Otosclerosis: treatment, surgery, symptoms,forms

Update: February 2019 Otosclerosis is
dystrophic-degenerative lesion of the middle ear, in the process
the development of which are replaced by the phase of destruction (destruction) of bone
tissues and deposits of calcium salts that form new dense
bone structures.

  • In this case, the symptoms of otosclerosis may not always be:
    �”Histological”, not affecting the pre-door and cochlea window
    found in 10% of the population
  • whereas the clinical is detected in about 1%.
  • Women suffer mostly, according to foreign data they are ill in
    2 times more often, domestic – make up 70–80% of all
  • The disease most often affects people between the ages of 15 and 45 and
    manifested bilateral hearing loss (hearing loss).

The nature of the hearing impairment is usually conductive, that is, it
decline caused by violation of zvukoprovodnost. However,
otosclerosis is found in 1.5-2.3% of patients with sensorineural
hearing loss At the same time, the so-called cochlear of his
shape: the process affects the cochlea, and affects the internal structures
maze, but does not violate the mobility of the stirrup.

Otosclerosis: causes

Otosclerosis of the ear is a hereditary pathology, the genes of which
transmitted by an autosomal dominant type (dominant autosomal
a sign means that it is enough for the manifestation of the disease
inherit a defective gene from a single parent of any gender), but
occur in 20–40% of cases (this phenomenon is called incomplete

These genes are supposed to activate the measles virus, proteins and
structural units of which are often found in foci of otosclerosis.
Antibodies to the virus are detected not only in the blood, but also in the perilymph:
fluid contained inside the cochlea. In favor of the theory
evidence that the incidence of otosclerosis has decreased
after the introduction of compulsory measles vaccination.

Another theory suggests that
autoimmune mechanisms – often found in the blood of patients
antibodies to collagen 2 and 9 types. Also subclinical
(no pronounced manifestations) neuroendocrine disorders.
The first manifestations of the disease usually occur on the background of stormy
hormonal adjustment: puberty, pregnancy,
the onset of menopause.


According to the forms of otosclerosis:

  • tympanal form of otosclerosis – bone carrying sound
    reduced by no more than 20 dB);
  • mixed form I: 20-30 dB;
  • mixed form II: 30–50 dB;
  • cochlear form – bone conduction more than 50 dB lower

According to the location of the foci of otosclerosis:

  • fenestral (changes in the boundaries of the pre-door-cochlear
  • cochlear (affected snail capsule);
  • mixed

According to the process stage:

  • active (otospongiosis, fibrous vascular lesions): in place
    otosclerosis forms immature, penetrated with vessels spongy
  • inactive (sclerotic) – sclerotic is formed
    dense mature bone.

By the rate of progression:

  • медленно текущие forms: снижение слуха до потери возможности к
    communication develops 9 – 10 years;
  • молниеносные forms: почти полная глухота развивается за
    several months due to the involvement of internal structures in the process
  • затянувшиеся forms: болезнь дебютирует в пожилом возрасте.

Clinical picture

Often the disease debuts in young women. And the earlier
the disease begins, the more actively it develops. Pregnancy
with otosclerosis can be a triggering factor, causing the first
symptoms and worsen the condition by speeding up hearing loss.

The first complaint that patients make is “causeless”
hearing loss, usually on both ears (one-sided hearing loss
occurs in about 30% of cases). But even with a two-way
hearing loss patients may complain of unilateral
hearing loss: the process is asymmetrical and subjective
�“Normal” will be perceived better hearing ear, even if about
norm we are no longer talking.

First, the low frequencies “disappear”: it becomes more difficult to understand
male speech. Then the hearing loss extends to high
frequencies. But the process never reaches complete deafness:
the patient hears his own speech even in the later stages of the disease.
Characteristic signs of otosclerosis: in a noisy environment, perception
speech improves, worsens when chewing and swallowing, intense
attention, simultaneous conversation of several people.

Another common symptom: low or midrange tinnitus.
Subjectively, it is described as the noise of falling water, the rustling of leaves,
rustle of the surf, the hum of wires. He is very hard tolerated by patients
often interferes with sleep, even suicides are described by this
the reason. The intensity of the noise is usually constant, but may increase
after drinking alcohol, physical exertion, stress,
overwork Unfortunately, this is the most difficult symptom to eliminate.
regardless of how to treat otosclerosis: many patients have noise in
ушах сохраняется и after operation.

About a quarter of the cases to these symptoms of otosclerosis
join dizziness and balance disorders caused by
elevated pressure inside the maze. Usually dizzy
positional: occurs at a certain turn, tilt of the head,
quick change of body position.


The main diagnostic criteria for otosclerosis:

  • bilateral conductive hearing loss;
  • normal patency of the auditory tubes;
  • the normal state of the eardrum;
  • family history.

On the audiogram with tympanal and mixed forms of otosclerosis
Conductive or mixed hearing loss is determined. Often
“Carhart’s tooth” appears – in the range of 2 – 3 kHz indicators
bone curve worsen by 5 – 15 dB. With speech audiometry –
100% speech intelligibility.

With cochlear otosclerosis, hearing loss is usually
sensorineural or mixed with a predominance of violations
sound perception. Audiogram without bone-air interval. With
This form distinguishes otosclerosis from other pathologies:

  • family history;
  • symmetric bilateral hearing loss
  • good speech intelligibility, which is not typical for other forms
    sensorineural hearing loss;
  • onset of the disease at a relatively young age;
  • progression of hearing loss for no apparent reason.
  • changes on CT (demineralization of the labyrinth capsule).

With тимпанометрии (измерении подвижности барабанной перепонки)
результаты в пределах нормы вне зависимости от forms

The only objective method for confirming a diagnosis is
computed tomography of the temporal bone with a slice thickness of 0.5 – 0.6
mm This is the only way to reveal the localization and prevalence.
foci, as well as the degree of activity of the process.

  • snail capsule density is reduced;
  • the stirrup is thicker than 0.6 mm;
  • the front part of the base of the stirrup is thickened (acquires
    triangular shape).

In addition, CT allows to detect structural features.
temporal bones that may be important when planning

Conservative therapy

Treatment of otosclerosis without surgery is indicated for patients with active
form or with its cochlear form. Therapy is aimed at
slowing down the activity of the process, warning the sensoronevral
hearing loss Used drugs:

  • bisphosphonates: drugs that inhibit the activity of osteoclasts
    (bone destroying cells) – Ksidofon, Fossamax,
  • sodium fluoride – fluoride ions reduce resorption (resorption)
  • calcium supplements;
  • альфакльцидол – предшественник витамина D3, который
    regulates mineral metabolism and stimulates bone protein synthesis
    Matrix – the protein skeleton of the bone.

Drug therapy is carried out courses for three months with
a three-month break. Initially planned at least two
courses. How self-treatment of otosclerosis conservative
therapy is rarely used. It does not restore hearing, but
allows you to prevent its loss by stopping the growth of foci
otosclerosis, which is especially important in its active phase, when
operation is not recommended due to the possibility of re-Russification


The operation for otosclerosis is called stapedoplasty. it
microsurgical intervention that restores transmission
sound on the chain of auditory ossicles. Usually with the pasture
the stirrup plate is either completely removed and replaced with a prosthesis,
or (if it is firmly fixed in the sclerotic
bones) a hole is drilled into it, where a piston is inserted,
connected to the chain of auditory ossicles. Intervention is carried out as
under general anesthesia, as well as under local anesthesia, the choice
pain relief is left to the doctor.

Indications for surgery:

  • complaints of hearing loss and tinnitus;
  • conductive or mixed hearing loss, bone air
    interval on the audiogram not less than 30 dB;
  • eardrum not perforated;
  • otosclerosis in the inactive phase.

Relative contraindications:

  • the active phase of the otosclerotic process;
  • the ear on which the operation is planned is the only

Strongly contraindicated infection
external or middle ear and somatic infections (ARVI, herpes,
tuberculosis, syphilis, etc.)

Contraindications to surgery for otosclerosis of the ear can also be
general condition of the patient (cardiovascular insufficiency and
similar pathologies). If Stapedoplasty cannot be performed
due to contraindications possible correction is limited to hearing
by the apparatus.

There are several options for stapedoplasty, but none of
they do not guarantee 100% recovery of hearing: 10% develop
postoperative conductive hearing loss, 3.5 – 5.9% –
sensorineural, 0.9 – 2% – deafness.

If the operation is not done under general anesthesia, the patient’s hearing is improved.
feels already on the operating table. After that, the auditory canal
the tampon is laid, and subjectively the rumor returns to the former
level – but only because the ear is “plugged”.

  • The first day after stapedoplasty the patient should lie on
    unoperated side, stand up, you can not turn his head. AT
    the first time to get out of bed can be no earlier than a day
    after the end of the operation.
  • On the second day after surgery, you can sit and walk carefully.
    ATысока вероятность головокружения, поэтому better move
    along the walls, supports.
  • On the fourth day, change the bandage.
  • A week later, remove the tampon.
  • Discharged from the hospital usually after 7 – 10 days.

A month after the operation, be sure to sleep on the “healthy” side. Everything
this time is impossible:

  • allow water to enter the ear (my head, ear canal)
    need to close with oiled cotton);
  • shake head, lean down;
  • SARS and flu are ill, but if you could not be saved – in no way
    case not blow your nose;
  • in general, any vibrations and shocks are contraindicated;

2 months after the operation can not ride the subway.

3 months after surgery can not:

  • lift weights (more than 10 kg);
  • to run and jump;
  • fly on a plane;
  • skydive;

Everything это время обязательно избегать громких звуков. If on
work noisy, operated ear should be protected with earplugs or
Use special noise headphones. Earplugs come in handy
and on holidays (fireworks, pyrotechnics, loud music).

Lifetime prohibited divingHearing stabilized on average
3 months after surgery, so focus on
audiogram, which will make at discharge, it makes no sense. More
indicative will be audiograms made after 3 and 6 months
after operation.

At first, all sounds will sound very loud and strong.
Then the world around will not be so loud – but this does not mean
of deterioration, this is a sign that the hearing aid has adapted
after operation.

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