Such a disease as otosclerosis occurs in 1% of the population, of which the female half of humanity accounts for 80%. 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 can be observed. As a rule, the only way to improve the quality of life is surgery. To date, there is no conservative therapy aimed at stopping the disease.
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, there are genetic abnormalities. Trigger for the development of the diseasean infectious disease can become, 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 damage to the bone capsule.
Other risks
The disease can appear against the background of an anomaly of the organ of hearing or with a chronic disease of the middle ear. Often the disease occurs in individuals with Paget's disease. Working in noisy conditions provokes the development of hearing loss. And as with most diseases, otosclerosis can be caused by extreme stress.
The principle of the hearing organ
Before you list the symptoms of otosclerosis, you should understand how the organ of hearing works. Anatomically, it consists of three parts:
- outer;
- average;
- inner ear.
First, the 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, having entered the inner ear along with the liquid, is transmitted to the hair cells. They are the nerve receptors that generate impulses that go further to the subcortical and cortical centers of hearing.
If a person is he althy, then the labyrinth capsule does not have secondary ossification. If the process of osteogenesis is activated, then symptoms of otosclerosis begin to appear, zones appear where the areas are abundantly supplied with blood, whichsclerosed over time and become mature bone. If there is no treatment, then the stirrup is immobilized and ankylosis is formed. Sometimes the snail and other parts of the labyrinth are drawn into the process. The result is hearing loss.
Classification
Today, there are three types of pathology, depending on the nature of changes in the hearing organ:
- 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 by operation are 100% impossible.
Mixed function is characterized not only by a decrease in sound conduction to the inner ear, but also by a decrease in the function of perception. The operation will only restore hearing function to the level of bone conduction.
Current speed
In 68% of patients, the rate of the course of the disease is characterized as slow, in 21% it is spasmodic. Only in 11% of patients the disease is transient.
Stages
Medics distinguish three stages of the course of the disease:
- initial;
- period characterized by the brightestsymptoms, exacerbation;
- thermal.
At the initial stage, the symptoms of otosclerosis are mild, there is a slight decrease in hearing, and often in one ear, noise may appear. This stage can last from two to three years.
At the second stage, hearing in the diseased ear is seriously deteriorating, and noise appears in the second. This stage can last 10 years or more.
The thermal stage is more typical for a disease that is fleeting 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, the stages follow each other, as if alternating.
Major complaints
What are the main symptoms of otosclerosis? In addition to stable hearing loss, the patient is much harder to understand male speech than female speech. That is, low tones are much harder to perceive. As the disease progresses, the patient stops even picking up high tones, and does not hear a whisper at all.
In cases where otosclerosis affects only the stirrup, Willis paracusis may appear, characterized by a tendency to better perceive sounds in a noisy environment, but this is a false sensation. In such cases, people are simply trying to shout over the background noise, so they speak louder.
Another syndrome characteristic of the disease is Weber's paracusis. When it appears, the patient observes a deterioration in hearing while chewing food.or while walking.
The most striking symptom of otosclerosis is noise in the ear, which first appears in one organ of hearing, then in the other. The noise can be like a high whistle or vice versa a low rumble. The severity of the noise is in no way dependent on the degree of hearing loss.
Against the background of hearing loss, Toynbee's symptom may occur, which is characterized by unclear perception of words if two or more people participate in a conversation.
Pain is not permanent, but bursting. Pain can appear only at the last stage of the disease and their place of localization is behind the ear. In addition to pain, the ears may feel heaviness or pressure.
Dizziness is not a mandatory 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 of otosclerosis appears - neurasthenic syndrome. In this case, a vivid hearing impairment is manifested, a person can no longer fully communicate. A sick person is in constant tension, closes and becomes 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.
Sick people with congenital pathology are characterized by Van der Hove-Kleik-Wardenburg syndrome. It is characterized not only by congenital deafness, but also by albinism, which is most oftenappears as strands of gray hair. Various types of dysplasia of the facial skeleton or soft tissues (on the face) may appear. The syndrome is usually inherited, partially or completely.
Diagnostic measures
Once symptoms appear, treatment for otosclerosis begins with a diagnosis of the condition. If the 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 does not undergo changes.
Additionally, audiometry is assigned to determine the degree of perception of whispered speech. A tuning fork examination gives the doctor an understanding of how much sound transmission through the air is reduced, what it is in the tissues, normal or increased. Acoustic impedancemetry allows you to determine the degree of reduced mobility of the auditory ossicles.
X-rays and computed tomography can be prescribed, which allows you to determine as accurately as possible where the focus of the disease is and how much it has spread to nearby organs, that is, to fully assess the symptoms of otosclerosis. Treatment will be prescribed after a complete diagnosis. Other additional studies may be prescribed to differentiate from other diseases. Many diseases have similar symptoms: otitis externa, cholesteatoma, Meniere's disease, chronic suppurative otitis media and others.
Clinical picture
Otosclerosis of the ear - 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 quite difficult to initially suspect the appearance of pathology. The gap between the appearance 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 severe hearing loss.
Another symptom that should be a reason to see a doctor is Schwartz's 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 and bone conduction.
Symptoms and treatment
Otosclerosis and surgery are practically synonyms, since it is very rarely possible to help the patient with conservative treatment. However, it is possible to improve the quality of life with ordinary drugs in the presence of a history of a mixed or cochlear form of the disease. In such cases, drugs are prescribed: Fosamax or Ksidifon. Vitamin D is used as an adjunct therapy. The course of treatment can be up to 6 months, it is necessary to carry out therapy annually.
But, this is not always the case, most often an operation is scheduled. 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 the level of 25 dB and withreduction of air conductivity up to 50 dB. But, in any case, the operation is not performed if the pathology is in the active phase.
As a rule, one of three types of operations is used:
- stapedoplasty;
- mobilization stirrup;
- fenestration of the labyrinth.
Stapedoplasty is the actual implantation of a prosthesis that completely replaces the stirrup. Very often, surgery is performed together with a stapedectomy. The prosthesis is made from the bones or cartilage of the patient himself, it can also be made from Teflon, ceramic or titanium. If two ears are involved in the process of destruction, then the operation is first performed on the ear that hears worse, and only after 6 months on the other.
Mobilization of the stirrup involves releasing it from immobilization, in places where bone fusion has occurred.
Fenestration creates a new window in front of the labyrinth. Although the result of such treatment can not be called stable. Over the course of several years, a significant improvement can be observed, but then, the window overgrows again, and the hearing loss progresses even more. The same can be said for the operation to mobilize the stirrup.
After surgery
Treatment of otosclerosis is a lengthy process. Improvements can be noticed after the operation only on the 7th or 10th day after the operation. For a whole month you can not fly in airplanes, you will have to completely abandon physical activity.
In some cases, patients may experience complications. ATthe organ of hearing may remain noise or dizziness remains. Less often, but still, ear liquorrhea, sensorineural hearing loss and a number of other undesirable consequences occur. However, the indicators of patients after stapedoplasty are very promising, in 80% of patients there is a stable improvement in hearing, there are no complications.
