Agreement between HRCT Imaging and Intraoperative Measurements in Predicting Stapedotomy Prosthesis Length in Otosclerosis Patients

Document Type : Original

Authors

1 Sinus and Surgical Endoscopic Research Center, Faculty of Medicine, Mashhad University of Medical Sciences, Iran.

2 Department of Radiology, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.

3 Student Research Committee, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran

4 Clinical Research Development Unit, Ghaem Hospital, Mashhad University of Medical Sciences, Mashhad, Iran.

10.22038/ijorl.2025.81759.3749

Abstract

Introduction:
This study aimed to evaluate the accuracy of preoperative high-resolution computed tomography (HRCT) imaging in measuring the distance from the long process of the incus to the footplate and its potential for predicting the optimal prosthesis length required for stapedotomy in patients with otosclerosis.
Materials and Methods:
This cross-sectional study included fifty patients scheduled for primary stapedotomy. A radiologist obtained and reconstructed preoperative HRCT scans of the temporal bone to measure the distance from the long process of the incus to the oval window in both axial and coronal views. These HRCT-derived measurements were then compared with intraoperative measurements performed by an otolaryngologist. The agreement between the two methods was assessed using correlation and Bland-Altman analysis.
Results:
The mean distances measured by HRCT and intraoperatively were 4.15mm and 4.27mm, respectively. A strong and statistically significant correlation (r=0.928, P<0.001) was observed between the two approaches, indicating a robust association. The Bland-Altman analysis revealed a mean bias of 0.11±0.07mm, with limits of agreement (LoAs) ranging from -0.02 to 0.26 mm, and no points exceeding the 95% LoAs. The maximum potential error between the two measurement methods was 0.28mm, suggesting that HRCT imaging can reliably predict prosthesis length. In a stratified analysis based on the surgical distance (≤4 mm [N=11], 4.25mm [N=25], ≥4.5mm [N=13]), good agreement was maintained in the Bland-Altman analysis.
Conclusion:
Preoperative HRCT imaging may be a valuable tool for accurately predicting the required prosthesis length prior to stapedotomy in otosclerosis patients.

Keywords

Main Subjects

References

  1. Declau F, Van Spaendonck M, Timmermans J, Michaels L, Liang J, Qiu J, et al. Prevalence of histologic otosclerosis: an unbiased temporal bone study in Caucasians. Otosclerosis and Stapes Surgery. 65: Karger Publishers; 2007. p. 6-16.
  2. Parving YS, Agnete. Clinical otosclerosis, prevalence estimates and spontaneous progress. Acta oto-laryngologica. 1999;119(4):468-72.
  3. Eza-Nuñez P, Manrique-Rodriguez M, Perez-Fernandez N. Otosclerosis among patients with dizziness. Rev Laryngol Otol Rhinol (Bord). 2010; 131(3):199-206.
  4. Uppal S, Bajaj Y, Rustom I, Coatesworth AP. Otosclerosis 1: the aetiopathogenesis of otosclerosis. Int J Clin Pract. 2009;63(10):1526-30.
  5. Nourollahian M, Irani S. Bilateral schwartze sign, decision-making for surgery. Iran J Otorhinolaryngol. 2013;25(73):263.
  6. Salomone R, Riskalla PE, Vicente Ade O, Boccalini MC, Chaves AG, Lopes R, et al. Pediatric otosclerosis: case report and literature review. Braz J Otorhinolaryngol. 2008;74(2):303-6.
  7. Virk JS, Singh A, Lingam RK. The role of imaging in the diagnosis and management of otosclerosis. Otol Neurotol. 2013;34(7):e55-60.
  8. de Oliveira Penido N, de Oliveira Vicente A. Medical Management of Otosclerosis. Otolaryngol Clin North Am. 2018;51(2):441-52.
  9. Gros A, Vatovec J, Zargi M, Jenko K. Success rate in revision stapes surgery for otosclerosis. Otol Neurotol. 2005;26(6):1143-8.
  10. Gosselin E, Elblidi A, Alhabib SF, Nader ME, Wanna G, Saliba I. Predictable prosthesis length on a high-resolution CT scan before a stapedotomy. Eur Arch Otorhinolaryngol. 2018;275(9):2219-26.
  11. Kösling S, Brandt S, Bloching M, Böhme S. [Indications of HR-CT in the early postoperative phase of stapedotomy]. Rofo. 2004;176(8):1122-6.
  12. Bajaj Y, Uppal S, Bhatti I, Coatesworth AP. Otosclerosis 3: the surgical management of otosclerosis. Int J Clin Pract. 2010;64(4):505-10.

 

 

 

 

 

  1. Bakhos D, Lescanne E, Charretier C, Robier A. A review of 89 revision stapes surgeries for otosclerosis. Eur Ann Otorhinolaryngol Head Neck Dis. 2010;127(5):177-82.
  2. Thiel G, Mills R. Persistent and recurrent conductive deafness following stapedotomy. J Laryngol Otol. 2011;125(5):460-6.
  3. Babighian GG, Albu S. Failures in stapedotomy for otosclerosis. Otolaryngol Head Neck Surg. 2009; 141(3):395-400.
  4. Adedeji TO, Indorewala S, Indorewala A, Nemade G. Stapedotomy and its effect on hearing - our experience with 54 cases. Afr Health Sci. 2016; 16(1):276-81.
  5. Schimanski G, Schimanski E, Berthold MR. Diagnostic findings in stapes revision surgery--a retrospective of 26 years. Otol Neurotol. 2011; 32(3): 373-83.
  6. Alzhrani F, Mokhatrish MM, Al-Momani MO, Alshehri H, Hagr A, Garadat SN. Effectiveness of stapedotomy in improving hearing sensitivity for 53 otosclerotic patients: retrospective review. Ann Saudi Med. 2017;37(1):49-55.
  7. Gosselin E, Elblidi A, Alhabib SF, Nader M-E, Wanna G, Saliba I. Predictable prosthesis length on a high-resolution CT scan before a stapedotomy. European Archives of Oto-Rhino-Laryngology. 2018;275(9):2219-26.
  8. Battista RA, Wiet RJ, Joy J. Revision stapedectomy. Otolaryngol Clin North Am. 2006; 39(4): 677-97, v-vi.
  9. Lippy WH, Battista RA, Berenholz L, Schuring AG, Burkey JM. Twenty-year review of revision stapedectomy. Otol Neurotol. 2003;24(4):560-6.
  10. Eftekharian A, Roozbahany NA, Shomali S. The distance between stapedial footplate and incus in otosclerosis surgery. J Otol. 2015;10(1):18-20.
  11. Silverstein H, Bendet E, Rosenberg S, Nichols M. Revision stapes surgery with and without laser: a comparison. Laryngoscope. 1994; 104(12):1431-8.
  12. Han WW, Incesulu A, McKenna MJ, Rauch SD, Nadol JB, Jr., Glynn RJ. Revision stapedectomy: intraoperative findings, results, and review of the literature. Laryngoscope. 1997; 107(9):1185-92.
  13. Prasad SG, Radhakrishnan S, Devarajan E, Thomas RS, Varghese L. Role of HRCT Temporal Bone in Predicting Surgical Difficulties Encountered in Fenestral Otosclerosis Surgery. Indian J Otolaryngol Head Neck Surg. 2022; 74 (Suppl 1): 581-8.
  14. Kwok P, Fisch U, Strutz J, May J. Stapes surgery: how precisely do different prostheses attach to the long process of the incus with different instruments and different surgeons? Otol Neurotol. 2002; 23(3):289-95.
Iranian Journal of Otorhinolaryngology
Volume 37, Issue 4
July and August 2025
Pages 205-211

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