Otosclerosis Part 3 - Treatment

🦻 Otosclerosis - Medical & Surgical Treatment

Continued from Part 1 - Otosclerosis Causes, Pathogenesis, Types, Pathology and Part 2 - Otosclerosis Symptoms, Signs, Differential Diagnosis.

This is Part 3 and the final part of the Otosclerosis series.

In this post, we will discuss:

• When no treatment is required
• Medical management options
• Hearing devices
• Surgical management (stapedotomy & stapedectomy)
• Far advanced otosclerosis
• Cochlear implantation
• Post operative care and complications

👀 Conservative Management in Otosclerosis

📌 Patient under Observation & Follow-up:

• Every 6-12 months with audiometry

What are the Indications for Observation in Otosclerosis?

💊 Medical Management in Otosclerosis

🧪 Sodium Fluoride Therapy

• Stabilizes active otosclerotic focus
• Prevents progression of cochlear (SNHL) component

What are the Indications of Sodium Fluoride in Otosclerosis?

What is the Mechanism of Action of Sodium Fluoride in Otosclerosis?

💉 Dosage & Administration

• Sodium fluoride: 40–50 mg/day
• Vitamin D3: 500 mg/day
• Given with calcium
  • Prevents secondary hyperparathyroidism

📌 Follow-up:

• Hearing assessment every 6 months
• Stop therapy after 2 years if stable

⛔ Contraindications

• Chronic nephritis
• Nitrogen retention

📘 In my detailed notes, I’ve discussed an exhaustive list of Contraindications of Sodium Fluoride in Otosclerosis.

💊 Bisphosphonates

• Reduce bone remodeling
• Newer generation drugs show promise
• May slow progressive SNHL
• Still under investigation

🎧 Hearing Devices in Otosclerosis

🔊 Hearing Aids

Indicated when:

• Patient refuses surgery
• Patient unfit for surgery
• Far advanced otosclerosis

What is the advantage & disadvantage of using Hearing Aids in Otosclerosis?

What is Far advanced Otosclerosis? What are the management options in Far advanced Otosclerosis?

🦴 Bone Anchored Hearing Aid (BAHA)

Ideal for:

• Only hearing ear
• Difficulty using conventional hearing aids
• Post-fenestration cavities

✔ No risk of dead ear

🔗 Direct Acoustic Cochlear Stimulation

📌 Device:

• Active middle ear implant
• Attached to stapes prosthesis
• Direct stimulation of perilymph

What are the Indications of Direct Acoustic Cochlear Stimulation in Otosclerosis?

🏥 Surgical Management of Otosclerosis

✂️ Indications for Stapes Surgery

• Fixed stapes with:

  • Air conduction ≥ 30 dB
  • A-B gap ≥ 15 dB
  • Negative Rinne (256 & 512 Hz)
  • Speech discrimination ≥ 60%

• Mixed hearing loss with good speech discrimination

⛔ Contraindications to Surgery

❌ Absolute

• Ménière’s disease
• Only hearing ear

⚠️ Relative

• Young children
• Pregnancy

📘 In my detailed notes, I’ve discussed an exhaustive list of Contraindications of Surgery in Otosclerosis.

🛠 Types of Stapes Surgery

• Stapedotomy (Preferred)

• Stapedectomy

• STAMP Procedure

What is STAMP procedure in Otosclerosis?

• Lasers in Stapes Surgery

What are the common lasers used in Otosclerosis?

What are the advantages of using Laser in Stapes surgery?

What are the Perioperative Hazards of using Laser in Stapes surgery?

🩺 Post Operative Care after Stapes Surgery

• Analgesics ± antibiotics

• Avoid:

  • Nose blowing
  • Straining

• Discharge: Same day

• Return to work: 1 week

• Audiometry follow-up:

  • 2–4 weeks
  • Then annually

• Sodium fluoride if SNHL component present

⚖️ Stapedotomy vs Stapedectomy (Quick Comparison)

🔄 Revision Stapes Surgery

• Higher risk of SNHL

• Poorer outcomes than primary surgery

• Laser preferred for:

  • Adhesions
  • Bleeding control
  • Prosthesis repositioning

🧠 Cochlear Implantation

✅ Indications

• Profound bilateral SNHL
• Far advanced otosclerosis
• Failed stapes surgery
• No benefit from hearing aids

📌 Key Exam Pearls

• Observation valid for mild disease
• Sodium fluoride = stabilizes SNHL
• Stapedotomy > Stapedectomy
• Schwartz sign = avoid surgery
• Cochlear Implantation is gold standard for far advanced otosclerosis