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A, Stenver multiplanar reformation CT in a 55-year-old woman with mixed hearing loss shows findings of lateralized piston syndrome. The piston is in the oval window, but no vestibular penetration (thin arrow) is noted. Note piston lateralization to the tympanic membrane (thick arrow). B, Poschl MPR (same patient as in A) shows the piston traversing the expected location of the incus long process, which is eroded (arrow).
