Otosclerosis
Otosclerosis is a condition characterized by abnormal bone growth near the middle ear, primarily affecting the stapes bone, which can lead to varying degrees of hearing loss. This bone fixation occurs when bony tissue grows improperly, hindering the stapes' ability to vibrate, crucial for sound transfer to the inner ear. Symptoms typically begin in early adulthood and can progressively worsen over time, affecting both ears in most cases. In addition to hearing loss, individuals may experience dizziness, balance issues, and tinnitus, which is a ringing or roaring noise in the ears.
The exact cause of otosclerosis remains unclear, but genetic factors play a significant role, with a higher prevalence among women and individuals with specific medical histories, such as previous measles infections. Diagnosis involves a thorough examination by an otolaryngologist, often aided by imaging tests. Treatment options range from monitoring milder cases to fitting hearing aids or surgical interventions like stapedectomy for more severe hearing loss. While some patients may also benefit from cochlear implants, it is crucial for individuals to discuss their symptoms and family medical history with healthcare providers to determine the best course of action.
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Otosclerosis
Otosclerosis is an abnormal growth of bone near the middle ear that often leads to hearing loss. The condition usually occurs when a small bone in the middle ear called the stapes becomes stuck in place. The stapes becomes fixed in place when bony tissue grows in places it should not, preventing the stapes from vibrating properly. Since the stapes bone has to vibrate for sound to travel from the middle ear to the inner ear, an individual with otosclerosis can experience mild to severe hearing loss depending on the severity of the condition. Stapes fixation is just one way otosclerosis can occur. The condition can appear if any of the small middle ear bones, called ossicles, become stuck together in an immovable clump. Hearing loss is the primary symptom associated with otosclerosis, but the condition can also cause dizziness and balance problems. Treatment varies depending on symptoms. The more severe cases of hearing loss may require surgery.
Background
Abnormal stiffening of the stapes was first described in 1704 by Italian anatomist Antonio Maria Valsalva as the cause of deafness. Over the next few centuries, medical experts began to notice similarities in stapes fixation while dissecting the temporal bones. The first physician to link these phenomena specifically to otosclerosis was Adam Politzer, who was the first to describe the condition as a distinctive disease involving the stiffening of the stapes and abnormal formation of new bone.
Although medical experts are not entirely sure what causes otosclerosis, several factors are common among patients with the abnormality. The condition usually emerges when a patient is young. It most commonly develops when patients are in their early twenties, and symptoms progressively worsen over the next decade. Otosclerosis can develop any time between ages ten and forty-five, however. More than three million Americans are affected by otosclerosis.
Researchers have identified a genetic component to developing otosclerosis. Nearly half of all individuals with otosclerosis possess a gene linked to the condition, and it often runs in families. Having the gene for otosclerosis does not mean a person will develop the condition though. Women have a higher risk of developing otosclerosis than men. Women who develop the abnormality during a pregnancy lose their hearing faster than women who are not pregnant when the condition emerges. Ethnicity also plays a role in who is more likely to develop otosclerosis. About 10 percent of Caucasians develop the condition, while otosclerosis is extremely rare in African Americans.
Otosclerosis is more likely to appear in individuals with certain medical conditions. Individuals who had measles at any point in their lives have a higher risk of developing otosclerosis. Patients who have experienced stress fractures to their bony tissue around the inner ear also have an increased chance of developing the condition. Immune system disorders have also been linked to otosclerosis.
Overview
The primary symptom of otosclerosis is hearing loss. Initially, hearing loss is minimal, with patients unable to hear whispering voices or low-pitched noises. Loss of hearing gradually increases with time. Hearing loss normally occurs in both ears, though a small percentage of affected patients only develop hearing loss in one ear. Symptoms can also include dizziness and balance problems since the equilibrium of the inner ear is disturbed. Patients may develop tinnitus, a condition characterized by persistent noise in the ear, usually a ringing or roaring sound.
A series of exams and tests are required to properly diagnose otosclerosis. Individuals experiencing hearing loss are advised to visit an otolaryngologist, also known as an ear, nose, and throat doctor. The doctor will examine the inner ear and test the patient's hearing. Patients with a family history of hearing loss should describe this history to the doctor, as it will help provide a better diagnosis. Some doctors will order a computerized tomography (CT) scan and X-rays of the ear.
Milder cases of otosclerosis will not usually require immediate treatment. Doctors often wait to see if the condition worsens and will periodically test a patient's hearing. Some doctors also suggest the use of a hearing aid. Some health professionals have recommended treating the condition with the dietary supplement sodium fluoride, which is supposed to slow the progression of the disease. Evidence proving this treatment's efficacy is limited. A few studies have shown that taking sodium fluoride can have a beneficial effect on the condition.
More serious cases of hearing loss can require surgery. Doctors will perform a procedure known as a stapedectomy, which involves a surgeon placing a mechanism inside the middle ear to move the fixed stapes bone or other small bones in the ear. This allows sound to pass through to the inner ear and improves hearing. Most stapedectomies are successful, but hearing loss can worsen in rare cases. Patients with otosclerosis in both ears will need two separate surgeries usually spaced six months apart. Patients are advised to refrain from blowing their nose for two to three weeks after surgery and to avoid people with respiratory infections and other contagious diseases. Health professionals also recommend avoiding loud noises, sudden changes in pressure, and situations that can make a person dizzy.
Another treatment option is a cochlear implant. This procedure is most beneficial to patients with the least amount of hearing loss prior to surgery. Although this treatment has proven successful in otosclerosis patients, they also had an increased risk of developing complications such as cochlear bone hardening and facial nerve stimulation.
Bibliography
"Adam Politzer (1835–1920) and the Description of Otosclerosis." Politzer Society, www.politzersociety.org/content.php?conid=685. Accessed 24 Oct. 2017.
"Otosclerosis." American Hearing Research Foundation, american-hearing.org/disorders/otosclerosis/#treatment. Accessed 24 Oct. 2017.
"Otosclerosis." MedlinePlus, medlineplus.gov/ency/article/001036.htm. Accessed 24 Oct. 2017.
"Otosclerosis." National Institute on Deafness and Other Communication Disorders, www.nidcd.nih.gov/health/otosclerosis. Accessed 24 Oct. 2017.
"Otosclerosis." New York Times, www.nytimes.com/health/guides/disease/otosclerosis/overview.html. Accessed 24 Oct. 2017.
Shohet, Jack A. "Otosclerosis." MedScape, emedicine.medscape.com/article/859760-overview#a4. Accessed 24 Oct. 2017.
"What Is Otosclerosis?" WebMD, www.webmd.com/cold-and-flu/ear-infection/otosclerosis-facts#2-4. Accessed 24 Oct. 2017.
"What You Should Know about Otosclerosis." American Academy of Otolaryngology, www.entnet.org/content/what-you-should-know-about-otosclerosis. Accessed 24 Oct. 2017.