Retrospective Review of Otic Capsule Contour and Thickness in Patients with Otosclerosis and Individuals with Normal Hearing on CT.

BACKGROUND AND PURPOSE: Otosclerosis is commonly identified on CT as a focus of hypodensity in the otic capsule anterior to the oval window. However, otosclerosis can have a sclerotic phase approximating the density of normal bone, making diagnosis challenging. This study assesses differences in otic capsule contour and thickness anterolateral to the anterior margin of the oval window in patients with otosclerosis compared with individuals with normal hearing. MATERIALS AND METHODS: Axial CT of 104 ears with clinically diagnosed otosclerosis and 108 consecutive ears of audiometrically normal individuals were retrospectively reviewed. Two radiologists independently evaluated the pattern of otosclerosis, otic capsule contour, and bone thickness on standardized axial images at the level of the oval window and cochleariform process. Measurements were made from the posterolateral margin of the cochlea to the apex of the otic capsule convex contour just anterolateral to the anterior margin of the oval window. In the absence of a convex contour, the sulcus between the oval window and the cochleariform process was identified, and measurement to the depth of the sulcus was used. Receiver operating characteristic analysis determined the best cutoff value of otic capsule thickness. RESULTS: Mean otic capsule thickness (2 SDs) was 3.08 (0.93) mm and 1.82 (0.31) mm in patients with otosclerosis and individuals with normal hearing, respectively (P < .001), with excellent interobserver agreement. Otic capsule thickness of >2.3 mm had 96.2% sensitivity, 100% specificity, 100% positive predictive value, and 96.4% negative predictive value for otosclerosis. A bulging/convex contour of the otic capsule had 68.3% sensitivity, 98.1% specificity, 97.3% positive predictive value, and 76.3% negative predictive value. CONCLUSIONS: Patients with otosclerosis have significantly thicker bone abutting the oval window than individuals with normal hearing.

Plunging ranula with prestyloid parapharyngeal space, masticator space, and parotid gland extension.

Plunging ranula with prestyloid parapharyngeal space, masticator space, and parotid gland extension. INTRODUCTION: Ranulas develop from mucous extravasation secondary to sublingual gland duct obstruction or trauma. Plunging ranula usually dive into the submandibular space. METHODS: This is the first reported case of a plunging ranula with direct extension to the prestyloid parapharyngeal space, masticator space, and parotid gland with avoidance of the submandibular space. RESULTS: The patient presented with a tender parotid mass, of which the differential is broad, including parotitis, parotid malignancy, metastatic malignancy, lymphoma, as well as other infectious etiologies. When an intraoral component is not identified, other differential considerations would be thyroglossal duct cyst, branchial cleft cyst, parathyroid cyst, cervical thymic cyst, dermoid cyst, cystic hygroma, or benign teratoma. CONCLUSION: The case is unique due to ranula extension into multiple spaces. For optimal treatment, the sublingual gland along with its tract and contents needs to completely removed.