
Overview of history, pathophysiology and
characteristics of otosclerosis

Discuss the diagnosis, clinical features
and treatment of otosclerosis

Discuss the surgical management of
otosclerosis through stapes surgery






Definition
History
Prevalence and Demographics
Etiology and Pathophysiology
Diagnosis
Management
 Non-Surgical
 Surgical

Conclusions

Metabolic bone
disease of the otic
capsule and ossicles

Involves abnormal
resorption/deposition
of bone which can
lead to fixation of the
stapes

Present with slowly
progressive
conductive or mixed
hearing loss

1735, Valsalva-described ankylosis of the stapes
to the oval window

1860, Toynbee-described fixation of the stapes as
a cause of hearing loss

1893, Politzer-first use of the term otosclerosis to
describe ankylosis of stapes footplate

1912, Siebenmann-microscopic examination of
the otic capsule revealing spongification of bone

1938, Julius LempertEndaural HSSC
fenestration operation

1953, Samuel RosenStapes mobilization

1955, Fowler-Anterior
crurotomy w/ footplate
fracture

1956, John Shea Jr.Stapedectomy with vein
interposition graft and
teflon prosthesis



Cholesteatoma
Ossicular discontinuity
Congenital stapes fixation
 Non progressive early hearing loss


Malleus head fixation
Paget’s disease
 Older onset, high alk phos, multiple sites

Osteogenesis imperfecta
 Blue sclera, multiple fx, progressive hearing loss

Superior semicircular canal dehiscence
 CHL, Tullio’s phenomenon, CT findings

Non-Surgical
 Hearing Aid
 Sodium Fluoride
 Bisphosphonates

Surgical (stapedectomy, stapedotomy etc.)

Antagonist of bone
remodeling

Replaces hydroxyl
radical in
hydroxyapatite

Thought to
decrease amount
of proteolytic
enzymes present in
perilymph

Fenestration of HSCC, Mobilization of
footplate, Anterior crurotomy( no longer
performed)

Stapedectomy
 Total vs. Partial
 Stapedotomy( laser assisted or microdrill)

Patient Selection
 ABG of at least 15 dB
 Worse hearing ear
 Good word discrimination

Relative contraindications





Active infection
TM perforation
Meniere’s disease
Pregnancy
Dilated cochlear or vestibular aqueduct
Absolute contraindication should be if affected ear is the only hearing
ear

Surgery is performed
transcanal through a
fixed speculum ( i.e
Shea speculum
holder)

Canal is injected at
bony cartilaginous
junction in 4
quadrants

Middle Ear examination
 Evaluate ossicular chain mobility
 Confirm stapes fixation
 Evaluate for middle ear anatomical variants( i.e
dehiscent facial nerve)

Prosthesis Selection(Length x Width)
 Length- measured from the
medial portion of the incus, but
the measurement is taken from
the lateral surface
▪ Subtract 0.25 mm from 4.5 mm= 4.25
mm in length
▪ Husain and Selesnick demonstrated
no significant difference in ABG
closure among lengths ranging from
3.75 to 4.75 mm.
 Width- 0.6 mm is standard. Laske
et al performed meta analysis
showing significantly improved
ABG closure with 0.6 vs. 0.4.

Prospective study over
14 years

Involved 2,525
patients, 3050
stapedectomies, adult
and pediatric arms

All had vein
interposition w/
prosthesis

ABG closure to 10 dB in
94.2% of patients

SNHL (>15 dB) seen in
<0.5% of patients







SNHL
Taste disturbance
Tinnitus
Vertigo
Facial paralysis
Perilymphatic fistula
Reparative granuloma

Otosclerosis is characterized by gradual progressive CHL or mixed
hearing loss that is usually bilateral and can be asymmetrical

Hearing aids are effective alternative and and often are offered in
lieu of surgery

In the literature, >90% of patients experience closure of ABG to
within 10 dB with <1% experiencing SNHL

Comparisons regarding technique are equivocal and ultimately
depend on surgeon skill or comfort level with a given technique( ie
laser vs. drill; total vs. stapes fenestration)

No definitve guidelines have yet been established for the use of
cochlear implant in advanced otosclerosis