Contents
In line with its mission, the Editorial Board of MedTvoiLokony makes every effort to provide reliable medical content supported by the latest scientific knowledge. The additional flag “Checked Content” indicates that the article has been reviewed by or written directly by a physician. This two-step verification: a medical journalist and a doctor allows us to provide the highest quality content in line with current medical knowledge.
Our commitment in this area has been appreciated, among others, by by the Association of Journalists for Health, which awarded the Editorial Board of MedTvoiLokony with the honorary title of the Great Educator.
Otosclerosis is a condition that affects the bone tissue of the middle ear and may even cause a complete loss of hearing. The causes of the disease are unknown, but a certain risk group has been demonstrated – it includes, among others, pregnancy, measles, gender (women get sick more often).
Otosclerosis – disease characteristics
Otosclerosis occurs when the bones of the middle ear develop abnormally and thus prevent sound from being transferred to the inside of the ear. The name of otosclerosis comes from Greek because it is a combination of two words: oto-ear and scler-hard. The disease is most often located around the oval window (inner ear), but it can also affect other ossicles, such as the anvil, round window or hammer. The causes of otosclerosis are not fully known, but there is talk of a certain risk group, which includes pregnant or breastfeeding women. Viral infections can have a significant impact. The disease occurs more often in women than in men.
Otosclerosis is little known, but almost 10% of patients tested for hearing problems have it. This ailment occurs in people between 15 and 40 years of age. It should be remembered that the disease will not pass by itself, the help of a surgeon is necessary.
The causes of otosclerosis
Otosclerosis is common among white people, less often black or yellow. Women account for over 60% of patients. The causes that influence the formation of otosclerosis include:
- hormonal disorders – in more than half of women, worsening of symptoms was observed during pregnancy, which is probably due to the high level of estrogen;
- inheritance – the probability that we will inherit otosclerosis from our parents is about twenty percent;
- measles virus – patients with otosclerosis have a high concentration of immunoglobulins against the measles virus, and in otosclerotic lesions there are structures similar to this virus;
- autoimmune factors – affect the disorder of the immune system.
Symptoms of otosclerosis
Hearing deterioration, usually bilateral, is considered the main symptom of otosclerosis. Usually, this hearing loss is conductive in nature, then the patient hears lower sounds worse. The other person’s speech is heard better in noise than in silence.
Symptoms of otosclerosis vary in severity: sometimes hearing problems increase gradually, other times hearing loss is sudden and rapid. Often the symptoms involve two ears. Accompanying symptoms may be tinnitus, head problems, problems with concentration.
Diagnosis of otosclerosis
In addition to the symptoms typical of otosclerosis, an ENT specialist conducts a family interview, during which information about the family history of hearing loss is important (siblings, parents, close relatives). One of the tests performed in diagnostics is otoscopy, which is usually normal, however, Schwarz’s symptom may sometimes appear, which is the appearance of the red cumulus membrane through the eardrum.
They are also useful for diagnosis reed testswhich is performed using a tuning fork that is made to vibrate. This test distinguishes between conductive and sensorineural hearing loss. It also performs PTA test of tonal audiometrywhich determines the patient’s hearing threshold in particular sound frequencies. Still other tests used in the diagnosis of otosclerosis include tympanometry – determining the efficiency of the movement of the bones inside the ear and in some cases computed tomography or magnetic resonance imaging.
Referring to the audiometry test, we can distinguish two types of this test:
- tonal – usually indicates conductive hearing loss, sometimes mixed, but rarely sensorineural hearing loss. During the examination, the patient is locked in a special quiet room where he or she receives the so-called «Answer button». Then headphones are put on his ears and sounds of varying intensity and frequency are made. The patient’s task is to indicate when he hears any sound, then the volume of the sound is reduced, which allows checking how softest the tone is heard by the examined person. A Carhart wave is often present in the graphical result of tonal audiometry with otosclerosis;
- impedance – usually it is correct because the test assesses the tension of the eardrum and the mobility of the stapes muscle. This is because otosclerosis does not affect the pressure inside the tympanic cavity. As a result of the immobilization of the stapes, the stapes reflex is canceled (it is a natural defense against high-intensity sounds).
Otosclerosis – treatment
Otosclerosis is treated surgically by removing the fossilized fragment of the stapes from the ear canal, which prevents its movement. They are replaced with prostheses that restore the ability to conduct sound impulses.
Usually, the patient is offered two methods of surgical treatment, performed under general or local anesthesia. The first is stapedectomy, and the other that stapedotomy. During stapedotomy, it is possible to immediately and intraoperatively determine the patient’s improvement in hearing. Both during the first and the second procedure, the doctor introduces a prosthesis into the middle ear in the completely or partially removed stapes. Surgical treatment can be used in both ears, but the interval between treatments should be at least six months, and preferably one year.
What next after the procedure?
The patient after surgery should sleep on the unoperated ear! Your doctor may prescribe antibiotics to help avoid possible infection. The patient may feel dizzy or nauseous for the first few days, and there may be problems with the taste sensation, but these symptoms return to normal quickly on their own. Postoperative recommendations also include avoiding visits to the pool or blowing your nose forcefully. The improvement in hearing is noticeable only after removing the dressings.
In patients with advanced otosclerosis, where there is profound sensorineural hearing loss and the hearing aid is ineffective, a cochlear implant may be performed to improve hearing.
Pharmacotherapy in otosclerosis
During conservative treatment of otosclerosis, fluoride preparations are used to inhibit the transformation of normal bone into sclerotic bone. Sodium fluoride is available in Polish pharmacies in the form of Fluossen. It is worth emphasizing that the effectiveness of this method has not been supported by specific studies, therefore it is rarely recommended by doctors. An alternative method is considered to be a hearing aid that is well suited to the patient and brings the greatest benefit in the early stages of the disease.
The content of the medTvoiLokony website is intended to improve, not replace, the contact between the Website User and their doctor. The website is intended for informational and educational purposes only. Before following the specialist knowledge, in particular medical advice, contained on our Website, you must consult a doctor. The Administrator does not bear any consequences resulting from the use of information contained on the Website.