Otosclerosis is a disease of unknown cause that results in bone deposition around one of the small bones of the middle ear. This bone, known as the stapes, is the smallest bone in the body and works as a sort of piston that moves to generates sound in the inner ear. Because bone is deposited around the stapes, this bone becomes immobile resulting in hearing loss. The amount of hearing loss tends to progress with time as more bone is deposited. In the majority of patients only one ear is affected but occasionally the process can be bilateral.
Treating otosclerosis can be medical, surgical or both. Medical options include use of a hearing aid which may provide the patient with enough hearing improvement so that they do not desire further treatment. In addition, occasionally patients are given fluoride which has been shown to slow the rate of bone deposition, although it is not curative. Surgery for otosclerosis typically involves removal of the stapes (stapedectomy), an outpatient surgical procedure done entirely through the ear canal. In this procedure the ear drum is elevated and the diseased stapes is removed. A new hole is made to connect to the inner ear and a prosthesis is placed to take the place of the stapes. In expert hands this surgery has an 80-90% success rate of improving hearing within 10 decibels of the unaffected ear.
Complications are infrequent but can include dizziness, which is temporary but can be severe, development of a fistula between the inner and middle ear, dislodgement of the prosthesis, a hole in the ear drum, and in rare cases, deafness. After the surgery you will be asked to avoid heavy lifting, nose blowing and contact sports for several weeks to allow the prosthesis to heal in place. It may take a few weeks for your hearing to improve after surgery. This is due to swelling and to the fact that during the surgery the middle ear is packed with absorbable material which dissolves over several weeks.
Although the surgery is highly effective, in many patients the bone deposition continues and they may require a revision procedure at some point. Revision surgery has a slightly lower success rate but can be as safe and effective. For patients that are not able to have revision stapes surgery and do not want a traditional hearing aid, they may be a candidate for a bone anchored hearing aid which is designed for people with this type of hearing loss (for more information about bone anchored hearing aid click here).
If you would like more information about otosclerosis or the treatment options for it, please feel free to give us a call.
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