Otosclerosis aetiology treatment and clinical features

1. Otosclerosis

2. Otosclerosis
 Otosclerosis is an autosomal dominant disease, in which
the fixation of footplate of the stapes in the oval window
will occur due to development of spongy bone from the
bony labyrinth, causing immobilization of the footplate
of the stapes, which reduces the transmission of
vibration to the inner ear

3. Etiology
It can be
1. Hereditary
2. Endocrine abnormalities
3. Metabolic abnormalities
4. Vascular abnormalities
5. Autoimmune and infectious
But none of the cause is been proven as
an exact cause

4. Pathophysiology
 Otosclerosis (otospongiosis) is an osseous dyscrasia,
limited to the temporal bone, and characterized by
resorption and formation of new bone in the area of the
Ossicles and Otic capsule
(the skeletal element enclosing
the inner ear mechanism).

5. Otosclerosis has two main forms:
 An early spongiotic phase (otospongiosis)
 The early phase is characterized by multiple active
cell groups including osteocytes, osteoblasts.
 It develops a spongy appearance because of vascular
dilation secondary to osteocyte resorption of bone
surrounding blood vessels.
 This can be seen grossly as red hue behind the
tympanic membrane termed “Schwartze's sign”

6. A late sclerotic phase
 Dense sclerotic bone forms in the areas of
previous resorption. Both the sclerotic and
spongiotic cells may be present at the same time.
Otosclerotic changes always begin in
endochondral bone (ossification of cartilage)
but may progress and enter even into the
membranous labyrinth.

7. Signs and symptoms
 Hearing loss – usually starts in one ear and then moves
to the other
 Dizziness, balance problems, tinnitus

8. Diagnositc features
 History collection
 Physical examination
 Audiometry
 Otoscopic examination
 Tympanometry
 CT scan

9.  Visualization - TM appears normal in the
majority of patients
 Schwartze sign is observed in 10% of patients –
otoscopic examination can reveal a reddish blush
of the tympanium caused by the vascular and
bony changes within the middle ear
 Rinne test: negative
 Weber test: laterization to poor Hearing level

10. Management
 Sodium fluoride with vitamin D and calcium
carbonate – to retard bone resorption and encourage
calcification of bony lesions
 Dose 20-120 mg per day

11. Florical
Fluoride: 3.75 mg
Calcium :145 mg
 Florical can be used three times
a day for otosclerosis.

12. Surgical management
 Stapedectomy – partial removal of the stapes
 Stapedotomy – opening in the stapes footplate
followed by prosthesis insertion
 Fenestration surgeries - Complete removal with
prosthesis insertion

13.  Surgery is usually performed under local
anesthesia.
 Poorer functioning ear is treated first
 Other ear may be treated on 6 months to 1 year later
 An endaural incision is made
 Gelfoam is used on the incision flap to limit
bleeding

14. 14
Prosthesis Placement
Cup piston prosthesis
Teflon piston prosthesis
House wire prosthesis
McGee/Fisch-type piston prosthesis

16. Nursing management (after ear
surgeries)
 Postoperatively patient may experience dizziness,
nausea and vomiting
 Some will have nystagmus due to the disturbance of
perilymph fluid.
 Decrease sudden movements
 Actions such as coughing, sneezing, lifting, bending,
and straining should be minimized.
 Do not try to get out of bed without assistance

17.  Take measures to prevent and cope up with vertigo
 Report fever, pain and drainage from the ear
 If the patient needs to cough or blow the nose, leave the
mouth open to help reduce the pressure
 Avoid crowds where respiratory infections may present
 Avoid high elevations or flying