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Physical examination * The results of your audiometry must be confirmed by a tuning fork test.

In most cases, only a 512- ! tuning fork is necessary. The "eber test is more sensiti#e than the $inne test. %e sure to mask the better-hearing ear &ith narro&-band noise &hen there is a substantial difference bet&een the t&o ears. %e a&are that cartilaginous colla'se, caused by the ear'hone, may yield a false-'ositi#e result for a conducti#e hearing loss. * (ou should be able to #ery closely 'redict the audiometric results by using your o&n #oice. If the 'atient hears the softest &his'er )&hen your li's are mo#ing*, the hearing loss is less than 15 d%. +ther benchmarks, a soft &his'er, less than 2- d%. a soft to medium &his'er, /to 0- d%. a moderate &his'er, 5- d%. a loud &his'er, 1- d%. a soft #oice, 2- d%. a medium #oice, 3- d%. and a shout, 4- d%. Patients &ith high-fre5uency hearing losses &ill still hear a soft &his'er. 6ask &ith &hite noise &hen there is a substantial difference in hearing bet&een the t&o ears. * Test the mo#ement of the malleus &ith your 'neumatic otosco'e or &ith direct 'al'ation under the microsco'e after anestheti!ing the umbo &ith 'henol. * If the hearing is nearly e5ual in the t&o ears and the decision is to either )1* 'erform re#ision surgery on the 're#iously o'erated ear or )2* o'erate on the 're#iously uno'erated ear, choose the second o'tion. 7uccess rates in 're#iously uno'erated ears are &ell abo#e 4-8, &hile those for re#ision surgery are a''roximately 258. * In 'lanning to o'erate on both ears in &hich the hearing is nearly e5ual, do the left ear first if you are right-handed. con#ersely, do the right ear first if you are left-handed. This is es'ecially im'ortant for obese 'atients, for 'atients &ith a large chest or short neck, and for 'atients &ho cannot freely turn their necks. * In 'atients &ith both otosclerosis and serous otitis media, treat the serous otitis media first. * Post'one surgery in 'atients &ith external otitis until the otitis is ade5uately treated. * Post'one surgery if the 'atient has any infection any&here. * 9o not 'erform surgery if the air-bone ga' is less than 2- d%. * :l&ays test each 'atient at least t&ice before surgery. * 9o not de'end on the 7ch&art! sign. It is rarely seen. * 6ake sure that the hearing aid is ke't out of the ear to be o'erated on for at least a &eek before surgery. * If the eardrum is atro'hic, be 're'ared to re'air it at the time of surgery by reinforcing the drum &ith fascia, 'erichondrium, or a #ein graft. * If there is attic retraction, be 're'ared to re'air it &ith cartilage or 'erichondrium. * If a 'erforation is 'resent and it is anything but #ery small, 'erform a tym'ano'lasty.

)1* * (ou &ill find more cases of obliterated otosclerosis in children than in adults )22 and 18.to 42 yr* yields the same good results as are seen in younger 'atients. for exam'le. )0* :ll recei#ed a 'iston 'rosthesis and a tissue graft.e#ertheless. 9isease in children is #ery often more ra'idly 'rogressi#e. In children &ith unilateral otosclerosis. &hich is a ty'e of ner#e loss. ?(ou 'robably ha#e cochlear otosclerosis. It &ill not im'ro#e your hearing.11. &e 'refer to &ait until the child is res'onsible enough to a#oid situations that &ould endanger the success of the sta'edectomy. * If exostosis is 'resent but not extremely ad#anced. The armed forces no& allo& their 'ilots to return to flight status if our 'rotocol is follo&ed. they had accumulated 0.hours of combat or simulated combat flying time and ex'erienced no inner ear 'roblems. %ut if the results in one ear are not good. )/* * :ir'lane 'ilots can undergo sta'edectomy if a 'iston and a tissue graft are used. "e ha#e o'erated on 'atients as young as 1 years. 9ecision making * (ou can 'erform a sta'edectomy on children &ith bilateral otosclerosis. the results are still gratifying. (ou can tell your 'atient. Patients 'resent &ith a moderate. )0* The same is true for the airlines. excellent s'eech discrimination. you ha#e a choice. * If the 'atient has ad#anced tym'anosderosis or a history of fre5uent #entilation tubes. )2* * >or 'atients &ith far ad#anced otosclerosis. the a#erage child &ould ha#e lost 2 d% of hearing )-. you ha#e o'erated on a 'arent and / siblings of a 0--year-old &oman &ho 'resents &ith a 0--d% . . and none of them ex'erienced any #estibular or otologic sym'toms.? +r you can say. do not o'erate on the other ear. Ten years 'osto'erati#ely. Three years 'osto'erati#ely.58 in adults. +lder 'atients &ill not ha#e any more unsteadiness than do younger 'atients. ha#e your audiologist make a series of molds that &ill gradually enlarge the canal o#er a 'eriod of 1 months to a year 'rior to surgery. <losure rates are 428 in children and 42. and your results &ill not be 5uite as good as those in adults. remo#e it at the time of sta'edectomy. they &ere 'ut through a decom'ression chamber.? * 9o not fail to make the diagnosis of cochlear otosclerosis if. sus'ect chronic ear disease.2 d%=yr*.7chedule the sta'edectomy for 0 to 1 months later. ?(ou ha#e a ner#e loss and there is nothing I can do for you. an absence of cochlear reflexes. but in many cases it &ill 're#ent further loss of the hearing ner#e itself. * 9o not hesitate to make the diagnosis of cochlear otosclerosis. * If a 'atient has a tiny canal. "e ha#e 'ublished a re'ort on the results of sta'edectomy in 4 fighter 'ilots. Three months after surgery. and #ery often a family history. It is easy. :s for treating cochlear otosclerosis. usually flat sensorineural hearing loss. res'ecti#ely*. you may 'erform a sta'edectomy e#en if the s'eech discrimination score is -. I am going to 'lace you on sodium fluoride. )1* * 7ta'edectomy in the elderly )2.

7ta'edectomy in the elderly.1-3)0 Pt 1*. Those &ho ex'erience gastric sym'toms on >lorical may s&itch to 6onocal. * If the sensorineural com'onent of the hearing loss continues to &orsen in 'osto'erati#e 'atients on >lorical and #itamin 9.@ of #itamin 9. . * 9o not 'erform a sta'edectomy on a 'atient &hose reflexes are 'resent. * Patients &ith #an der oe#e syndrome should not be denied sta'edectomy. * 9o not o'erate on a 'atient &hose first language is Anglish and &hose hearing loss is 2. :m C +tol 1441. 7churing :D. 9a#idson %F. there is a 258 chance that he or she &ill ha#e one in the other ear. e#en if the reflexes are 'resent. Baryngosco'e 1443. >ucci 6C. :dolescents can be treated &ith 2. >ar-ad#anced otosclerosis. $i!er >6. 7churing :D.* Eat!a# C. They &ill do almost as &ell as 'atients &ho do not ha#e osteogenesis im'erfecta. obtain com'uted tomogra'hy of the tem'oral bones to rule out su'erior semicircular canal dehiscence. * If an obliterated foot'late is found in one ear. there is a 0-8 chance that it &ill be found in the other. %urkey C6.and long-term results of sta'edectomy in children.* Bi''y " .mg of risedronate t&ice a &eek.12)1*. 7hamiss :. %attista $:. $i!er >6.2 mg=day of sodium fluoride. Bi''y " .mg of <altrate )concentrated calcium* and /. the longer the treatment should be. :m C +tol 1441. )/. the greater the ner#e in#ol#ement is.d% or less unless their s'eech discrimination score is 3-8 or better.225-3. * If a 'atient has a conducti#e hearing loss and reflexes are 'resent. Treatment can continue indefinitely after surgery. all adults should be treated &ith >lorical )a sodium fluoride and calcium su''lement*.3/1-0. 7hort. al&ays offer a 'atient &ith a moderate hearing loss a hearing aid trial in lieu of surgery. )5* $eferences )1. * "hen a''ro'riate. %urkey C6. * If a 'atient has or had a dehiscent o#erhanging facial ner#e in one ear.15)2*. :m C +tol 1440. * :s soon as a diagnosis of otosclerosis is made. 'lus 0-.514-22.* Bi''y " . )0.hearing loss &ith good s'eech discrimination and absent reflexes. )2.302-4. "e often 'ut 'atients like this on sodium fluoride. :dults &ho are taking a tetracycline or &ho ha#e kidney stones can take >lorical. a form of sodium fluoride and calcium that is absorbed in the intestine rather than the stomach. et al. 2 to 0 tablets 'er day de'ending on the amount of ner#e loss and the si!e of the 'atient. add 1-. 7ta'edectomy in combat 'ilots.* Bi''y " .12)1*.

"arren. . Bi''y " . >indings and results in 1.ose and Throat. >rom The Bi''y Drou' for Aar. +hio.eurotol 2--1. <+P($ID T 2--3 Gendome Drou' BB< .3-bilateral sta'edectomies. <engage Bearning. :ll rights reser#ed.1-/-2. Erieger B". <o'yright 2--3 Dale.* 9aniels $B. +tol .o 'ortion of this article can be re'roduced &ithout the ex'ress &ritten 'ermission from the co'yright holder.)5. The other ear.22)5*. .