CT. More than 300 patients with the clinical diagnosis of chronic otitis media have been examined. This study encompasses 23 proved cases.

The Correlation of Temporal Bone CT With Surgery Findings in Evaluation of Chronic Inflammatory Diseases of The Middle Ear

“…With spiral CT he detected tympanosclerosis in 10 (3.3%) of 300 patients with chronic otitis media. According to Swartz foci of tympanosclerosis appear as punctate or lattice like masses with calcium density (23). In his study Dr. Eralp could not detect 2 tympanosclerosis cases with CT which were diagnosed clinically and surgically (24).…”

External and middle ear diseases: radiological diagnosis based on clinical signs and symptoms

“…Post-inflammatory ossicular chain fixation (PIOF) is a common problem in patients with conductive hearing loss [25]. On CT images, three distinctive forms of PIOF can be evaluated:

Presence of fibrous tissue , usually in the niche of oval window, forming a so-called “peristapedial tent” (Fig.

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“…In the setting of chronic middle ear inflammation, cholesteatomas arise as the result of tympanic membrane retraction or perforation [24, 25]. …”

Malleus head fixation: histopathology revisited

“…Clinically, the disease presents in the form of either unilateral or, more rarely, bilateral progressive conductive hearing loss with an intact tympanic membrane [1]. The diagnosis is made at the time of surgery or with the help of preoperative high-resolution CT scans of the temporal bones [4]. Some histopathologic studies [5,6] have been performed to reveal the histologic nature of MHF and confirmed the tympanosclerotic or otosclerotic origin of the fixation.…”