Systematic Reviews
Copyright ©The Author(s) 2017. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Jul 16, 2017; 5(7): 286-291
Published online Jul 16, 2017. doi: 10.12998/wjcc.v5.i7.286
Diagnostic performance of high resolution computed tomography in otosclerosis
Todd Kanzara, Jagdeep Singh Virk
Todd Kanzara, ENT Department, Countess of Chester Hospital, Chester, Cheshire CH2 1UL, United Kingdom
Jagdeep Singh Virk, ENT Department, Royal National Throat, Nose and Ear Hospital, London WC1X 8DA, United Kingdom
Author contributions: Kanzara T drafted the manuscript and performed the literature search; Virk JS assisted with manuscript design, literature search and editing.
Conflict-of-interest statement: Nothing to declare.
Data sharing statement: Technical appendix, statistical code, and dataset available from the corresponding author at Dryad repository, who will provide a permanent, citable and open-access home for the dataset.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Todd Kanzara, LLB (Hons), MRCS (ENT), ENT Department, Countess of Chester Hospital, Liverpool Road, Chester, Cheshire CH2 1UL, United Kingdom. todd.kanzara@nhs.net
Telephone: +44-779-6945100 Fax: +44-124-4365000
Received: January 28, 2017
Peer-review started: February 9, 2017
First decision: April 18, 2017
Revised: May 12, 2017
Accepted: May 30, 2017
Article in press: May 31, 2017
Published online: July 16, 2017
Abstract
AIM

To determine the sensitivity and specificity of high resolution computed tomography (HRCT) in the diagnosis of otosclerosis.

METHODS

A systematic literature review was undertaken to include Level I-III studies (Oxford Centre for Evidenced based Medicine) that utilised HRCT to detect histology confirmed otosclerosis. Quantitative synthesis was then performed.

RESULTS

Based on available level III literature, HRCT has a relatively low sensitivity of 58% (95%CI: 49.4-66.9), a high specificity, 95% (95%CI: 89.9-98.0) and a positive predictive value of 92% (95%CI: 84.1-95.8). HRCT is better at diagnosing the more prevalent fenestral form of otosclerosis but remains vulnerable to inframillimetre, retrofenestral and dense sclerotic lesions, despite the advent of more advanced CT scanners with improved collimation.

CONCLUSION

Whilst the diagnosis of otosclerosis remains largely clinical, HRCT remains the gold standard imaging of choice for the middle ear and serves as a useful adjunct to the clinician, helping to delineate extent of disease and exclude other causes.

Keywords: Otosclerosis, High resolution computed tomography, Otospongiosis, Retrofenestral, Sensitivity, Specificity, Fenestral, Computed tomography

Core tip: Diagnosis of otosclerosis remains clinical and high resolution computed tomography (HRCT) can be a useful adjunct when assessing the extent of disease and excluding other causes. HRCT of the temporal bones has a high specificity and low sensitivity and is particularly vulnerable to inframillimetre lesions.