otosclerosis


What is otosclerosis?

Otosclerosis is a disease of the temporal bone.(bone surrounding the ear)Otosclerosis affects the ears only and not other parts of the body. It can cause hearing loss when hard bone forms around the stapes, reducing the vibration of stapes thereby decreasing transmission of sound to the inner ear. This is called conductive hearing loss. As the disease progresses, otosclerosis can interfere with the inner ear nerve cells causing sensorineural hearing loss.

It tends to run in families and can be hereditary.Although it is autosomal dominant,everybody who inherits the gene donot get symptoms
Both ears are usually involved.Rarey disease can be unilateral.Disease starts in the teens or early twenties. It progresses in pregnancy due to hormonal changes.

Symptoms
symptoms are slowly progressive hearing loss and noises in the ears(tinnitus). The degree of hearing loss may range from slight to severe. It can be conductive, sensorineural or both.
The intensity of the tinnitus is not necessarily related to the degree or type of hearing loss. Very rarely, otosclerosis may also cause dizziness.These patients are usually soft spoken as they hear their own voice very loud due to good conduction via bones.

Diagnosis

When an otolaryngologist see a soft spoken patient who has normal ear drums and a hearingloss, otosclerosis is suspected. whether hearing loss is conductive or sensorineural can be determined only by careful hearing tests.

Management options

a) No treatment is needed if the hearing impairment is mild.
b) Hearing aids to amplify sounds so that the user can hear better.
c)surgery to remove fixed stapes and fix artificial stapes

The risks of surgery can be avoided by having hearing aids.Audiologist can discuss the various types of hearing aids available and make a recommendation based on the specific needs of an individual.
The stapedotomy operation

If both ears are affected, the operation is usually done on the poorer ear. The patient may still need a hearing aid in the opposite ear.

The operation usually takes about an hour. This can be done under general or local anaesthesia.Middle ear is opened in to. The top part of the stapes is removed with fine instruments. A small opening is then made at the base, or “footplate”, of the stapes into the inner ear. A plastic or metal prosthesis is then put into the ear to conduct sound. You will have packing placed in the ear canal.

How successful is the operation?

The chances of obtaining a good result from this operation by experienced surgeons are over 80 percent.

complications

Total Loss of hearing:
This complication happens in around one in 100 patients. Therefore the poorer hearing ear is normally selected for surgery first.Patient cannot obtain benefit from a hearing aid in that ear.

Dizziness:
Dizziness is common for a few hours following stapedotomy and may result in nausea and vomiting. Some unsteadiness can occur during the first few days following surgery; dizziness on quick head movement may persist for several weeks. On rare occasions, dizziness is prolonged.

Taste disturbance:
The taste nerve runs close to the eardrum and may occasionally be damaged. This can cause an abnormal taste on one side of the tongue. This is usually temporary but it can be permanent in one in ten patients.

Tinnitus:
If hearing loss worsens after surgery,patient may experience noises in the ear.
Other complications: Some specialists also advise against scuba diving, sky diving or use of firearm following a stapedotomy operation.
When you go home:

Hospital stay is one or two days.At home you may take pain killers for the slight pain you experience.
Mild dizziness is normal after the operation.
There may be blood stained discharge from the ear canal. This usually comes from the ear dressings. The packing in the ear canal will be removed after two or three weeks.
You may need to take two to three weeks off work.

Plug the ear with a cotton wool ball coated with Vaseline when you are having a shower or washing your hair.
Avoid straining for the first few weeks after surgery, that is, no heavy lifting. Only blow the nose gently.Flying is allowed after some time.

Hearing loss may persist up to three months. You should consult the surgeon if there is a sudden onset of deafness, dizziness or severe pain after you are discharged from the hospital.