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Cross-sectional CT images and clinical records of 47 patients (89 temporal bones) were evaluated for the presence, location, and imaging features of cavitary and noncavitaryotospongiotic plaques, as well as clinical symptoms and complications in those who underwent cochlear implantation. Noncavitaryotospongiotic plaques were present in 86 (97%) temporal bones and cavitary plaques in 30 (35%). Cavitary plaques predominated with increasing age, mostly involving the anteroinferior wall of the internal auditory canal, and their presence was not associated with a higher grade of otospongiosis by imaging or with a specific type of hearing loss. The authors conclude that cavitary plaques occurred in one-third of patients with otospongiosis.