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Understanding Otosclerosis: Diagnosis & Treatment

This document provides an overview of otosclerosis, including its etiology, pathology, clinical presentation, diagnosis, and treatment. Otosclerosis is a hereditary disease where mature bone in the otic capsule is replaced by thicker, more vascular spongy bone. It commonly causes conductive or mixed hearing loss. Diagnosis involves audiological tests showing characteristic patterns of hearing loss. Treatment options include sodium fluoride medication to slow progression, or stapedectomy surgery to restore hearing if conservative measures fail.

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Mariana Cabral
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228 views46 pages

Understanding Otosclerosis: Diagnosis & Treatment

This document provides an overview of otosclerosis, including its etiology, pathology, clinical presentation, diagnosis, and treatment. Otosclerosis is a hereditary disease where mature bone in the otic capsule is replaced by thicker, more vascular spongy bone. It commonly causes conductive or mixed hearing loss. Diagnosis involves audiological tests showing characteristic patterns of hearing loss. Treatment options include sodium fluoride medication to slow progression, or stapedectomy surgery to restore hearing if conservative measures fail.

Uploaded by

Mariana Cabral
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd

Otosclerosis

Introduction
Aetiology
Pathology
Clinical Picture

Examination
Audiological Tests
Differential Diagnosis
Treatment

Otosclerosis
Oto,

sclerosis

Mature lamellar bone is replaced by


unorganized spongy bone of greater
thickness and vascularity

Common

disease, 1: 200
Frequently in fair females
Progressive hearing loss
Familial tendency

Aetiology
Unknown aetiology
Disorder affecting growth of collagen
Many theories:

Genetic
Race
Sex
Age of onset
Pregnancy
Infection
Immune disorder
Trauma
Metabolic
Vascular
Anat./Histological abn of temporal bone

Pathology
Hereditary disease
Disease of otic capsule
Phases of bone resorption & bone
formation
Removal of mature bone by osteoclasts
Replacement by woven bone of more
cellularity, vascularity and thickness

SITES
Any part of temporal
bone
Fistula ante fenestrum
Fistula Post fenestrum
Oval window

Round window
Promontory
Cochlea
B/L sym. Affection

Physiologic Effect

Before

After

Symptoms
Deafness

Tinnitus
Paracusis willisi
Family history
Low modulated voice
Vertigo

Examination
External Ear Examination - Normal
Tympanic Membrane normal
Flemingo pink blush
Eustachian Tube patent
Blue sclera & fragile bone as part of Vonder Hoeve syndrome

Tuning Fork test


Rinnes

Weber
ABC

test

test

Negative
Lateralized to deafer
ear
Normal

Audiological test
Pure

tone audiometery

Conductive
Mixed

loss dip at 2K

loss
Sensory loss

Conductive Deafness

Mixed Deafness

Sensori-neural Deafness

Impedance Audiometry
Helps

to diff. from other causes of


conductive loss
Type As curve
Type B curve in SOM
Type C In E. T. catarrh
Type Ad in Ossicular discontinuity

Normal Impedance

Ossicular Discontinuity

As Curve

Differential Diagnosis

Otitis media with effusion


Ossicular discontinuity
Adhesive ottitis media
Cong. Footplate fixation

Tympanosclerosis
Cong. Cholesteatoma
CSOM
Vender Hoeve syndrome

Treatment
Medical

treatment
Surgical treatment
Hearing rehabilitation

Medical Treatment

Sodium flouride
50mg-75

Decreases

mg daily x 2 yrs

osteoclastic activity
Increases osteoblastic bone formation

Indications

Positive Schwartz sign


Progressive SN loss with surgically confirmed otosclerosis
SN loss with positive family history
Positive Radiological Evidence

Contra indication

Chronic Nephritis
Rheumatoid arthritis
Pregnant & lactating mother
Age < 18 yrs
Allergy to Sod. Fluoride
Skeltal flourosis
Peptic ulcer

Surgical Treatment
Fenestration
Stapes

mobilisation
Stapedectomy
Stapedotomy

Criteria for Stapedectomy


Conductive loss not < 30db
Good cochlear reserve
Good speech discrimination
Conductive loss not > 60 db

Indications for Stapedectomy


Otosclerosis

Tympanosclerosis
Pagets disease
Congenital foot plate fixation

Contra indications
Active

disease
Pregnancy
Poor cochlear reserve
Only hearing ear
General medical disease
Vertigo

Procedure

Local
Infiltration

INCISION

Flap elevation

Lifting Annulus

Exposure of Stapes

Stapedial Tenotomy

Supra structure Removal

Piston in Place

Stapedotomy

Sound Conduction After Surgery

Post op Advise

Not to blow nose forcefully


Not to sneeze with closed mouth
Avoid loud noises
Not to climb mountains, Not to board non
pressurized aircraft.
Report to Surgeon for Vertigo/Decreased
hearing
Diving when swimming
Lifting heavy weights

Hearing rehabilitation

Hearing Aids
Pocket
BTE
ITC

Model

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