Dr. AJAY MANICKAMJR, DEPT ENTRG KAR MEDICAL COLLEGE

OTOSCLEROSIS

It is the disease of the otic capsule, where normal enchondral bone is replaced by spongy vascular bone formation leading to ankylosis of the footplate of stapes

OTOSCLEROSIS

Exact etiology unknownHereditaryAutosomal dominantRacial – common in caucasianHormonal – more during pregnancy & puberty

Age – 15 to 45 yearsMale: Female = 1:2

ETIOLOGY

Various etiological factors (age, sex, hereditary, hormones)

Affects otic & labyrinthine capsules leading to enlargement of perivascular space

Bone absorption by osteoclastic activity

Within time mucoperiosteum of middle ear increase in thickness and becomes vascular

Disease advances

1. Stapedial otosclerosis2. Cochlear otosclerosis or round window involvement

PATHOGENESIS

Stapedial otosclerosis1. Anterior focus2. Posterior focus3. Lobster – claw type4. Biscuit type5. Circumferential typeCochlear otosclerosis1. Round window area2. Other areas of labyrinthHistological type – lesion detected only on post

morterm1. Early spongiotic phase2. Late sclerotic phase

TYPES

Voice is low modulated – soft spoken patients – patients hear their own voice louder

Deafness – mainly conductive - sensorineural or mixed in cochlear type

Paracusis willsii – hears better in noisy surroundingsTinnitus Vertigo lasts maximum for 3 weeks and usually don’t

recurBezold’s triad –1. Absolute negative rinne2. Raised lower tone limit3. Prolonged bone conduction

SYMPTOMS

In active otosclerosis congested area seen in TM called as FLAMINGO PINK BLUSH or SCHWARTZ SIGN

SIGNS

Rinne’s test – negativeWeber’s test – lateralised to affected earAbsolute bone conduction test normal

TUNING FORK TEST

Carhart’s notch –dip at 2KHz 1. Loss of inertial component of bone conduction2. Fixation of stapes disrupts ossicular resonance at

about 2000 HzCookie bite pattern – mixed hearing loss

PURE TONE AUDIOMETRY

As type curve in tympanometry

TYMPANOMETRY

Double ring effect – due to spongiosis within thickened capsule

CT SCAN OF TEMPORAL BONE

Ossicular discontinuityCongenital fixation of stapes footplate

Secretory otits mediaFixed malleus syndromeTympanosclerosis

DIFFERENTIAL DIAGNOSIS

Medical No medical treatment

Sodium fluoride can be given in cochlear otosclerosis

Surgical 1.Stapedectomy

2.Small fenestra stapedectomy3.Stapedotomy

4.Vein-graft tendon interpositon operation5.LASER stapedotomy

TREATMENT

Stapedotomy surgery

SURGERY