about otoscelrosis in ent

1. OTOSCLEROSIS
BY RITIKA BHATIA
SHUBHANGI PALVE
GROUP- 1902
GEOMEDI UNIVERSITY

2. ANATOMY OF LABYRINTH
• Otic labyrinth: aka membranous labyrinth. consist of utricle, saccule,
cochlea, semicircular ducts, endolymphatic ducts and sac.
• periotic labyrinth: surrounds otic labyrinth and filled with
perilymph.includes vestibule, scala tympani, perilymphatic spaces
and periotic ducts.
• otic capsule: bony labyrinth. it has 3 layers- endosteal, enchondreal
and periosteal.

4. OTOSCLEROSIS
• Also called otospongiosis, is a primary disease of bony labyrinth.
• in otosclerosis, irregular psongy bone replace part of normal dense
endochondral layer of bony otic capsule.
• in other words, normal endochondral bone is converted into wavy
spongy bone.
• if it involves cochlea, its called cochlear otosclerosis.

6. ETIOLOGY
• exact cause is unknown.
• anatomical basis: fissula ante fenestram (in front of oval window) can
cause stapedial type of otosclerosis.
• heredity
• race: whites>
• sex: female>males
• age: 20-30 years
• viral infection

7. TYPES
• 1. STAPEDIAL: cause stapes fixation and conductive deafness.lesions
start in fissula ante fenestram(anteriorly) or posteriorly or around
margin of footplate. it could be biscuit type(without involving anular
ligament) or obliterative type.
• 2. COCHLEAR: involves region of round window or other areas in otic
capsule.it may cause sensorineural hearing lossdue to toxic materials
liberation in innear ear fluid.
• 3. HISTOLOGIC: it is asymptomatic and neither cause conductive nor
sensorineural hearing loss.

9. SYMPTOMS
• hearing loss: painless, progressive, insidious onset. mostly bilateral
conductive hearinbg loss.
• paracusis willissi: paradoxically better hearing in noisy environment.
• tinnitus: mostly seen in cochlear otosclerosis and active lesions.
• vertigo
• speech: monotonous, well modulated speech.

10. SIGNS
• tympanic membrane is usually normal and mobile. sometimes a
reddish blue sign appears on promontory is called schwartzee sign.
• eustachian tube is normal.
• tuning fork test:
• negative rinne
• weber lateralised to greater conductive loss ear
• absolute bone conduction normal(decreased in cochlear otosclerosis)
• pure tone audiometry- loss of air conduction.
• bone conduction normal
• tympanometry curved in ossicular stiffness.

12. DIFFERENTIAL DIAGNOSIS
• differentiated from other causes like
• otitis media
• adhesive otitis media
• tympanosclerosis
• attic fixation of malleus head
• congenital stapes fixation

13. TREATMENT
• MEDICAL: Sodium fluoride to stop all destruction.
• decrease proteolytic enzyme activity
• decrease osteoclastic activity.
• increase bone formation
• Stapedotomy:
• stapedius tendon cut, incudostapedial joint is separated and removal of complete stapes.
• no longer done because of high chances of fistula formation and sensorineural hear loss.
• Stapedotomy:
• only supra structure is removed.
• head,neck, anterior and posterior crura of stapes removed sparing footplate behind.
• piston placed in opening (centre of footplate) and other end is attached to incus.
• done in worst ear first to check the chances of complication.
• Alternative for surgery is hearing aid.

16. COMPLICATIONS FOLLOWING SURGERY
• FACIAL NERVE PALSY: due to dehiscence of fallopian canal and
continuous compression of facial nerve.
• type 5 tympanoplasty(fenestration operation)- fistula on lateral
semicricular canal can cause vertigo due to pressure changes.

17. CONTRAINDICATIONS:
• only heraing ear
• associated menieres disease: more chance of sensorineural hear loss
• professional athletes, air travellers, piltos, drivers
• those who work in noisy surroundings.
• pregnancy
• active otosclerosis(done after maturation)

18. THANK YOU