1. Otosclerosis

2. Otosclerosis
Otosclerosis is an autosomal dominant disease, in which the fixation of footplate of the stapes in the oval window will occur due to development of spongy bone from the bony labyrinth, causing immobilization of the footplate of the stapes, which reduces the transmission of vibration to the inner ear

3. Etiology It can be Hereditary Endocrine abnormalities
Metabolic abnormalities
Vascular abnormalities
Autoimmune and infectious
But none of the cause is been proven as an exact cause

4. Pathophysiology
Otosclerosis (otospongiosis) is an osseous dyscrasia, limited to the temporal bone, and characterized by resorption and formation of new bone in the area of the Ossicles and Otic capsule (the skeletal element enclosing the inner ear mechanism).

5. Otosclerosis has two main forms:
An early spongiotic phase (otospongiosis)
The early phase is characterized by multiple active cell groups including osteocytes, osteoblasts.
It develops a spongy appearance because of vascular dilation secondary to osteocyte resorption of bone surrounding blood vessels.
This can be seen grossly as red hue behind the tympanic membrane termed “Schwartze's sign”

6. A late sclerotic phase
Dense sclerotic bone forms in the areas of previous resorption. Both the sclerotic and spongiotic cells may be present at the same time. Otosclerotic changes always begin in endochondral bone (ossification of cartilage) but may progress and enter even into the membranous labyrinth.

7. Signs and symptoms
Hearing loss – usually starts in one ear and then moves to the other
Dizziness, balance problems, tinnitus

8. Diagnositc features History collection Physical examination Audiometry
Otoscopic examination
Tympanometry
CT scan

9. Visualization - TM appears normal in the majority of patients
Schwartze sign is observed in 10% of patients – otoscopic examination can reveal a reddish blush of the tympanium caused by the vascular and bony changes within the middle ear
Rinne test: negative
Weber test: laterization to poor Hearing level

10. Management
Sodium fluoride with vitamin D and calcium carbonate – to retard bone resorption and encourage calcification of bony lesions
Dose mg per day

11. Fluoride: 3.75 mg Calcium :145 mg
Florical
Fluoride: 3.75 mg Calcium :145 mg
Florical can be used three times a day for otosclerosis.

12. Surgical management Stapedectomy – partial removal of the stapes
Stapedotomy – opening in the stapes footplate followed by prosthesis insertion
Fenestration surgeries - Complete removal with prosthesis insertion

13. Surgery is usually performed under local anesthesia.
Poorer functioning ear is treated first
Other ear may be treated on 6 months to 1 year later
An endaural incision is made
Gelfoam is used on the incision flap to limit bleeding

14. Teflon piston prosthesis
Prosthesis Placement
Cup piston prosthesis
Teflon piston prosthesis
House wire prosthesis
McGee/Fisch-type piston prosthesis

16. Nursing management (after ear surgeries)
Postoperatively patient may experience dizziness, nausea and vomiting
Some will have nystagmus due to the disturbance of perilymph fluid.
Decrease sudden movements
Actions such as coughing, sneezing, lifting, bending, and straining should be minimized.
Do not try to get out of bed without assistance

17. Take measures to prevent and cope up with vertigo
Report fever, pain and drainage from the ear
If the patient needs to cough or blow the nose, leave the mouth open to help reduce the pressure
Avoid crowds where respiratory infections may present
Avoid high elevations or flying