Sensorineural hearing loss and CT abnormalities in otosclerosis: Insights from otopathological specimens

• Otosclerosis is linked to a high rate of Sensorineural Hearing Loss (SNHL). • The prevalence of SNHL we found is higher than earlier reported. • Many otosclerosis cases with sensorineural loss may go undiagnosed, hindering care. • Our study offers insights to support further research in diagnosis and treatment. To identify audiometric profiles of otosclerosis patients and present Computed Tomography (CT) findings with their otopathological correlates using human temporal bone specimens. We analyzed sequential patients diagnosed with otosclerosis at a university hospital. Each patient underwent hearing evaluations and CT scans. We assessed the type and severity of hearing loss and the presence and location of otosclerotic foci. Audiometric results and CT images were compared. Additionally, representative otopathological specimens from the Paparella Otopathology & Pathogenesis Laboratory were examined to understand the impact of otosclerotic foci on cochlear and inner ear structures. The study included 40 patients (25 female, 15 male; mean age 50.9 years, range 24–72). Most patients were white (62.5%), with others being black (35%) or Asian (2.5%). Symptoms typically began at age 36.4 years, with an average disease duration of 14.3 years. Audiometric analysis of 71 ears (excluding 9 previously operated) showed mixed hearing loss in 64.78%, sensorineural loss in 23.94%, conductive loss in 2.81%, and normal hearing in 8.45%. Our data revealed a significantly higher prevalence of sensorineural hearing loss among patients with otosclerosis compared to previous reports. This disparity may be due to our higher diagnostic rate, as CT scans were used for patients with unexplained sensorineural hearing loss, and the longer disease course related to delayed specialist access caused by structural issues in the Brazilian health system. Relevant CT findings are presented and compared with similar otopathology specimens. Our study highlights a higher prevalence of mixed and sensorineural hearing loss in patients with otosclerosis than previously reported, suggesting that otosclerosis may be associated with more significant auditory impairment than commonly recognized. However, given the limitations of our retrospective design and the potential influence of co-morbidities, these findings should be interpreted with caution. 2.