The document outlines the learning objectives related to otosclerosis, covering its definition, causes, pathophysiology, clinical manifestations, diagnostic measures, and management strategies. It highlights that otosclerosis leads to conductive or mixed hearing loss due to the abnormal bone growth around the stapes in the middle ear. The management includes both medical treatments and surgical interventions, with an emphasis on assessing the patient's condition, providing education, and ensuring follow-up care.

1. DEPARTMENT OF
MEDICAL SURGICAL NURSING

2. LEARNING OBJECTIVES
At the end of this lecture, students should be able to :
• define otosclerosis
• list out the causes
• explain the pathophysiology
• enumerate the diagnostic measures
• describe the management

3. Introduction
• primary metabolic bone disease of the otic
capsule and ossicles
• It causes fixation of the ossicles (stapes)
• It results in conductive or mixed hearing loss.
• It is genetically-mediated via autosomal
dominant transmission

4. Definition
• Otosclerosis or “hardening of the ear” result from
the formation of an abnormal spongy bone , like
bone growth along the stapes in the middle ear.
• With the new bone growth , the stapes become
immobile prevents transmission as sound vibration
into the ear, leading to conductive hearing loss.
• Otosclerosis usually affect the both ears.

8. Etiology
Many theories have been proposed such as
• Hereditary, endocrine,
• metabolic, Infectious lesion
• Vascular
• Measles
• autoimmune

9. Pathophysiology
• Due to etiological causes
• Formation of new bone, or re growth at the area of stepes
• limited to the vibration of the bone
• Conducting hearing loss

10. Clinical Manifestations
• Hearing loss
• Dizziness
• Tinnitus
• Roaring
• Buzzing the ear
• Vertigo
• headache & earache

11. Diagnostic evaluation
• History
• Physial examination
• Tuning fork test
• Audiometry test
• Tympanocentesis – fluid for middle ear send for culture
• CT scan – collection of fluidin ear & mastoid region ,
abscess formation
• MRI – evaluation of tumor & soft tissue
• AUDIOGRAPHY – to assess hearing loss

12. Diagnosis
• Slowly progressive
• Tinnitus is associated with 75% patients
• The age of onset of hearing loss is young

13. Diagnosis
• low-volume speech.
• Paracusis of Willis.
• Two-thirds of patients will report a family history of
hearing loss.
• Women with pregnancy worse her hearing

14. Complications
• Complete deafness
• Nerve damage
• Infection, dizziness, pain, or blood clot in the ear
after surgery

15. Management
• Otosclerosis may slowly get worse. The condition
may not require treatment until you having severe
hearing problems.
• Medications such as fluoride, calcium, or vitamin D
may help to slow the hearing loss, but the benefits
have not yet been proved.
• No known medical treatment exists for this form of
deafness, but amplification with a hearing aid may
be helpful.

16. • Administer analgesics such as –
• IBUPROFEN
• OXYCODONE
• ACETAMENOPHEN (PCM)
• Hearing aid may be used to treat the hearing loss
General measures :
• Avoidance of noise full environment
• Side lying position
• Continuous applications of medications
• High protein diet

17. Surgical interventions
• Stapedectomy - The removal of
portion of the sclerotic stepes
footplate of stapes or complete
removal of the stapes and the
implant with prosthesis to
maintain suitable conduction.

18. • Stapedotomy - Modern surgery called stapedotomy
is performed by drilling a small hole in the stapes
footplate with micro drill or laser, and the insertion
of a piston like prosthesis.

20. Non-surgical interventions
• Amplification: hearing aide
• Patients who do not want to undergo
surgery for otosclerosis
• patients who are not fit for surgery.

21. Non-surgical interventions
• Medical treatment:
• Usual dose is about 20-120mg of fluoride a
day
• Efficacy of the treatment can be evaluated
2 years later.

22. Nursing assessment
1. History of onset & progression of symptoms
2. Extend of hearing loss via audiometry
3. Rinne/weber test – to evaluate loss of air
conduction
4.Past medical history of leasons and infection
5.Family history of otosclerosis

23. • Nursing diagnosis :
• Impaired hearing activity related to disease
condition
• Acute pain related to disease process
• Risk for injury related to hearing loss
• Imbalance nutritional status less than body
requirement related to vertigo
• Anxiety related to surgical intervention and
prognosis
• Knowledge deficit related to surgical intervention

24. • Interventions
• Assess the general condition of patient
• Provide side lying position
• Remove sound or noise from the patient area
• Reassure patient that dizziness is tempory
• Maintain fluid balance of the patient
• Prepare patient for surgical intervention
• Explain the surgical procedure and get inform
consent

25. • Explain the use of hearing device
• Assess the sign of bleeding , drainage at the site of
surgery
• Provide medication as per doctors prescription
• Health education should be given to patient
regarding diet like use of calcium rich diet, high
protein diet, use of hearing device, medication and
followup

26. • Evaluation
• Evaluate the patient condition and hearing activity
of the patient
• Ask the patient for regular follow up

27. Summary
So far we have discussed about definition, etiology, clinical
manifestations, investigations, and managements of
otosclerosis.

28. Bibliography
• Lewis et al, Medical Surgical Nursing, Mosby
Elsevier,7th edition.
• Joyce.M.Black et al, Medical Surgical Nursing,
Saunders publication.
• Brunner and Siddhartha, Medical Surgical Nursing,
Lippincott Williams and Wilkins.

29. Thank You