How is Otosclerosis treated?

Patients with Otosclerosis have 3 treatment options:
  1. Nonsurgical measures
  2. Amplification
  3. Surgery
Each option and the advantages and disadvantages should be discussed with the patient.

Nonsurgical Measures

Therapeutic strategies to prevent the progression and control of Otosclerosis have been directed at the suppression of bone remodeling with fluorides. However the efficacy of these agents has not been definitively proved and otologists vary widely in their recommendations regarding the use of these medications.

Sodium Fluoride therapy

Fluoride therapy has been found to significantly arrest the progression of sensori-neural hearing loss in the low and high frequencies. Sodium fluoride is typically dosed at 50 mg daily in patient with evidence of active disease.

Fluoride therapy is contraindicated in patients with chronic nephritis and chronic rheumatoid arthritis, as well as in pregnant and lactating women, children and patients with a demonstrated allergy to fluoride. Gastrointestinal disturbances are the most common adverse effect of fluoride therapy. Taking enteric-coated capsules after meals largely prevents these adverse effects. Because there is also the rare possibility of skeletal fluorosis, a skeletal survey should be taken at intervals during the treatment.

Because the efficacy of this treatment is not clearly defined, each patient’s response should be considered independently, with an assessment made of the risk versus the benefits.

Amplification

Most patients with Otosclerosis have normal cochlear function with excellent speech discrimination and are therefore good hearing aid candidates. Before proceeding with surgery, patients should be encouraged to try a hearing aid (or aids), Some patients become successful hearing aid users and can therefore avoid surgery and its risks. However, although there is no risk to the patient with hearing aid use, there are some significant disadvantages when compared with the result of a successful surgery.

The disadvantages include a poorer sound quality, cosmesis, cost, maintenance requirements, being able to hear only when the aid is in use, occlusion effect and comfort. In practice most patients under age 60 with good sensori-neural reserve prefer to have surgery

Surgical Measures

Most patients with conductive hearing loss due to Otosclerosis can be treated surgically. The average patient with Otosclerosis and a bone conduction level of 0-25 dB in the speech range and an air conduction level of 45-65 dB is a suitable candidate for surgery.

Contraindication to surgery
  1. A medically unfit patient
  2. An only-hearing ear that does well with amplification
  3. Pregnancy
  4. Occupational considerations: Surgery may be inadvisable in individuals whose occupation or activities demand considerable physical strain or precise balance (eg. Pilots, scuba divers and construction workers)
Preoperative Considerations

Surgery can be performed under local or general anesthesia, depending on the preference of both the patient and the surgeon. There are several advantages to local anesthesia.. (1) The patient’s hearing can be tested after prosthesis placement by repositioning the tympanic membrane and either talking with the patient or performing tuning fork tests. (2) If the patient complains of vertigo during the procedure, the surgeon can alter his or her technique to reduce the vestibular irritation. (3) The patients can avoid the postoperative nausea that often accompanies general anesthesia; the newly reconstructed ear is therefore not subjected to the potentially extreme pressures associated with arousal from anesthesia and vomiting.

Surgical Technique

Many subtle variations are used by various surgeons, but the basic concept and steps of the procedure are similar.

Fixed Stapes ossicle is removed & then replaced by a new prosthesis (piston), procedure called Stapedotomy. Patient starts hearing immediately on the operation table itself. No external incision is seen; neither any suturing is required.

A wide variety of stapes prostheses are available, and they are made of stainless steel, platinum and Teflon; all these prostheses are MRI compatible.

Wide variety of stapes prostheses


Modifications in Stapedectomy Technique






Laser Use

Lasers are commonly used in Otosclerosis surgery. The cited advantages of laser use are an improved ability to prepare a bloodless fenestra, a reduced risk of footplate subluxation and precise cuts in the footplate without disturbing the otosclerotic focus. Various types of lasers have been used including the CO2, KTP and argon lasers.

Potential Post-operative complications of surgery
  1. Sensori-neural Loss
  2. Tinnitus
  3. Dysgeusia (Taste Disturbance), where patient complaints of a Salty or Metallic Taste which gradually resolves over a few weeks or months. Rarely, it persists indefinitely.
  4. Infection
  5. Dizziness
  6. Phonophobia
Self-care after stapedectomy

After surgery, it is important (particularly in the early post-operative phase) to protect the structures within the ear from infection, pressure and noise to reduce the risk of complications. Be guided by your surgeon, but general suggestions include:
  • Avoid blowing your nose.
  • Avoid cold temperatures.
  • Reduce your risk of upper respiratory tract infections by avoiding sick people.
  • Avoid changes in air pressure (air travel or scuba diving)
  • Avoid loud noises
  • See your doctor promptly if you experience ear pain, dizziness or fever, as these symptoms could indicate an infection.
Otosclerosis
  • What is Otosclerosis?
  • How do we hear?
  • What causes Otosclerosis?
  • Symptoms of Otosclerosis?
  • How is Otosclerosis diagnosed?
  • Genetics Factors & Natural History
  • How is Otosclerosis treated?