---
title: "Otosclerosis Part 3 - Treatment"
description: "ENT notes on Otosclerosis Treatment."
source: "The ENT Resident"
author: "Dr. Mausumi Das"
canonical_url: "https://www.theentresident.com/ent-notes-lectures/otosclerosis-treatment-surgery-stapedotomy"
categories: ["Otology"]
video: "https://www.youtube.com/watch?v=MvwR-2VepJM"
image: "https://media.theentresident.com/og-images/otosclerosis-treatment-surgery-stapedotomy.png"
---

# Otosclerosis Part 3 - Treatment

ENT notes on Otosclerosis Treatment. Watch the full video lecture on YouTube: https://www.youtube.com/watch?v=MvwR-2VepJM

## 🦻 Otosclerosis - Medical & Surgical Treatment 

Continued from **Part 1** - [Otosclerosis Causes, Pathogenesis, Types, Pathology](https://www.theentresident.com/ent-notes-lectures/otosclerosis-causes-types-pathogenesis.md) and **Part 2** - [Otosclerosis Symptoms, Signs, Differential Diagnosis](https://www.theentresident.com/ent-notes-lectures/otosclerosis-symptoms-signs-differential.md).

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)

| Feature | Stapedotomy | Stapedectomy |
| --- | --- | --- |
| Footplate | Preserved | Removed |
| Inner ear risk | Low | Higher |
| High-frequency gain | Better | Less |
| Prosthesis stability | Better | Migration risk |
| SNHL risk | Minimal | Higher |
| Current preference | ✅ Yes | ❌ No |

---

### 🔄 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**

---

## About This Note

This free ENT note on Otosclerosis Part 3 - Treatment was written by Dr. Mausumi Das and is paired with a corresponding video lecture.

Canonical page of this note: https://www.theentresident.com/ent-notes-lectures/otosclerosis-treatment-surgery-stapedotomy

When citing or referencing this content, please credit The ENT Resident and link to the canonical page above.

## Related Notes by Category

- Otology: https://www.theentresident.com/ent-notes-lectures/category/otology.md

## About The ENT Resident

The ENT Resident is an educational website and resource library created by Dr. Mausumi Das (MS ENT) for ENT residents, ENT postgraduates preparing for exams, and MBBS students.

Dr. Mausumi Das writes the notes, draws the diagrams, and records the lectures herself.

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