Tympanosclerosis: causes, symptoms, diagnosis, treatment

Tympanosclerosis is characterized by cicatricial-degenerative manifestations in the middle ear caused by a preceding inflammatory-destructive process that ended with the formation of cicatricial tissue. As a result, various variants of scarring of the middle ear structures arise, consisting in the replacement of the mucous membrane with connective tissue deposits that restrict mobility in the joints of the auditory ossicles, causing obliteration of the windows of the ear labyrinth, causing circulatory disorders in the area of the labyrinthine wall and compression of the tympanic plexus. These pathological and anatomical factors cause, on the one hand, sound conduction disorders, on the other hand, trophic disorders of the tympanic plexus, its constant irritation and, as a consequence, secondary labyrinthine disease, manifested by constant tinnitus, perceptual hearing loss and vestibular dysfunction syndrome.

Causes of tympanosclerosis. The determining factors in the development of tympanosclerosis are acute or chronic catarrhal or purulent inflammation of the middle ear. Contributing factors are:

1. intermittent or permanent obstruction of the auditory tube;
2. the presence of chronic peritubal infection in the area of lymphadenoid tissue;
3. individual tendency to transform connective tissue into cicatricial sclerotic tissue;
4. metabolic disorders leading to pansclerosis, increased cholesterol and urea levels in the blood;
5. allergy;
6. frequent inflammatory diseases of the upper respiratory tract.

The clinical course of tympanosclerosis is characterized by progressive hearing loss and gradual increase in symptoms of cochleo- and vestibulopathy. With a long-term course of the disease, signs of perceptive hearing loss develop, leading to a mixed form and a decrease in the reserve of the cochlea. With a bone-air gap of less than 20 dB, surgical treatment of hearing loss is of little promise.

The diagnosis of tympanosclerosis is established on the basis of complaints, otoscopic picture, data from acoumetry and audiometry, and X-ray examination.

Complaints: hearing loss, constant subjective low-frequency noise in the ear, periodic mild dizziness. Acumetry indicates the presence of conductive or mixed (with a long-term process) hearing loss (conductive hearing loss): SR - from "at the auricle" to 3 m, negative Schwabach test, with Weber test - lateralization of sound to the diseased ear. Ascending type of tonal audiogram with the presence of a cochlear reserve determined by the degree of involvement of the sound-perceiving apparatus in the process. X-ray examination (projections according to Schüller and Chaussee, transorbital according to Guillen, tomography, CT) indicate various types of destructive changes in the temporal bone, which indicate the presence of scar tissue in the tympanic cavity and various types of destruction of its elements.

Treatment for tympanosclerosis can be non-surgical (depending on the degree of development of tympanosclerosis) and surgical. The first involves the use of mainly physiotherapeutic methods and, first of all, the restoration of the ventilation function of the auditory tube; the second - various types of tympanoplasty), and also, under appropriate anatomical conditions, stapedoplasty.