0:00

I'd like to show this next case of bilateral

0:04

fenestral otospongiosis.

0:06

Here we have, on the right side, a patient who has

0:12

an area of demineralized bone in the fissula ante fenestram,

0:17

anterior to the vestibule and oval window.

0:21

And we have just a faint view of the stapes' footplate, here.

0:27

Again, we use the term otospongiosis instead

0:31

of its synonym otosclerosis,

0:35

to emphasize that this is spongiotic demineralized bone,

0:40

not sclerotic hyperdense bone.

0:43

This patient had conductive hearing loss,

0:46

secondary to the fixation of the stapes.

0:49

What is the recourse?

0:50

Well, as you can see on this left hand side,

0:54

which was the more affected side,

0:57

the patient has a structure which

1:00

is leading to the oval window,

1:04

which appears more dense than one would

1:07

expect for a normal stapes.

1:11

Here is the vestibule with the oval window.

1:15

Here is this abnormal structure.

1:18

And what this represents is what is known as a PORP.

1:22

It's a Partial Ossicular Replacement Prosthesis.

1:27

This is a prosthesis for the stapes,

1:30

and it's a single piston prosthesis that will communicate

1:35

with the incus and lead to improved transmission of the

1:43

vibrations of sound into the perilymph and the endolymph.

1:48

So, this is one of the ways that one can treat patients

1:52

who have otospongiosis with a stapes prosthesis,

1:56

if the issue is purely fixation of the stapes.

2:00

Let me just point out the spongiotic bone

2:04

in this patient's symptomatic side.

2:07

So, this area where the bone

2:09

is a little bit more lucent, right here,

2:12

as subtle as this may seem,

2:14

this is how we make the diagnosis of otospongiosis.

2:18

This area of bone,

2:20

which is more lucent than the area

2:23

typically around the cochlea,

2:25

represents the otospongiosis.

2:29

Here is the malleus and incus,

2:32

the long process of the incus communicating right there with

2:38

the partial ossicular prosthesis, stapes prosthesis.