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Definition
Hereditary disease of bony labyrinth showing
Antonio Valsalva
First described
ankylosis of stapes
in 1741
Adam Politzer
Coined the term
Otosclerosis
in 1893
Friedrich Siebenmann
Coined the term
Otospongiosis
in 1912
Epidemiology
Exact etiology is unknown (? Viral)
Female : Male = 2 : 1
Age: Common in 20 - 40 years
Types of Otosclerosis
A. Stapedial
Symptoms of Otosclerosis
1. Deafness: Bilateral, slowly progressive
Symptoms of Otosclerosis
4. Paracusis Willisii: Pt has better hearing in noisy surroundings (people increase their voice intensity & pts speech discrimination becomes better).
Otoscopy
Normal T.M. is seen in
seen in otospongiosis
(2 - 10 % cases)
Schwartze sign /
Flamingo pink blush.
Weber
Lateralizes to Deaf ear Lateralizes to Better ear Lateralizes to Better ear
A.B.C.
Normal
Cochlear
Decreased
Mixed
Decreased
Otosclerosis
Normal / SNHL
No change
Intensity es
No change
Intensity es
Carharts notch
Proposed theories
Speech Audiometry
Speech Discrimination Score (maximum score achieved) is almost 100 %.
Speech Audiometry
Impedance Audiometry
As curve seen in 40 %
cases of otosclerosis. Normal middle ear pressure + decreased middle ear compliance. Others have A curve.
Differential Diagnosis
Otitis Media with Effusion: type B tympanogram
Stapes mobilization: Kessel (1880), Rosen (1952) Lateral semicircular canal fenestration: Holmgren
Johannes Kessel
Samuel Rosen
Gunnar Holmgren
Maurice Sourdille
Julius Lempert
Extremes of age
Pregnancy
Per-meatal Incision
cm
Teflon piston
Length of piston = medial surface of incus to stapes footplate + 0.25 mm Range = 3.75 4.25 mm
Laser Stapedotomy
Stapedius vaporization
Footplate fenestration
Rossette formation
Stapedotomy Piston
Stapedectomy
Footplate Fenestration
Footplate removal
Intra-operative Floating footplate Submerged footplate Dislocated incus Perforated TM Damage to facial nerve or chorda tympani
Post-operative Otitis media Oval window granuloma Perilymph fistula Sensori-neural HL Persistent air-bone gap Vestibular dysfunction
Sodium Fluoride
Given in cochlear otosclerosis & active focus of otospongiosis (Schwartze sign). Acts by: a. Decreases bone resorption b. Increases bone formation
Hearing Aid
For patients who:
Refuse surgery
Thank You