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Imaging findings of isolated congenital middle ear malformation on high-resolution computed tomography
Xiaoxi Chen1, Jiajie Tian1, Jing Wen1
1Department of Radiology, Affiliated Hospital of Zunyi Medical University, Zunyi, Guizhou, China.
Insights
High-resolution computed tomography (HRCT) effectively detects many congenital middle ear malformations (CMEM), including ossicular defects and facial nerve issues. However, HRCT has limitations in visualizing certain joint fusions and fixations.
Area of Science:
- Otorhinolaryngology
- Medical Imaging
- Radiology
Background:
- Congenital middle ear malformation (CMEM) presents unique diagnostic challenges.
- Accurate preoperative imaging is crucial for surgical planning in CMEM cases.
Purpose of the Study:
- To analyze the high-resolution computed tomography (HRCT) imaging features of isolated congenital middle ear malformation (CMEM).
- To evaluate the diagnostic capabilities of HRCT for various CMEM anatomical abnormalities.
Main Methods:
- Retrospective collection of 37 patients with surgically confirmed isolated CMEM (January 2018 - June 2023).
- Analysis of preoperative HRCT findings by neuroradiologists correlated with intraoperative findings.
- Evaluation of HRCT's ability to detect specific ossicular and facial nerve abnormalities.
Main Results:
- HRCT visualized common defects including incudostapedial joint, incus long process, and stapes superstructure abnormalities.
- High detection rates for stapes superstructure defects (96.0%) and oval window atresia (85.7%) were observed.
- HRCT demonstrated limitations in detecting incudomalleolar joint fusion (41.7%) and could not visualize soft tissue pseudo-connections or stapes footplate fixation.
Conclusions:
- Preoperative HRCT is a valuable tool for diagnosing isolated CMEM, particularly for ossicular and facial nerve abnormalities.
- HRCT excels at identifying ossicular defects, incudostapedial joint discontinuity, oval window atresia, and facial nerve anomalies.
- Limitations include lower detection rates for incudomalleolar joint fusion and inability to visualize soft tissue pseudo-connections or stapes footplate fixation.
Purpose:
This study aims to analyze the imaging features of isolated congenital middle ear malformation (CMEM) on high-resolution computed tomography (HRCT).
Methods:
We retrospectively collected patients with surgically confirmed diagnosis of isolated CMEM in our hospital between January 2018 and June 2023. All patients underwent HRCT before surgery. The preoperative imaging findings were analyzed by neuroradiologists with full knowledge of the intraoperative findings.
Results:
37 patients were included in this study, including 25 males and 12 females, with a median age of 16 years. A total of 44 ears underwent surgery. The most commonly affected structures were incudostapedial joint, incus long process, and stapes superstructure, followed by stapes footplate, oval window, incudomalleolar join, tympanic segment of the facial nerve canal, incus body, incus short process and malleus. All incus defect/hypoplasia/malposition, stapes superstructure deformity, malleus deformity, incudostapedial joint discontinuity, and facial nerve canal malposition/abnormal bifurcation could be observed on HRCT. Additionally, 96.0% of stapes superstructure defect, 85.7% of oval window atresia, and 41.7% of incudomalleolar joint fusion, could be visualized on HRCT. HRCT could not show ossicular soft tissue pseudo-connection and stapes footplate fixation.
Conclusions:
Preoperative HRCT is an important tool for diagnosing isolated CMEM. The advantages of HRCT lie in its ability to detect ossicular defects/deformities, incudostapedial joint discontinuity, oval window atresia, and facial nerve abnormalities. However, it has a low detection rate for incudomalleolar joint fusion and cannot show ossicular soft tissue pseudo-connection and stapes footplate fixation.
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