What happens in otosclerosis ?

Your ear has 3 little bones :
malleus ,incus  and stapes
The malleus is partly attached to your ear drum on the inner side.The incus has a joining with the malleus . Stapes the smallest bone, is touching the incus and the oval window.

 

Otosclerosis  also known as otospongiosis is a problem of increased bone turnover .
Normally  the stapes footplate has low bone metabolism.
But if you have this problem.More bone will form around the stapes footplate.
This fixes the footplate with the surrounding  bone.
The footplate moves less with sound vibrations.
Result :You hear less

 

 

How sound  wave reaches your brain?

The sound waves pass from your eardrum -malleus-incus-stapes-oval window – inner ear auditory nerve – hearing part of your brain.
So any problems in this hearing  road .
You hear less.

 

 

Why do you hear less when stapes footplate is fixed?

The footplate is like a bony cover  over  the  oval window .
Oval window is the connection between  the middle ear containing air, with the inner ear containing perilymph.
It is covered by a membrane  ,the oval window membrane.
Perilymph is  a fluid which bathes your hearing and balance sensory organs present in the inner ear .
It also gives food to the nerve cells.

When stapes is fixed ,the sound energy from the middle ear doesn’t  reach the inner ear.
No sound in inner ear,brain has no sound energy to process into words.

 

What problems will   you have with Otosclerosis? 

Hearing loss:Most commonly conductive hearing loss.

75% case presents with both ear problems  at presentation.

3rd or 4 th  decade of life:most common 

90% before 50 years.

Dizziness is unusual with Otosclerosis .In this case we have to rule out Meniere’s Syndrome .

Tests which will help in diagnosis 

• Pure tone audiometry 
• Tympanometry 
• Acousic  Reflex

 

 

Who are at risk?

If you have Otosclerosis  in one ear.
Family history of hearing problem with Otosclerosis.
Pregnancy  can increase the problem.

What to do if you have Otosclerosis? 

• Hearing Aid
• Surgery.

Since  hearing loss is because  of reduced sound transmission. When you amplify sound by hearing aid you hear better.

 

Is there a problem if you delay surgery?

According to Shambaugh’s (Surgery of the Ear 6th Edition ):
“Since delayed surgery in no way decreases the result ,hearing aid as an option should always be mentioned.
This is mainly  because stapes Surgery has strict post op rules.
It  alao has a range of potential problems   .

 

Complications  of Otosclerosis  Surgery

• Sensorineural  hearing loss(1%) :complete /partial.
• Vertigo
• Ear drum perforation 
• Facial nerve injury
• Delayed failure
• Perilymph fistula
• Taste disturbance 
• Failure after surgery to improve hearing.

 

Special counselling  before surgery for:

• Professional tasters
• Pilots
• Divers
• Parachuters

 

Surgery for Otosclerosis 

Stapedotomy:Laser and cold surgery with piston prosthesis. 
A small hole is made in the fixed stapes footplate .Then a small prosthesis will connect the incus /malleus with this hole.
Better sound transmission.
You hear better.Hole in the stapes is made with instruments or laser.
Stapedectomy :Rarely done
The entire stapes footplate   will be removed .A graft will be placed over the hole  .A prosthesis  connected between malleus/ incus and the stapes hole.

 

What to do after stapes Surgery?

Precautions  after Otosclerosis Surgery are very important. 

While taking a shower, and washing the hair,  you  should plug the ear with a cotton ball ,soaked in Vaseline.

It is important  not  to put pressure on the ear for a few days after surgery.

Avoid:

• Blowing nose,
• Lifting heavy objects,
• swimming underwater, diving ,
• descending rapidly in high-rise elevators,
• taking an airplane flight should be avoided.Strictly for 1 month postoperative. 
• Avoid people with cold and cough as far as possible.Acute otitis media due to cold puts you at risk of labyrinthitis and meningitis.  

The Avoid list  should  be strictly followed for the best postoperative  results.

Long term plan should be after discussing with your doctor

It is important to avoid water entry in the ear.
 Water in the ear can  cause infection.
Infection can spread to your inner ear and brain through the connection in the footplate.
This will cause  labyrinthitis.

 

 

 

Problems which can occur with

labyrinthitis

• Complete hearing loss
• Meningitis
• Dizziness  with long term serious problems.

 

Do you have   a sudden reduced  hearing without dizziness ,post surgery after first improvement

 

This may be due to displaced prosthesis.

 

You can consider  getting 
*PURE TONE AUDIOMETRY AND TYMPANOMETRY  .Then visit  your surgeon  as soon as possible for more clarification. 

After any ear surgery your doctor will advice you about postoperative  follow-up schedule.

Most often it’s at 2 weeks
1 month
3 months and 6 months.

Above all don’t stop praying ,thinking positive and following  a healthy lifestyle. Everything works together  to make good things happen

Did you like this FAQ.Sometimes its difficult  to remember all the Do’s and don’ts.

Do share to help spread awareness. A lot depends on postoperative  followup and care.

 

Disclaimer :

This is meant to help and spread awareness and is not meant as a replacement  for professional advice. .For  personalized medical protocols you should always consult your doctor.