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Symons and Fanning Classification in Otosclerosis and its Relation to Audiologic Parameters, Stapes Footplate
Abstract:
Introduction Otosclerosis is a clinical diagnosis despite mostly performed preoperative imaging. Radiological classifications and findings correlate heterogeneously with audiometric parameters. The objective of this study was to investigate the inter- and intrarater reliability between two raters of different departments regarding the widely used Symons and Fanning Classification (SFC) and correlate this with further radiological features and audiometric parameter. Methods This was a retrospective data analysis conducted on 63 surgical confirmed otosclerotic ears from 56 patients in a single tertiary referral center. Radiological classification and findings were assessed independently by two investigators, a neuroradiologist and ear-, nose and throat specialist, from a preoperative cone beam computed tomography. Inter- and intrarater reliability of the Symons and Fanning classification and its correlation were compared with hearing level, round window involvement, and stapes footplate thickness. Results Interrater reliability slightly increased over a six-month period and was considered to be weak at both time points. There was no correlation between the SFC of each rater, between the rater matches and the hearing level. Round window involvement was seen in 16% (10/63) of patients and showed no association with preoperative hearing level or audiometric outcome. Higher grading according to the SFC revealed no association with stapes footplate thickness. Conclusion The reproducibility of the SFC on cone beam computed tomography (CBCT) has found to be limited when grading was performed independently by two specialists from different disciplines. No significant associations were observed between radiologic staging and stapes footplate thickness, and in relation to hearing level or round window involvement. The rater or timepoint was no decisive factor. These findings indicate that the predictive value of the classification for preoperative audiologic counselling remains conditionally applicable.