|
What is Otosclerosis?
Otosclerosis is a condition producing hearing loss due to impaired movement of the stapes bone of hearing from fixation from abnormal adjacent bony formation. The stapes (one of the three little bones of hearing - malleus, incus and stapes) is unable to vibrate or transmit acoustic energy to the inner ear (containing the nerve endings).
Although the underlying cause of this abnormal bony formation is unknown, recent information suggests that the measles virus interacting with collagen disorders may contribute to the development of otosclerosis. Genetic predisposition to otosclerosis has been observed although this seems to be less so as society becomes more heterogeneous. The lowered incidence of otosclerosis may be partly due to the mixing of genetic pool and measles vaccine.
How is the hearing loss managed?
Conductive hearing loss is treated with amplification with a hearing aid or surgery. Amplification with a hearing aid is very successful because the inner ear (nerve) function is usually normal. Sometimes the abnormal bone metabolism may affect the sensorineural (nerve) function in the cochlear, which can reduce hearing.
Frequently, patients do not want to resort to hearing aids when successful surgery can improve hearing in otosclerosis. Otological microsurgery replaces the immobile stapes bone with a mobile prosthesis- usually made of stainless steel/platinum and/or teflon, which is not rejected by the body. In properly selected cases, the hearing improvement can reach complete or near-complete elimination of the conductive hearing loss in 96% of the operative cases in the hands of experienced otological surgeons. Three percent may have no change, and up to 1% may have loss of hearing including inner ear nerve dysfunction, which would not be aidable with a hearing aid. Dizziness may occur following stapedectomy; it is usually transient (that is, a few days).
If there is a mixed hearing loss (that is, an accumulative hearing loss from conductive (stapes) and sensorineural (nerve) deficit), successful surgery will resolve only the conductive component. A hearing aid still may be required for the sensorineural loss if is symptomatic.
How long is the surgery and how long will I be out of work?
The surgery takes about 1 hour. It can be performed with local or general anesthesia. Post operative bed rest for 24 hours is recommended. The patient is then discharged. Patients are advised not to incur the risk of barotrauma (flying, scuba diving, weight lifting, and heavy exertion) for 2 weeks after surgery.
Post operative management.
Patients will be seen in the office one week after surgery for suture removal. Usually antibiotics are prescribed for 10 days following surgery. The operated ear canal should be kept dry for 10 days following surgery. During shower or bathing, a cotton plug with Vaseline may be placed in the outer part of the ear to protect it from water.
An audiogram (hearing test) will be obtained at six weeks after surgery, at which time the hearing should be significantly improved.
Are there any non-surgical treatments for Otosclerosis?
Some believe that otosclerosis is the end result of abnormal active softening of the bone surrounding the inner ear: a process called otospongiosis (oto=ear, spongiosis=softening). This softening of bone may be moderated by dietary supplement with mineral fluoride and calcium in a preparation called Florical. A multiple vitamin containing Vitamin D needs to be taken daily to assure adequate absorption of calcium. Didronel (Etidronate Diaxodium) has been utilized by some to regulate bone metabolism in the medical management of otospongiosis.
There is considerable controversy concerning the efficacies of these medical therapies in affecting the course and symptoms of otospongiosis/otosclerosis. Generally these medications have minimal side affects, but people find that continued medical regimen bothersome - especially if the results of these therapies are uncertain. Your otologist may recommend such therapy depending on your individual situation.
|
