Case contributed by Azza Elgendy
Diagnosis almost certain


Progressive conductive hearing loss.

Patient Data

Age: 35 years
Gender: Male

There is bilateral left greater than right fenestral and cochlear otospongiosis as manifested by arc-like hypo hypodensities starting at the fissula ante fenestram and surrounding the cochlea and vestibule, extending into the anterior wall of the internal auditory canals.

There is also partial opacification of the basal turn of the left cochlea causing stenosis of the round window niche. 

Case Discussion

This is an advanced case of otosclerosis. There is involvement of fissula ante fenestram, oval window, round window and the otic capsules. The left side is showing both fenestral and cochlear otosclerosis.

Otosclerosis is a disease of the bony labyrinth. It starts at the fissula ante fenestram and spreads posteriorly to involve the oval window and then is called the fenestral type.

If it progresses it will involve the round window, pericochlear region and the otic capsule and then it is called the cochlear type.

This case is very advanced because the lucencies surrounding the otic capsule, and spreading to the anterior wall of the IACs. There is also bony overgrowth of the basal turn of the cochlea obliterating the round window niche.

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