CSD 4400 HEARING DISORDERS AND EVALUATION

Topic 7 The Middle Ear and Disorders Otosclerosis Other Pathologies

OTOSCLEROSIS

Disorder of the inner ear (bony labyrinth) Excessive vascularization and bone deposition Most common sites of invasion is the round window and the footplate of the stapes Results is stapes fixation

OTOSCLEROSIS: FACTS
1. Relatively common condition affecting 7.3% of 2. 3. 4. 5.

Caucasian males and 10.3% of Caucasian females Otosclerosis causes hearing loss in 0.3% of the general population 2/3 of patients treated are female 75% of cases are bilateral The disease is progressive with symptoms becoming noticeable by the 3rd decade

ETIOLOGY OF OTOSCLEROSIS
Basically unknown Two prevailing theories
1.
Genetic
Appears true for approximately 50-70% of cases More common in females Hearing loss tends to accelerate during pregnancy

2.

Viral

SYMPTOMS OF OTOSCLEROSIS

Schwartze Sign Tinnitus Other usual signs of conductive hearing loss

Better speech understanding in noisy settings rather than quiet ones Problem of attenuation rather than distortion

AUDIOMETRIC FINDINGS

Typical audiogram of early otosclerosis

1. 2. 3.

Conductive HL Rising configuration

Flat in later stages

Carharts notch

AUDIOMETRIC FINDINGS
Advanced otosclerosis:
1. 2. 3. 4.

More moderate conductive hearing loss Flat configuration Normal tympanograms Negative ARs

CASE STUDY: EARLY OTOSLEROSIS

Middle aged woman eventually diagnosed in early stages of otosclerosis
Audiogram Speech audiometry

CASE STUDY: EARLY OTOSLEROSIS

Middle aged woman eventually diagnosed in early stages of otosclerosis

Tympanograms

TREATMENT
Medication
Floride treatments

Surgery
Fenestration Stapes mobilization Stapedectomy Stepedotomy

STEPEDECTOMY
What follows is a step-by-step animation of stepedectomy surgery You can find this and other interesting middle ear surgical procedures at:
http://www.earsurgery.org

THE SURGICAL PROCEDURE

THE SURGICAL PROCEDURE (CONT)

THE SURGICAL PROCEDURE (CONT)

THE SURGICAL PROCEDURE (CONT)

CONCLUDING REMARKS

Medical treatments do not cure the disorder Otosclerosis and hearing aids

OTHER MIDDLE EAR PATHOLOGIES

Congenital middle ear malformations

Stapes fixation
Audiometric example

OTHER MIDDLE EAR PATHOLOGIES

Trauma
Triad of symptoms
1. 2. 3.

Loss of consciousness Bleeding from the ear Hearing loss

An audiometric example

CONCLUDING REMARKS ABOUT MIDDLE EAR PATHOLOGY

Medical referral is a must for any newly identified conductive hearing loss Shift in management from amplification to medical treatment