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This is a patient who had conductive hearing loss and

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was a young adult. So for conductive hearing loss,

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we want to make sure that we don't have problems

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with the external auditory canal or middle ear.

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Since otitis media is the most common source of conductive

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hearing loss. In this case, we see the normal ossicles,

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we see the normal stapes.

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However, when we are looking at the stapes,

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which is seen here, and then we look at our vestibule,

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we notice a little area of bone that looks demineralized.

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It should be as bright as that around the cochlea.

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And this small area of demineralized bone represents

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the phenomenon that is seen in otospongiosis.

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So this subtle area of demineralized bone,

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which is just adjacent to the anterior crus of the

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stapes, represents fenestral otospongiosis.

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I'm going to magnify this a little bit more.

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Here we have the stapes,

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here we have the vestibule.

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Here we have our apical and middle turn of the cochlea,

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and just a little bit of the basal turn of the cochlea.

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This soft tissue right here is the example of fenestral

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otospongiosis that should not be loosened bone.

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It should be the same density as this bone.

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And you can see it on multiple sections here

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in the area of the fistula antiphonestrum.

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And you can see that by virtue of its proximity

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to the anterior limb of the stapes,

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it can cause that conductive hearing loss.

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Now let's look at the contralateral side and let's magnify

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this to the same extent as we had it before.

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And let's see what we see.

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So it's pretty obvious to me

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because right here we have demineralized

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bone that shouldn't be there.

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Vestibule, lateral, semicircular canal, cochlea,

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stapes coming in here. I believe we'll have to scroll,

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but the area of abnormality is this more lucent bone, otospongiosis.

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Again use the term otospongiosis so you know to look for

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more lucent bone. If you use the term otosclerosis,

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you may be mistaken in looking for more dense bone.

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It's not more dense, it's more lucent.

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Why then was it called otosclerosis?

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In the very end stage of disease,

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it will become more dense.

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But that's late stage.

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And nowadays it's treated before it gets to that stage.

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Let's just scroll one more time,

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make sure that we see this numb.

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And this is the area of abnormality in Otospongiosis.

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And right there oh, this is awesome.

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Hold on. I love this too much.

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Let me mark this up for you.

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Why am I excited about this?

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You're seeing the posterior footplate of the stapes.

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You're seeing the anterior footplate of the stapes.

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You're seeing the capitulum of the stapes.

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And you're seeing the spongiotic bone, the otospongiosis,

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right at its junction with the anterior crus of the

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stapes, leading to fixation of the footplate.

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Absence of transmission of the vibrations occurring

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from sound into the inner ear structures,

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hence conductive hearing loss secondary to otospongiosis.

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This made my day.