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Otosclerosis: diagnosis
Last reviewed: 23.04.2024
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The first manifestations of the disease in an overwhelming number of cases associated with a specific cause is not possible. A third of women in the history reveal a link between the first signs of hearing loss and pregnancy or childbirth, the period of breastfeeding. Hearing loss is progressive, at first the hearing loss is one-sided, then another ear is involved in the process. The patient's instructions for unilateral damage to the hearing organ require clarification, since on the background of a previously ill and worse hearing ear, hearing on the other hand seems normal to them.
Physical examination
Otoscopic signs of otosclerosis are extremely scarce. Characteristic symptoms are found only in 10-21% of patients. These include the symptom of Lempert (thinning of the tympanic membrane with a change in its color due to fibrous layer atrophy) and the Schwartz symptom (the transmission of pink-colored hyperemic mucous membrane in the cape area through a thin eardrum: a sign of the active stage of otosclerosis). Characteristically, the absence or decrease in the amount of sulfur (Touwnee symptom), atrophy and dry skin of the external auditory canal. When otosclerosis is also observed a decrease in the sensitivity of the skin of the external auditory canal and tympanic membrane, a decrease in the secretion of sweat glands, a wide external auditory meatus (the Virchowski-Tillo symptom). None of the otoscopic signs of otosclerosis can be called pathognomonic, they can be taken into account and evaluated only in conjunction with other manifestations of the disease.
Laboratory research
Not applicable.
Instrumental research
Audiologic examination of patients with otosclerosis is the foundation in the diagnosis and refinement of the form of the disease. The perception of low-frequency tuning forks in air conduction is worse for them. Quite widely used are various tuning fork tests, based on comparison of hearing in bone and air sound. The Rinne experiment is a method of differential diagnosis of damage to sound-receiving and sound-conducting devices, based on a comparison of the duration of sound perception in the study of bone and air sound conductivity using a tuning fork C128 (less often C512), transferred from the mastoid to the external auditory canal. The predominance of the first over the second is usually referred to as the positive experience of Rinne. For patients with mixed or conductive otosclerosis, with a bone-to-air interval of more than 20 dB, the negative experience of Rinne is characteristic. Also negative are Bing's experiments. Jelly and a symptom of the Politzer-Federici.
The most common in the diagnosis of otosclerosis was a tone threshold audiometry. Assess not only the level of hearing by air and bone, but also by the value of the bone-air interval (snail reserve). Otosclerosis is characterized by an increase in thresholds in air sound, more often in the form of an ascending curve with a slight ascent. With the development of the disease, the sound of high frequencies deteriorates, which leads to a "flattening" of the audiometric curve. For the diagnosis, the results of impedance audiometry and X-ray examination are also important.
Differential diagnostics
Differential diagnosis is necessary to determine the indication for surgery depending on the form of the disease (the effect of surgery can be expected in a tympanic and mixed form, with sufficient bone-to-air interval and the threshold of sound perception through the bone no higher than 30 dB according to audiological research).
Among diseases accompanied by a disturbance in sound production, an adhesive median otitis is released, which develops as a consequence of the inflammation of the middle ear. Otoscopy can detect cicatrical changes in the tympanic membrane, which are possible in patients with otosclerosis. The progression of hearing loss in patients with adhesive medial otitis media due to the development of cicatricial changes in the tympanic cavity also complicates differential diagnosis.
Traumatic damage to the chain of auditory ossicles the patient associates with the suffered head trauma, however the hearing thresholds in this situation are stable. The latter feature is also characteristic of various congenital anomalies of the middle ear and can be detected already in early childhood. In addition, the symptoms of otosclerosis are similar to those in neoplasms of the middle ear (neurinoma of the facial nerve, congenital cholesteatoma). Essential aid in differential diagnosis is provided by CT.
Indications for consultation of other specialists
Consultation of an otoneurologist (neurologist) is indicated in case of dizziness and with unilateral progressive perceptual hearing loss.
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