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Otosclerosis PATIENT INFORMATION

Otosclerosis is a condition involving abnormal bone growth in the inner ear. This condition is usually passed on through families. Much of the current research available indicates that this condition is induced by some external factor in those persons susceptible to these outside influences, which may include certain types of viral infection. Nevertheless, it does seem that these people have some hereditary factor that predisposes them to be vulnerable to such a condition. Although it most often runs in families, it can skip generations and different people in the families. Sometimes it occurs spontaneously outside of any hereditary influence.

This condition can occur in small children and in older adults. There is nothing a person can do to prevent this from occurring. Conversely, there is nothing that anyone did through negligence or otherwise that would cause this to occur.

Otosclerosis involves the inner ear and the bottom part of the third hearing bone, or the "footplate" of the stapes. The bone of the inner ear and that surrounding the stapes footplate undergoes a series of resorption and regrowth such that it causes fixation of the stapes or third hearing bone in many cases. This leads to a conductive hearing loss or problem with conduction of hearing from the eardrum to the inner ear.

In addition to conductive hearing loss, this process can also cause nerve or sensori-neural hearing loss due to a toxic effect of the bony growth on fluids of the inner ear.

In many cases, there is a mixed hearing loss or both conductive and sensori-neural hearing loss.

Treatment For Otosclerosis

Medical Treatment
There is no non-surgical treatment that would help fixation of the stapes. With sensori-neural hearing loss or nerve hearing loss from otosclerosis, a preparation of fluoride is often prescribed in the form of Flourical (Mericon Industries, Peoria, Illinois). Usually, it is recommended to take two tablets three times a day for about six months. There is evidence to suggest that the incorporation of fluoride into this new bony growth in the otosclerotic process will help arrest the disease and reduce future nerve hearing loss. This preparation is available without a prescription in most drug stores and health food stores. In patients with kidney problems and disease of the bone, this may be a bad idea, and you are advised to consult your general medical doctor in that regard. In many cases, this is not helpful and you will be advised whether or not you should try this at all.

Surgical Treatment (Diagram B)
In cases of a conductive hearing loss due to fixation of the third bone of hearing, surgery is available to correct this. The surgery can be done under a local or general anesthetic. The ear drum is reflected forward and the joint between the second and third ear bones is dislocated. A laser is then used to vaporize the top part of the stapes bone. A small hole is then created in the bottom of the stapes bone with the laser to afford an entrance into the fluid of the inner ear. A small plastic piston is then fixed to the second hearing bone and placed in the small opening created with the laser. This reconstitutes vibration from the eardrum to be passed through to the inner ear fluids and restores the hearing. This is the usual scenario of surgery for otosclerosis. Sometimes, there are modifications of this that may include total removal of the third hearing bone. As operations go, this is one of the safest and most effective available. In over 95% of the cases, a good result is achieved with great improvement in hearing. About 0.5 to 1% of the time, the hearing is severely worse, such that even a hearing aid is not helpful. Most of the time, this operation lasts a lifetime. Occasionally, there can be failures years later from scarring or movement of the prosthetic device that is placed in the ear, but this is unusual. The advantage of surgery is that it restores the hearing and avoids the need for a mechanical device. The hearing is better than you would normally get with a hearing aid. However, the disadvantage is that there are some small risks involved with the surgery.

Observation
If your hearing loss is not bothering you and you don't want to do anything about it, you certainly don't have to. Otosclerosis will not spread to other bones in your body and will not cause any other health problems. You could live to be 300 years old without doing anything to your ear.

Hearing Aids
Hearing aids work quite well with this type of hearing loss and would serve you very well. The benefits of a hearing aid are that they do not include any of the risks involved with surgery. The disadvantage is that you don't hear when the hearing aid is out and they also break on occasion. It requires a good supply of batteries to be around and you can't hear when you are sleeping because the hearing aid is out. It is also somewhat problematic when involved in athletic events in which there is a great deal of sweating, and it cannot be used when swimming or showering. Also, the hearing you get with a hearing aid is not quite the same as your own actual hearing. Many people try a hearing aid for a while to see if it is satisfactory. In those persons who are satisfied, they keep wearing the hearing aid. For those that are not, they elect to choose surgery.

What to Expect Following Surgery
There is usually not very much pain following stapes surgery. There is usually a little bit of dizziness. This usually persists about twenty-four hours. Occasionally it lasts for a few weeks. The hearing is not usually better immediately following surgery due to some packing in the ear canal and swelling. Usually, one sees some improvement within about three weeks following surgery, and maximum hearing gained is usually seen at four months.

There may be some slight drainage from the ear for the first few days after surgery. This is okay. Just put a cotton ball at the edge of the ear canal to catch any drip. If there develops any yellow, white or infection type drainage, please call the clinic immediately.

You will most likely be given a prescription for some antibiotics and pain medicine. Please take these as directed. It is advisable to take some pain medicine every four hours for the first twenty-four hours following surgery to prevent any pain, as it is easier to keep pain from happening rather than to chase it after it has started. It is imperative not to blow your nose for the first two weeks following surgery. If you need to, sniff gently. Also avoid any straining. Use a laxative, if necessary. Avoid straining, such as lifting. Do not lift anything over ten pounds for the first two weeks. This is necessary to prevent any increase in the fluid pressure in the inner ear that occurs with any type of straining. It is not unusual to have a little bit of ringing in the ear following surgery. If this becomes severe, please call the clinic. This should go away within a few weeks.

It is also not unusual to experience a little metal taste in the mouth following this type of surgery. It usually goes away within a few weeks. In rare cases, this may persist beyond a few months.

The surgery is done as an outpatient in most cases. You will definitely need someone to drive you to and from the hospital. If your work involves no lifting or straining, you can plan to return to normal duties within a week following surgery.

Risks and Complications of Surgery

Hearing Loss
In less than 1% of the cases, the hearing is totally lost such that hearing aids are not useful. This is a rare occurrence and we are not sure why that happens. We think it has something to do with the opening of the inner ear to the outside. In over 95% of the cases, the hearing is improved greatly.

Dizziness
It is not uncommon to be slightly dizzy after stapes surgery for a few days. On rare occasions, in less than 1% of the cases, this dizziness persists greater than a couple of weeks. On some occasions, it requires another operation to correct it. This is perhaps the worst problem that ever occurs with this operation.

Facial Paralysis
The facial nerve courses right along and around the stapes bone. Theoretically, this nerve can be injured with stapes operation. This is extremely rare, occurring less than 1 in 1,000 cases. Usually it occurs when there is an abnormal development of the nerve itself.

Tinnitus
Occasionally, there can be worsening of ringing in the ear following this operation. Usually, this goes away with time; however, it may persist. This is also an unusual problem.

Taste
The taste nerve courses between the ear bones. Occasionally this nerve is damaged and loss of taste occurs on that side of the tongue. Usually the taste returns, but loss of taste on that side can be persistent. A metallic taste for a few weeks after surgery is normal due to manipulation of this nerve.

Summary
Overall, the stapes operation is an extremely safe and effective operation to restore hearing to those with hearing loss due to otosclerosis. This is especially true in the present day with the availability of lasers and the modern techniques that make this surgery even safer. Please write down any questions you might have regarding otosclerosis and your particular problem, and we will be glad to answer them.

The content of this site is intended for information purposes only; it is not meant to take the place of seeing a healthcare professional. If you have any concerns regarding your own or someone else's health, we strongly encourage you to consult a physician.

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