Otosclerosis
Last reviewed: 23.04.2024
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Otoskleroz (otosposgio) - a disease of the body deafness, caused by a focal pathological process in the bone maze, often leading to the fixation of the base of the stapes in the window of the vestibule, manifested by progressive, usually bilateral, hearing loss and tinnitus. This is the focal change of the endochondral layer of the osteal capsule of the ear maze.
ICD-10 code
- H80 Otosclerosis.
- H80.0 Otosclerosis involving the oval window, non-littering.
- H80.1 Otosclerosis involving the oval window, obliterating.
- H80.2 Cochlear otosclerosis.
- H80.8 Other forms of otosclerosis.
- H80.9 Otosclerosis, unspecified.
Epidemiology of otosclerosis
The prevalence of otosclerosis in the population is approximately 1%. The disease occurs in all age groups, clinical manifestations are more often found at the age of 20-50 years. Women predominate in the ratio of 2 to 1. A low prevalence among immigrants from Africa (0.5% of the population).
Classification of otosclerosis
By the character of the audiometric curve, we distinguish tympanic (fenestral), cochlear (retrofenestral, intra-intraluminal, labyrinth) and mixed (tympanocchlear, fenestro retenfenestral) forms of otosclerosis. The first is characterized by normal values of auditory sensitivity in bone sound conduction. The second audiological curve does not differ from neurosensory hearing loss. The third combines the signs of the first and second.
Causes of otosclerosis
The cause of otosclerosis is not established. Among the numerous theories of the onset of the disease, the effect of inflammation and infection is distinguished.
Recent studies have identified a provoking role for measles virus in patients with a genetic predisposition to otosclerosis. Elevated IgG peaks, specific for measles virus antigens, were observed in perilymph patients. These antigens are also isolated immunohistochemical methods from the active otosclerotic focus, but the actual value of the virus in the development of the disease is not established.
Otosclerosis - Causes and pathogenesis
Symptoms of otosclerosis
Symptoms of otosclerosis are a progressive hearing loss with a certain speed and a sense of noise in the ears. The periods of stabilization are followed by periods of significant deterioration of hearing, but regression of hearing loss, like deafness, never occurs. Rarely observed rapid development of the disease, characteristic of the so-called juvenile form, in which pronounced hearing loss develops in a short period of time. According to a number of authors, for the period from 20 to 40 years, 70-80% of cases of the first manifestation of otosclerosis occur. Hearing loss with otosclerosis, as a rule, is bilateral, and between its appearance on one and the other side can pass from several months to years. A characteristic feature of otosclerosis is a relatively better perception of speech in terms of noise than in silence - paracusis willisii (Willisia symptom, Willis phenomenon, paracosis).
Diagnosis of otosclerosis
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).
Treatment of otosclerosis
Hearing loss with otosclerosis is well adjusted with the help of hearing aids, so the preliminary conversation with the patient should end with explaining to him the choice of the method of treatment - surgical (with a certain probability of complications) or electroacoustic (lacking this defect).
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