Clinical Relevance of temporal bone CBCT before intratympanic application of corticosteroids

Introduction Intratympanic application of corticosteroids is a well established option in the treatment of sudden sensorineural hearing loss. Applicated drugs are assumed to diffuse through the round window (RW) membrane into the inner ear. The question arises, whether pre-therapeutic radiologic imaging is necessary to detect morphologic abnormalities of the tympanic cavity.

Methods In total, 27 patients with regular otomicroscopic findings received CBCT scans of the temporal bones (Xoran MiniCAT, Xoran Technologies, USA; slice thickness of 0.3 mm) before application of intratympanic corticosteroids in 2018. Imaging was retrospectively analyzed on the basis of a standardized questionnaire (e.g. secondary membranes at the RW, bony overhangs).

Results There was a well pneumatized mastoid in 17 cases (63 %) and a well ventilated middle ear in 25 cases (93 %). We found bony overhangs at the RW in 7 cases (26 %) and obstructing soft tissue in 4 cases (15 %). Secondary membranes at the RW were seen in one case (15 %). High riding jugular vein bulbs nor cochlear dysplasias were seen.

Conclusion In nearly all cases we detected morphologic variances, which possibly interact with diffusion processes of the drug into the inner ear. Clear recommendations on pretherapeutic imaging in intratympanic treatments cannot be made. From a medicolegal point of view we however recommend diagnostic imaging.

Poster-PDF A-1584.PDF

Publication History

Article published online:
10 June 2020