A disease such as otosclerosis occurs in 1% of the population, of which 80% are in the female half of humanity. At risk are people aged 20 to 35 years. The disease is characterized by gradual development and is most often unilateral.
What is this disease?
Otosclerosis is a lesion of the bone capsule, which is located in the labyrinth of the inner ear. Then ankylosis begins and, as a result, hearing loss.
Along with the main symptoms of otosclerosis, dizziness and tinnitus may occur. As a rule, surgery is the only way to improve the quality of life. To date, conservative therapy aimed at stopping the disease does not exist.
Causes of occurrence
Despite the rapid development of medicine, today it is not known why the disease develops. However, it has been established that otosclerosis has hereditary features. In addition, in 40% of patients, along with pathology, genetic abnormalities occur. An infectious disease can become a trigger for the development of the disease, and most often such a disease is measles, as well as hormonal disruptions, in particular those associated with gestation, menopause and even lactation. Some endocrine diseases can cause bone capsule damage.
Other risks
The disease can appear against the background of an abnormality of the organ of hearing or with a chronic disease of the middle ear. Often, the disease occurs in people with Paget's disease. Work in conditions of increased noise provokes the development of hearing loss. And as is the case with most diseases, otosclerosis can appear due to extreme stress.
The principle of the hearing organ
Before listing the symptoms of otosclerosis, you should understand how the hearing organ works. Anatomically, it consists of three parts:
- external;
- average;
- inner ear.
Initially, sound enters the outer ear and reaches the eardrum. Further, the vibrations are transmitted to the middle and inner ear, between which there is a small oval window connected by a stirrup. Sound, once in the inner ear with fluid, is transmitted to the hair cells. They are the nerve receptors that generate impulses that go further into the subcortical and cortical centers of hearing.
If a person is healthy, then the capsule of the labyrinth does not have secondary ossification. If the process of osteogenesis is activated, then the symptoms of otosclerosis begin to appear, zones appear where areas are abundantly supplied with blood, which eventually sclerosize and turn into a mature bone. If there is no treatment, then the stumbling immobilizes and ankylosis forms. Sometimes a snail and other parts of the maze are drawn into the process. As a result, hearing loss is observed.
Classification
To date, three types of pathology are distinguished, depending on the nature of the changes in the organ of hearing:
- fenestral or stapedial;
- cochlear;
- mixed.
The stapedial form is characterized by the location of the focus of the disease in the labyrinth window. In this situation, the symptoms and signs of otosclerosis appear exclusively in the sound-conducting function. It is believed that this is a favorable form, since the probability of restoring hearing through surgery is almost 99%.
The cochlear form is characterized by a lesion outside the window, in the area of the cochlear bone capsule. In this situation, sound-conducting functions using the operation are 100% impossible.
Mixed function is characterized not only by a decrease in sound conduction into the inner ear, but also by a decrease in perception function. The operation will only restore the auditory function to the level of bone conduction.
Flow rate
In 68% of patients, the rate of the disease is characterized as slow, in 21% it is spasmodic. Only in 11% of patients the disease is fleeting.
Stages
Doctors distinguish three stages of the course of the disease:
- initial;
- a period characterized by the most striking symptoms, exacerbation;
- thermal.
At the initial stage, the symptoms of otosclerosis are mild, there is a slight decrease in hearing, and often on one ear, noise may appear. This stage can last from two to three years.
In the second stage, hearing in the sore ear is seriously impaired, in the second there is noise. This stage can last 10 years or more.
The thermal stage is more characteristic of a disease that occurs transiently and manifests itself in deep hearing loss, the treatment of which is practically ineffective.
A possible symptom of ear otosclerosis, characteristic of all stages of the disease, may be dizziness. Often, the disease proceeds in waves, stages alternate, as if alternating.
The main complaints
What are the main symptoms of otosclerosis? In addition to stable hearing loss, the patient understands male speech more difficult than female. That is, low tones are much more difficult to perceive. In the process of how the disease progresses, the patient ceases to even pick up high tones, and does not hear a whisper at all.
In cases where otosclerosis only affects the stapes, Willis paracusis may appear, characterized by a tendency to better perceive sounds in noisy environments, but this is a false sensation. In such cases, people just try to shout out background noise, so they speak louder.
Another syndrome characteristic of the disease is Weber paracusis. When it appears, the patient observes hearing impairment while chewing food or while walking.
The most striking symptom of otosclerosis is a noise in the ear, which first appears in one organ of hearing, then in another. The noise may be like a high whistle or, conversely, a low hum. The severity of noise in no way depends on the degree of hearing loss.
Against the background of hearing loss, a Toynbee symptom may occur, which is characterized by an unclear perception of words if two or more people participate in the conversation.
Pain is not constant, but is bursting in nature. Pain can appear exclusively at the last stage of the disease and their place of localization is the behind-the-ear area. In addition to pain in the ears, heaviness or compression can be felt.
Dizziness is not an obligatory symptom of pathology, and even if it is, it is not intense enough. If dizziness is severe, then you should think about another reason for its appearance.
In the later stages, a very characteristic symptom for otosclerosis appears - neurasthenic syndrome. In this case, a bright hearing impairment is manifested, a person can no longer fully communicate. A sick person is in constant tension, closes and become lethargic. The condition is often accompanied by apathy and sleep disturbance, that is, it is impossible to fall asleep at night, and during the day you constantly want to sleep. Most often, neurasthenia occurs due to a significant hearing loss with pronounced noises.
For sick people with congenital pathology, Van der Hoove - Kleik - Wardenburg syndrome is characteristic. It is characterized not only by congenital deafness, but also by albinism, which most often manifests itself in the form of locks of gray hair. The appearance of various types of dysplasia of the facial skeleton or soft tissues (on the face) is possible. The syndrome is usually inherited, in part or in full.
Diagnostic measures
After the onset of symptoms, treatment of otosclerosis begins with a diagnosis of the condition. If a doctor suspects a disease, then he performs an otoscopy and uses other research methods. As a rule, the study makes it possible to determine the changes characteristic of the disease. This may be dryness of the external passage, atrophy and decreased sensitivity, lack of sulfur. As usual, the eardrum is not subject to change.
Additionally, audiometry is prescribed to determine the degree of perception of whispering speech. A tuning fork examination gives the doctor an understanding of how much sound transmission through the air is reduced, whether it is normal or elevated in the tissues. Acoustic impedancemetry allows you to determine the degree of decrease in the mobility of the auditory ossicles.
Radiography and computed tomography can be assigned, which allows you to accurately determine where the focus of the disease is and how much it has spread to nearby organs, that is, to fully evaluate the symptoms of otosclerosis. Treatment will be prescribed after a full diagnosis. Other additional studies may be prescribed to differentiate from other diseases. Many diseases have similar symptoms: external otitis media, cholesteatoma, Meniere's disease, chronic suppurative otitis media, and others.
Clinical picture
Ear otosclerosis - symptoms, diagnosis and treatment of otosclerosis, it is very important if all this is determined and prescribed at an early stage of the disease. But, the danger of the disease is that it is rather difficult to initially suspect the appearance of a pathology. The gap between the onset of the first symptoms and the acute form can be calculated in years. In light of this, the disease often goes unnoticed, and patients go to a medical institution only with a strong hearing loss.
Another symptom that should be the reason for going to the doctor is Schwartz symptom. As a rule, the symptom is considered indirect and is characterized by the progression of treble hearing loss, which can be detected both with air conduction and with bone.
Symptoms and treatment
Otosclerosis and surgery are almost synonymous, since it is very rarely possible to help the patient with conservative treatment. Nevertheless, it is possible to improve the quality of life with ordinary drugs if there is a mixed or cochlear form of the disease in the anamnesis. In such cases, drugs are prescribed: Fosamax or Xidiphon. Vitamin D is used as adjunctive therapy. The course of treatment can be up to 6 months; therapy is necessary annually.
But, this does not always happen, the operation is most often prescribed. Otosclerosis is an insidious disease, in the presence of which it is quite difficult to restore hearing. Surgical intervention is indicated with a decrease in bone conduction at a level of 25 dB and with a decrease in air conduction to 50 dB. But, in any case, the operation is not performed if the pathology is in the active phase.
Typically, one of three types of operations is used:
- stapedoplasty;
- mobilization of stapes;
- fenestration of the maze.
Stapedoplasty is the actual implantation of a prosthesis that completely replaces the stirrup. Very often, surgery is performed along with stapedctomy. The prosthesis is made of bones or cartilage of the patient himself, and it can also be made of Teflon, ceramic or titanium. If two ears are involved in the process of destruction, then first the operation is performed on the ear that hears worse, and only after 6 months on the other.
Mobilization of the stapes involves the liberation of the ngo from immobilization, in places where bone splices have occurred.
With fenestration, a new window is created in anticipation of the maze. Although the result of such treatment cannot be called stable. Over the course of several years, a significant improvement can be observed, but then the window grows again and the hearing loss progresses even more. The same can be said of the stirrup mobilization operation.
After operation
Treatment of otosclerosis is a long process. Improvements can be seen after surgery only 7 or 10 days after surgery. For a whole month you can’t fly on airplanes, you will have to completely abandon physical activity.
In some cases, patients may experience complications. Noise may persist in your hearing or dizziness. Less commonly, but still there is ear liquorrhea, sensorineural hearing loss and a number of other undesirable consequences. However, the performance of patients after stapedoplasty gives great promise, in 80% of patients there is a stable improvement in hearing, there are no complications.