Otosclerosis: Symptoms and Treatment Methods
Otosclerosis of the ear is a pathology in which there is an overgrowth of tissues connecting the inner and middle ear. As statistics show, women most often suffer from pathology. They account for up to 85% of all cases. In general, otosclerosis is diagnosed in 1% of the population.
Pathology develops slowly. The average age of the sick is 20-35 years. The defeat is predominantly one-sided. The second ear becomes involved in the pathological process after several months or even years.
- Otosclerosis - what is it?
- Predisposing factors
- Causes of otosclerosis
- Otosclerosis symptoms
- Otosclerosis treatment
- Complications and consequences
- Prevention of otosclerosis
Otosclerosis - what is it?
Otosclerosis is a lesion of the bone capsule of the labyrinth of the inner ear, during which the tissues undergo dystrophic changes. Over time, the stirrup loses its natural mobility, the patient develops hearing loss. According to ICD 10, otosclerosis was assigned the code H80.
In addition to damage to the ear tissues, internal organs and their systems can be affected. The pathological process often involves the vegetative-vascular and neuroendocrine systems, as well as the musculoskeletal system. This leads to a variety of symptoms.
According to the International Union of Otolaryngologists, otosclerosis progresses in pregnant women. If the patient is carrying the first child, then the course of the disease worsens in 30% of future women in labor, with the second pregnancy this figure increases to 50%, and with the third pregnancy - up to 80%.
The risk of developing pathology increases as a result of exposure to the following factors:
- Hereditary predisposition.
Disorders in the endocrine system.
- Failure in the metabolism of phosphorus and calcium.
- Pregnancy and childbirth.
- Deficiency in the body of magnesium and fluoride.
- Postponed infectious diseases.
- Severe intoxication of the body.
- Diseases of the somatic sphere.
- Injuries to the inner ear.
Causes of otosclerosis
The reasons that lead to the development of otosclerosis of the ear:
Hereditary predisposition. Disturbances in the growth and functioning of the tissues of the inner ear occur in close blood relatives in 40% of cases. Most of these patients suffer not only from damage to the middle and inner ear, but also from joint diseases, disorders of the thyroid gland, etc. Therefore, scientists assume that the inferiority of the development of connective tissue is a consequence of genetic disorders that are inherited.
Postponed infectious diseases. They are especially dangerous for people who are prone to deafness at the level of genetics. Most often, otosclerosis in such patients develops after measles.
Belonging to the female sex. It has been experimentally proved that excessive growth of bone tissue in the ear is observed in women during the period of hormonal instability. Pathology can manifest during puberty, after the first menstruation, during pregnancy, after childbirth, during menopause. About 80% of all cases are women. Tumors of the endocrine glands can provoke otosclerosis of the ear.
Ear injury. In terms of the development of otosclerosis, it is acoustic trauma that is especially dangerous. Moreover, the duration of the sound effect on the structures of the ear does not matter.
Circulatory disorders. If the internal structures of the ear do not receive normal nutrition, then this leads to the development of a pathological process.
Inflammation of the internal structures of the ear. Chronic sluggish processes are especially dangerous in terms of the development of the disease. The structures of the ear are constantly injured, which leads to the replacement of normal tissue with scar tissue.
Otosclerosis can cause complete deafness, so it is so important to know its symptoms and be able to distinguish them in time.
The main manifestations of pathology include:
- Background tinnitus.
- Dizziness that occurs when the head is turned sharply.
- Nausea and vomiting.
- Pain behind the ear. It is pressing, concentrated in the area of the mastoid process.
- Ear congestion, hearing impairment.
- Heightened perception of high frequency sounds. Low frequency sounds, on the other hand, are worse for a person.
- Willis paracusis. It seems to a person with otosclerosis that their hearing improves when there is noisy around.
- Weber's paracusis. Hearing impairment occurs when chewing or walking, in any situation where soft tissue movement occurs. It is caused by irritation of the inner ear cochlea.
- As the pathology progresses, a person ceases to perceive not only low, but also high sounds.
- Manifestations of a neurasthenic symptom. The patient has headaches, he becomes apathetic, he suffers from insomnia. During the day, a person looks tired, memory and attention decreases.
Toynbee's symptom. It is manifested by an unclear perception of speech when several people are talking at once.
If a person does not receive the necessary treatment, then the disease progresses, its symptoms intensify all the time. In some patients, one ear is involved in the pathological process, while in others two hearing organs are involved.
There are several classifications of otosclerosis.
Depending on the pathological changes in the inner and middle ear, there are:
Fenestral (stapedial) otosclerosis. Pathological tissue proliferation occurs in the area of the labyrinth windows. The ear ceases to perform normally its sound-conducting function. This form of the disease has the most favorable prognosis. If treatment is carried out on time (surgery is required), then the likelihood of full hearing recovery is high.
Cochlear otosclerosis. The affected areas are concentrated in the area of the cochlear capsule. With this type of disease, the sound-conducting function of the inner ear worsens. Even surgery does not fully restore hearing.
Mixed form of pathology. In a patient, not only the function of perception decreases, but also the conduction of sound through the structures of the inner ear. Timely therapy allows you to restore hearing before it is completely carried out.
Depending on the rate of development of otosclerosis, such varieties are distinguished as:
A transient form of the disease. It is diagnosed in 11% of all patients.
- Slow form of the disease. It occurs most often and occurs in 68% of cases.
An abrupt form of pathology. It is diagnosed in 21% of patients.
Otosclerosis goes through 2 stages:
Otospongy. This is the active stage of the pathology.
Sclerotic. This stage is with low activity of the pathological process.
The processes of softening and sclerosis of the ear bone tissue alternate all the time.
Diagnosis of otosclerosis is reduced to the following steps:
Taking anamnesis, listening to patient complaints. A person indicates noise in the ears and in the head, a feeling of pressure in the ear canal, etc.
Examination of the tympanic membrane. During its implementation, the doctor does not visualize any pathological changes.
Using a tuning fork to determine hearing acuity.
Carrying out audiometry. This method allows you to measure hearing acuity, determine the sensitivity of the hearing aid to sounds of different frequencies. During the procedure, the patient is put on headphones that give various signals. When a person hears a sound, he must press a button. This allows you to plot your hearing acuity (audiogram). In a patient with otosclerosis, there will be a violation of the air conduction of sound along the chain of the auditory ossicles. At the same time, the function of sound perception by the auditory receptors remains intact (bone conduction of sound).
Tympanometry. This study is aimed at determining the mobility of the tympanic membrane, assessing the conduction of sound by the auditory ossicles, and determining the pressure level in the middle ear. Most often, no abnormalities are found in a patient with otosclerosis. Therefore, tympanometry is performed only if other diseases of the middle ear are suspected.
Ultrasound. This study makes it possible to distinguish otosclerosis from cochlear neuritis, since these pathologies give similar symptoms. However, with cochlear neuritis, the conduction of ultrasonic waves through the tissues is greatly impaired.
Vestibulometry, otolithometry, stabilography. These studies are aimed at assessing the patient's vestibular function.
Acoustic reflexes. They are assessed by registering changes in the resistance of the elements of the outer and middle ear when exposed to high frequency sounds. As a rule, acoustic reflexes are absent in patients with otosclerosis.
To clarify the diagnosis, the patient may need to consult an audiologist and a surgeon.
The therapy for the patient is selected depending on the form of the disease and on the stage of its development. If the pathology was discovered during the period when it just began to develop, then the prognosis is maximally favorable and hearing loss develops very rarely. Moreover, it is possible to do only with conservative methods of therapy.
If a patient is diagnosed with an active or cochlear form of otosclerosis, then conservative methods can cope with the disease.
The patient is prescribed drugs such as:
- Bisphosphonates: Fosavance, Fosamax. These funds allow you to stop the destructive effect of osteoclasts on bone tissue.
- Sodium fluoride. Its use prevents the resorption of bone tissue, allowing it to maintain its integrity.
- Calcium preparations.
- Alfacalcidol. This drug allows you to normalize mineral metabolism and promotes the production of bone matrix proteins, which make up the skeleton of the bone.
The drugs will need to be taken in courses of 3 months. Then they take a break for the same period. As a rule, patients are required to undergo at least 2 courses. Most often it is not possible to manage with drugs alone, since drugs do not allow to restore the function of hearing, but make it possible not to lose it, preventing the growth of foci of otosclerosis. This is very important when the disease is in an active phase and it is not possible to perform an operation.
If the disease progresses, or the doctor believes that drug correction will not bring an effect, then the patient is referred for surgery. It is not prescribed for patients with cochlear otosclerosis, since surgery will not bring results. Such patients are indicated for medical correction and the use of a hearing aid.
Otosclerosis surgery restores normal sound transmission in the middle ear.
There are three types of surgery:
Stapedoplasty. The operation is performed under local anesthesia and involves removing the stapes. They are replaced with a prosthesis that works like a piston. The prosthesis is made from the patient's own tissues, or from titanium, Teflon or ceramic. The operation allows you to achieve the desired results, since the mobility of the auditory ossicles is normalized. The effect is absent in only 1% of patients. First, the procedure is performed on one ear. If everything goes well, then after six months, surgery is indicated on the second ear.
Fenestration of the maze. The procedure is performed under general anesthesia, although local anesthesia is sometimes done. Control is carried out using a microscope. In the inner ear, the doctor makes a new oval window. It is located in the lateral semicircular canal. In recent years, such a procedure has been used less and less.
Mobilization of the stirrup. The operation allows to restore the mobility of the stapes in the patient. For this, the bone fusion from the auditory bone is removed, due to which it begins to work as before. However, after a few years, the hearing loss will return as the bone tissue grows back. This operation has been practiced less and less in recent years.
Physiotherapy can improve the effect of the treatment. Most often, experts recommend that patients with otosclerosis undergo electrophoresis on the mastoid region and darsonvalization.
Physiotherapy procedures increase blood flow in the affected area, due to which the nutrition of nerve fibers improves, the patient's well-being is stabilized.
A patient with otosclerosis is prescribed:
Electrophoresis with Dibazol, nicotinic acid, Papaverine, Drotaverine.
Transorbital galvanization. This procedure improves tissue nutrition by increasing blood flow.
Darsonvalization. During the procedure, nerve fibers are irritated, which increases their excitability and improves microcirculation in tissues.
Diadynamic therapy. The procedure stimulates the conduction of impulses to the auditory nerve, normalizes tissue blood supply.
Amplipulse therapy. The procedure has a neurostimulating effect.
Galvanization of the brain. This procedure has a sedative effect and reduces his excessive excitability.
Complications and consequences
Patients with otosclerosis are at risk of complete hearing loss. A person loses the ability to contact other people, cannot fulfill his professional duties. Many people with otosclerosis suffer from mental and neurological disorders. Therefore, it is so important to see a doctor after the first symptoms of illness appear.
If it is not possible to cope with deafness with the help of surgery or with the use of a hearing aid, then the person is assigned the 2nd disability group. After 2 years it will be removed. During this time, the patient must learn to communicate with gestures, acquire the skills of reading words on the lips. After 2 years, the patient is given the third disability group.
Sometimes complications of otosclerosis develop in people who have already undergone surgery. These include:
- Noise in ears.
- Sensorineural hearing loss.
- Damage to the tympanic membrane.
- Increased perilymph pressure in the inner ear.
Patients with such disorders are either prescribed drugs to eliminate them, or undergo a second operation. The surgeon will need to resort to patients with paresis of the facial nerve, with a displacement of the prosthesis, with tissue necrosis in the inner ear or labyrinth.
Sometimes during surgery, an infection is introduced into the tissue. This can lead to the development of otitis media and even inflammation of the brain. Such patients need hospitalization and emergency therapy.
Prevention of otosclerosis
There are no specific measures for the prevention of otosclerosis. The only medical recommendation is to administer a measles vaccine. Situations that could lead to ear infections should also be avoided. If there were cases of otosclerosis in the family history, then you need to be more careful about your health.
It is necessary to prevent the development of otitis media, and if it happens, then you need to start treatment on time. This will preserve your hearing for years to come.
The author of the article: Lazarev Oleg Vladimirovich | ENT
Education: In 2009, he received a diploma in the specialty "General Medicine" at the Petrozavodsk State University. After completing an internship at the Murmansk Regional Clinical Hospital, he received a diploma in Otorhinolaryngology (2010)