Preoperative Diagnosis of Otosclerosis

Otosclerosis is a unique osseous remodeling disorder of the human temporal bone, which is also considered as a disease of measles virus-associated inflammatory-autoimmune reaction against the middle layer of the otic capsule: globuli interossei. Its preoperative diagnosis is rather difficult, and there is no consensus-based diagnostic protocol with enough high sensitivity and specificity for the clinical confirmation of the disease. On the other hand, the preoperative diagnosis or clinical diagnosis of otosclerosis was potentially important considering several differential diagnostic-, prognostic-, and legal-ethical factors and problems. At this time, combination of various well-defined and new preoperative diagnostic methods might serve a strong clinical suspicion for otosclerosis. This fact might provide the basis of diagnosis and helps to avoid unnecessary stapes surgeries, serious intraoperative complications, and “blinded surgeries”: explorative tympanostomies that are unacceptable for most of the patients with conductive hearing loss. In this chapter, an overview is provided about the potential preoperative diagnostic tools and their specificity and sensitivity levels in case of otosclerosis or non-otosclerotic stapes fixations. Finally, authors recommend a considerable preoperative diagnostic protocol for the confirmation or exclusion of otosclerosis.