Magnetic Resonance Imaging as a Useful Tool in the Evaluation of Clinical Treatment of Otospongiosis

Objectives: Evaluate the applicability of magnetic resonance imaging (MRI) as a method for monitoring the activity of otospongiotic lesions before and after clinical treatment. Methods: Prospective, randomized, controlled, double‐ blind study involving 31 patients with clinical, audiometric, and tomographic diagnosis of otosclerosis. If computed tomography (CT) demonstrated active lesions, these patients underwent (MRI) in order to detect otospongiotic foci, seen as areas of gadolinium enhancement. Patients were divided into three groups and received treatment with placebo, alendronate sodium, or sodium fluoride for 6 months. After this period, clinical and audiometric evaluations and a second MRI were performed. The MRIs were evaluated by both a neuroradiologist and an otolaryngologist in a subjective (visual) and objective (using specific eFilm Workstation software) manner. Outcomes were assessed by comparing the MRI, clinical, and audiometric evaluations in the pre‐ and post‐treatment periods. Results: Otospongiosis was most predominantly identified in the region anterior to the oval window (RAOW), and this site was reliable for comparing pre‐ and post‐treatment scans. The patients in the alendronate and sodium fluoride groups had MRI findings that suggested a decrease in activity of otospongiotic lesions, more relevant in the alendronate group. These findings were statistically significant for both subjective and objective MRI evaluations. Conclusions: MRI shows higher sensitivity for detecting reduction in inflammatory activity of otospongiosis compared to clinical and audiometric findings. The objective MRI evaluation was the most accurate method of monitoring clinical treatment response in otospongiosis.