Otosclerosis

Shankai Yin Prof

Dept of Otolaryngology
Affiliated Sixth Hospital
Otolaryngology Institute
Shanghai Jiao Tong university
上海市第六人民医院
Shanghai Sixth People’s Hospital
History

 1704 Valsalva autopsy

 1894 Politzer “otosclerosis”
 1930s Lempert horizontal canal
fenestration
 1953 Rosen stapes mobilization
 1955 Shea stapedectomy

上海市第六人民医院
Shanghai Sixth People’s Hospital
Histopathology

Increased osteoclastic activity results in perivascular

bony resorption forming fibrotic spaces (lytic phase),
osteoblasts
within the fibrotic spaces producing immature bone (bone
production phase), cycling of resorption and bone
formation results in otosclerotic bone (remodeling phase)

上海市第六人民医院
Shanghai Sixth People’s Hospital
上海市第六人民医院
Shanghai Sixth People’s Hospital
上海市第六人民医院
Shanghai Sixth People’s Hospital
上海市第六人民医院
Shanghai Sixth People’s Hospital
上海市第六人民医院
Shanghai Sixth People’s Hospital
Biscuit footplate
上海市第六人民医院 Cochlear involvement
Shanghai Sixth People’s Hospital
Epidemiology

 Hereditary in 70% of cases

 Autosomal dominant
 Incomplete penetrance
 7-10% Caucasian temporal bones
 1% Caucasians with symptoms
 Other races lesser incidence

上海市第六人民医院
Shanghai Sixth People’s Hospital
Symptoms

 Slowly progressive hearing loss

ipsilateral or bilateral
 Tinnitus in 75%
 Vestibular complaints 25%

上海市第六人民医院
Shanghai Sixth People’s Hospital
Diagnosis

 History
 Physical examination
 Audiogram
 Imaging
 Surgical exploration

上海市第六人民医院
Shanghai Sixth People’s Hospital
Physical examination

 Otomicroscopy
 normal
 Schwartze’s sign
 Tuning forks

上海市第六人民医院
Shanghai Sixth People’s Hospital
Differential diagnosis

 Tympanosclerosis
 MEE
 incus/malleus fixation
 ossicular discontinuity
 congenital footplate fixation

上海市第六人民医院
Shanghai Sixth People’s Hospital
Systemic diseases

 Osteogenesis  Pagets disease

imperfecta  crowding in
 stapes fixation epitympanum
 blue sclera  elevated alk phos
 fractures  skeletal bone
involvement

上海市第六人民医院
Shanghai Sixth People’s Hospital
Imaging

 Multidirectional tomography
 CT
 MRI

上海市第六人民医院
Shanghai Sixth People’s Hospital
Audiology

 Tympanometry
 Acoustic Reflexes
 Pure tone audiogram
 Speech discrimination

上海市第六人民医院
Shanghai Sixth People’s Hospital
Tympanogram

 Normal type A
 Shallow type As

上海市第六人民医院
Shanghai Sixth People’s Hospital
Acoustic Reflexes

 Very sensitive
 “On-Off”
phenomenon
 precedes hearing
loss

上海市第六人民医院
Shanghai Sixth People’s Hospital
Pure tone audio

上海市第六人民医院
Shanghai Sixth People’s Hospital
Management

 Amplification
 Medical therapy
 Stapes surgery

上海市第六人民医院
Shanghai Sixth People’s Hospital
Amplification

 Refuse surgery
 Poor surgical candidate
 following improvement of CHL

上海市第六人民医院
Shanghai Sixth People’s Hospital
Medical management

 Sodium fluoride
 Vitamin D
 Calcium carbonate

上海市第六人民医院
Shanghai Sixth People’s Hospital
Stapes surgery

 Total Stapedectomy
 Partial Stapedectomy
 Anterior crurotomy
 Stapedotomy

上海市第六人民医院
Shanghai Sixth People’s Hospital
Goals

 Open the oval window for sound

transmission
 reconstruct sound conducting
mechanism
 without complication

上海市第六人民医院
Shanghai Sixth People’s Hospital
Variations

 Procedure
 Stapedotomy
 drill
 laser (CO2, KTP, argon)
 Prosthesis
 Oval window seal

上海市第六人民医院
Shanghai Sixth People’s Hospital