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Conservative Treatment of Otosclerosis

By Dimitrios N. Gelis, Evangelos Golas, Konstantinos Lytridis, Trifon Kyratzidi

September  2004

VELEREFONTIS  SCIENTIFIC  EDITIONS

Korinthos , Greece

 

CONSERVATIVE TREATMENT OF OTOSCLEROSIS®

Tel : 0030-741-26631

FAX : 0030-741-85030

e-mail : pharmage@otenet.gr

www.gelis.gr

 

Dr Dimitrios N. Gelis, MD, DDS, Dr of Med.

Otorhinolaryngologist; Specialized in ORL Allergy and Neurootology, and Phoniatrics, Korinthia, Greece,

Evangelos Golas MD, Otorhinolaryngologist; Specialized in ORL Allergy and Neurootology, and Phoniatrics,, Iohannina,  Hepirus, Greece.

Konstantinos Lytridis, MD, Otorhinolaryngologist, Specialized in ORL Allergy and Neurootology, Levadia,  Viotia, Greece.

Dr Trifon Kyratzidis, MD, Otorhinolaryngologist, Dr of Med.; Specialized in   Neurootology, Otosurgery, and Cochlear Implants, Verria, Imathia, Greece.

 

INTRODUCTION

Otosclerosis is a bone dysplasia limited to the optic capsule causing abnormal resumption and redeposition of bone. The existence of the entity "pure labyrinthine otosclerosis" or "cochlear otosclerosis" is not accepted by all authors; however, there is clinical and histologic evidence to support the existence of a progressive sensorineural hearing loss due to otospongiotic-otosclerotic lesions of the labyrinthine capsule, although diagnosis of this condition may be difficult. The involvement of the inner ear is described as degenerative changes in the spiral ligament, stria vascularis, organ of Corti, and cochlear neurons. The most frequent audiometric configuration is a "bite-type" curve, but flat or rising shapes can also be observed; speech discrimination appears unusually good for a pure sensorineural hearing loss and recruitment is frequently absent. A cochlear otosclerosis should be suspected when there is a family history of otosclerosis, the onset of the hearing loss occurs from the third to fifth decade, and worsening of the hearing loss is observed during periods of intense hormonal and endocrine activity, a positive Schwartze sign is present and bilateral sensorineural loss is associated with signs of unilateral stapedial ankylosis. A definitive diagnosis of cochlear otosclerosis can be made only with computed tomography, which allows a quantitative assessment of the involvement of the labyrinthine capsule by spongiotic or sclerotic areas. The factors to be considered are: otosclerotic foci 1 mm or more in diameter and a density different from that of the normal otic capsule, partially or completely erased contour of the capsule, double ring effect, bony neoformation in the labyrinthine spaces, and increased thickness of the cochlear capsule, (Sellari-Franceschini S. et al, 1998) (15).