Treatment of otosclerosis abroad
Otosclerosis is a disease peculiar with the pathological growth of the bone tissues in the middle ear. It leads to the deterioration of bilateral hearing. Illness may result in the complete loss of hearing in certain cases.
Otosclerosis is common and found in 1% of the population. Incidence is higher in women than in men and reaches 3-4%.
Causes of otosclerosis
The causes of otosclerosis remain unknown. There a lot of existing theories as for the origin of the illness. The most common of them is the infectious-inflammatory theory. According to the theory, bone tissue grows as a result of the inflammation caused by a measles virus or other infectious agent.
Risk factors of the disease are:
- Female sex
- European or Asian race
- Genetic predisposition
- long-term inflammatory processes in the middle ear
- Paget's disease
- congenital defects in the development of the hearing organ
Trigger factors of otosclerosis (symptoms begin to progress after their impact) are:
Symptoms of Otosclerosis
Two main symptoms of otosclerosis are progressing hearing loss and tinnitus. The clinical course is peculiar with the stabilization periods when hearing doesn’t worsen and periods of progression disorders. Regression of the disease is not characteristic of otosclerosis as patient doesn’t regain his/her hearing without surgical intervention.
First symptoms normally appear between the ages of 20-40 years old. The disease starts within these years for 80% of patients. If otosclerosis occurs earlier than 20 years, this is an unfavourable prognostic sign. The disease often progresses rapidly and leads to deafness.
Features of the otosclerosis clinical course are:
- A person poorly understands speech, especially if several people speak at the same time. Meanwhile, the perception of speech improves significantly against the background of monotonous noise.
- Bilateral damage is peculiar for the otosclerosis. Nonetheless, symptoms can appear in the one ear first and then affect the other ear after a few months or even years.
- Noise in the ears is observed in 90% of patients. Normally, it is a low-frequency noise. Unlike it, high-frequency noise indicates the damage of blood vessels.
- About 25% of patients complain about a feeling of pressure in the ears.
- Vestibular apparatus (dizziness) damage is not typical for this disease.
Objective symptoms are detected only in 15% of patients. These can be next clinical signs:
- Lempert’s symptom which is a thinning of the tympanic membrane and a change in its colour
- Schwartze’s symptom means a visualization of a hyperemic (reddened) mucosa through the tympanic membrane
- Toynbee’s symptom is a decrease in the amount of earwax
- Tillo’s symptom presupposes an increased width of external auditory canal
- Atrophy, dryness, decrease in the sensitivity of the skin of the external auditory canal
Diagnostics of otosclerosis
Laboratory methods are not applied in the diagnostics of otosclerosis. The following instrumental methods help a doctor to confirm a diagnosis:
- Tone threshold audiometry
- Impedance audiometry
- Computed tomography of the temporal bone
Treatment of otosclerosis abroad
The aim of treatment is to slow down the progression of otosclerosis and restore the sound transmission. Surgical intervention is preferable here.
There are several types of surgery involved to restore the hearing, but the majority of them help to improve hearing temporarily.
That’s why an intervention called stapedoplasty is the most common in the treatment of the disease as it offers a chance for a long-term improvement.
- Stapedoplasty is the removal of the sclerotic altered stirrup-shaped bone (one of the bones of the middle ear) that is replaced by a prosthesis. The implant can be artificial - made of ceramics, Teflon or titanium. It is also possible to establish a biological prosthesis. It is made from the patient's cartilage or bone tissue.
- Stapedotomy is an improved variant of this surgery. A hole is made with the laser in the basis of the stirrup-shaped bone. Afterwards, a piston-type prosthesis is installed. Such a surgery is more preferable and is actively implemented in German hospitals. If you compare the effectiveness of the two interventions, stapedotomy has a much lower risk of postoperative complications.
Other treatment methods are:
- Sodium fluoride is administered to patients to slow the progression of otosclerosis
- Hearing aids help to improve hearing to patients who did not have a timely surgery or refused it
Prognosis for the otosclerosis
Natural course of the disease is peculiar with the progression of hearing loss and prognosis is unfavourable.
The question is how fast pathological process will progress:
- 70% of patients have a slow course of development of the disease
- 20% of patients have an abrupt onset of the illness (characterised by long periods of stability, followed by a sharp deterioration of hearing)
- 10% of patients have transient onset of the illness (mainly in young patients)
Hospitals in the developing countries can ensure hearing improvement in 80% of cases after the surgery. Surgery in German hospitals guarantees improvement in 90-95% of cases.
Complications are possible after the surgery, so it’s advisable to receive treatment in German hospitals to minimize the risks.