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Shankai Yin Prof Dept of Otolaryngology Affiliated Sixth Hospital Otolaryngology Institute Shanghai Jiao Tong univ

Otosclerosis. Shankai Yin Prof Dept of Otolaryngology Affiliated Sixth Hospital Otolaryngology Institute Shanghai Jiao Tong university. History. 1704 Valsalva autopsy 1894 Politzer “ otosclerosis ” 1930s Lempert horizontal canal fenestration

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Shankai Yin Prof Dept of Otolaryngology Affiliated Sixth Hospital Otolaryngology Institute Shanghai Jiao Tong univ

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  1. Otosclerosis Shankai Yin Prof Dept of Otolaryngology Affiliated Sixth Hospital Otolaryngology Institute Shanghai Jiao Tong university

  2. History • 1704 Valsalva autopsy • 1894 Politzer “otosclerosis” • 1930s Lempert horizontal canal fenestration • 1953 Rosen stapes mobilization • 1955 Shea stapedectomy

  3. Histopathology Increased osteoclastic activity results in perivascular bony resorption forming fibrotic spaces (lytic phase), osteoblasts within the fibrotic spaces producing immature bone (bone production phase), cycling of resorption and bone formation results in otosclerotic bone (remodeling phase)

  4. Biscuit footplate

  5. Cochlear involvement

  6. Epidemiology • Hereditary in 70% of cases • Autosomal dominant • Incomplete penetrance • 7-10% Caucasian temporal bones • 1% Caucasians with symptoms • Other races lesser incidence

  7. Symptoms • Slowly progressive hearing loss ipsilateral or bilateral • Tinnitus in 75% • Vestibular complaints 25%

  8. Diagnosis • History • Physical examination • Audiogram • Imaging • Surgical exploration

  9. Physical examination • Otomicroscopy • normal • Schwartze’s sign • Tuning forks

  10. Differential diagnosis • Tympanosclerosis • MEE • incus/malleus fixation • ossicular discontinuity • congenital footplate fixation

  11. Systemic diseases • Osteogenesis imperfecta • stapes fixation • blue sclera • fractures • Pagets disease • crowding in epitympanum • elevated alk phos • skeletal bone involvement

  12. Imaging • Multidirectional tomography • CT • MRI

  13. Audiology • Tympanometry • Acoustic Reflexes • Pure tone audiogram • Speech discrimination

  14. Tympanogram • Normal type A • Shallow type As

  15. Acoustic Reflexes • Very sensitive • “On-Off” phenomenon • precedes hearing loss

  16. Pure tone audio

  17. Management • Amplification • Medical therapy • Stapes surgery

  18. Amplification • Refuse surgery • Poor surgical candidate • following improvement of CHL

  19. Medical management • Sodium fluoride • Vitamin D • Calcium carbonate

  20. Stapes surgery • Total Stapedectomy • Partial Stapedectomy • Anterior crurotomy • Stapedotomy

  21. Goals • Open the oval window for sound transmission • reconstruct sound conducting mechanism • without complication

  22. Variations • Procedure • Stapedotomy • drill • laser (CO2, KTP, argon) • Prosthesis • Oval window seal

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