Otosclerosis

 Otosclerosis

Otosclerosis refers "hardening of the ear". 

Otosclerosis result from formation of abnormal sponge like bone growth. In middle ear,  stapes becomes immobile prevents transmission of sound vibration into ear, result in conductive hearing loss.

Risk Factors and Causes

1. Hereditary factors

2. Viral infection

Types of Otosclerosis

1. Stapedial otosclerosis

Fixation of stapes causing conductive deafness.

2. Cochlear otosclerosis

Otosclerotic process upon membranous labyrinth producing sensorineural deafness.

3. Mixed otosclerosis 

Both fixation of stapes and involvement of labyrinth producing hearing loss.

4. Histological otosclerosis 

Don't produce any symptoms during life, revealed only at postmortem.

Clinical Manifestations

1. Hearing loss; conductive or sensorineural 

2. Paracusis (incorrect hearing)

3. Dizziness

4. Tinnitus

5. Balance and coordination problem

6. Vertigo

7. Buzzing

Diagnostic Evaluation

1. Audiometric Testing

To determine extent of hearing loss (intensity and tone)

2. Imaging studies

Temporal bone CT scan

3. Vestibular testing

To determine balance problem

4. Whisper voice test

Show decreased hearing 

5. Rinne's test

Used to evaluate hearing loss in one ear. 

Sound transmitted through air conduction. Keep tuning fork 2cm away from ear.

Then press firmly base of tuning fork at mastoid bone, called bone conduction.

6. Weber test

Strike the base of a tuning fork on the midline of head.

It used to evaluate unilateral conductive and sensorineural hearing loss.

Management 

1. Oral fluoride, calcium and vitamin D

2. Hearing Aid

Surgical Management

1. Stapedectomy

Removing portion of sclerotic stapes footplate and replacing with implant or prosthesis.

2. Stapedotomy 

Drilling a small hole in stapes footplate with micro -drill or laser and insert piston like prosthesis.

Nursing Management

Postion postoperatively According to order;

1. Lying on non- operated side prevent displacement of graft.

2. Lying on operated side facilitate drainage

3. Instruct client chance position gradually to prevent vertigo

4. Ask to client about pain, headache, vertigo, unusual sensation

5. Observe presence of packing, edema from surgery

6. Instruct the patient to avoid sneezing, blowing nose, swimming.

Instruct the patient while sneezing keep mouth open to equalize pressure in ear to prevent displacement of prosthesis.

7. Use diversional therapy for pain and relaxation techniques.

8. Antibiotics given to prevent infection

9. Antiemetic given promptly to prevent nausea