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Patient undergoing HEENT workup.

Our appreciation is extended to Dr. Bharat Kakarala,
Indiana University Department of Radiology,
for contributing this case.

History:  Patient undergoing HEENT workup.


Review the image below. Can you select the most likely clinical presentation?

Hearing loss.Fever and mental status changes.Pulastile tinnitus.Epistaxis.Cranial nerve palsey.Image
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Patient undergoing HEENT workup.



Same image again shown below. Can you determine the laterality of the hearing loss?

Left side.Right side.Bilateral.Image
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Patient undergoing HEENT workup.



Based on the finding depicted below, can you select the actual diagnosis?

Paget's disease.Fibrous dysplasia.Fenestral otosclerosis.Cochlear otosclerosis.Cholesteatoma.Image
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Patient undergoing HEENT workup.

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Findings:  Left-sided area of lucency seen along anterior portion of oval window


Differential diagnosis:

  • Fenestral otosclerosis
  • Bony labyrinth infection
  • Tympanosclerosis
  • Paget's disease
  • Fibrous dysplasia
  • Osteoradionecrosis
Diagnosis:  Fenestral otosclerosis
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Patient undergoing HEENT workup.


Key points - Fenestral Otosclerosis:
 

  • Most common presenting symptom is progressive conductive hearing loss, followed by tinnitus
  • Occurs in 1% of the population
  • In patients with conductive hearing loss 90% of time fenestral otosclerosis is the cause
  • 85% fenestral otosclerosis vs. 15% cochlear otosclerosis is the typical breakdown for types of otosclerosis
  • Fenestral otosclerosis begins at fistula ante fenestram and spreads posteriorly along oval window to the round window
  • The disease process continues to spread to the otic capsule
  • The active process eventually fixes the stapes footplate in the oval window and ultimately results in conductive hearing loss

References: 

  1. Statdx.  Author: Ric Harnsberger MD, StatDx - Fenestral Otosclerosis.
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Patient undergoing HEENT workup.


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