Otosclerosis Workup

  • Author: Jack A Shohet, MD; Chief Editor: Arlen D Meyers, MD, MBA   more...
 
Updated: Sep 27, 2011
 

Imaging Studies

Computed tomography scanning of the temporal bone can often demonstrate foci of demineralization in the otic capsule in cases of cochlear otosclerosis.

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Other Tests

A full audiometric evaluation, including impedance testing, is necessary.

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Histologic Findings

See Pathophysiology.

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Proceed to Treatment & Management
 
 
Contributor Information and Disclosures
Author

Jack A Shohet, MD  President, Shohet Ear Associates Medical Group, Inc; Associate Clinical Professor, Department of Otolaryngology-Head and Neck Surgery, University of California, Irvine, School of Medicine

Jack A Shohet, MD is a member of the following medical societies: American Academy of Otolaryngology-Head and Neck Surgery, American Medical Association, American Neurotology Society, American Tinnitus Association, and California Medical Association

Disclosure: Nothing to disclose.

Specialty Editor Board

Cliff A Megerian, MD, FACS  Medical Director of Adult and Pediatric Cochlear Implant Program, Vice-Chairman and Director of Otology and Neurotology, University Hospitals of Cleveland; Professor, Department of Otolaryngology-Head and Neck Surgery and Neurological Surgery, Case Western Reserve University School of Medicine

Cliff A Megerian, MD, FACS is a member of the following medical societies: American Academy of Otolaryngology-Head and Neck Surgery, American College of Surgeons, American Neurotology Society, American Otological Society, Association for Research in Otolaryngology, Massachusetts Medical Society, Society for Neuroscience, Society of University Otolaryngologists-Head and Neck Surgeons, and Triological Society

Disclosure: cochlear americas Consulting fee Board membership

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

Gerard J Gianoli, MD  Clinical Associate Professor, Department of Otolaryngology-Head and Neck Surgery, Tulane University School of Medicine; Vice President, The Ear and Balance Institute; Chief Executive Officer, Ponchartrain Surgery Center

Gerard J Gianoli, MD is a member of the following medical societies: American Academy of Otolaryngology-Head and Neck Surgery, American College of Surgeons, American Neurotology Society, American Otological Society, Society of University Otolaryngologists-Head and Neck Surgeons, and Triological Society

Disclosure: Vesticon, Inc. None Board membership

Christopher L Slack, MD  Private Practice in Otolaryngology and Facial Plastic Surgery, Associated Coastal ENT; Medical Director, Treasure Coast Sleep Disorders

Christopher L Slack, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Facial Plastic and Reconstructive Surgery, American Academy of Otolaryngology-Head and Neck Surgery, and American Medical Association

Disclosure: Nothing to disclose.

Chief Editor

Arlen D Meyers, MD, MBA  Professor, Department of Otolaryngology-Head and Neck Surgery, University of Colorado School of Medicine

Arlen D Meyers, MD, MBA is a member of the following medical societies: American Academy of Facial Plastic and Reconstructive Surgery, American Academy of Otolaryngology-Head and Neck Surgery, and American Head and Neck Society

Disclosure: Covidien Corp Consulting fee Consulting; US Tobacco Corporation Unrestricted gift Unknown; Axis Three Corporation Ownership interest Consulting; Omni Biosciences Ownership interest Consulting; Sentegra Ownership interest Board membership; Syndicom Ownership interest Consulting; Oxlo Consulting; Medvoy Ownership interest Management position; Cerescan Imaging Honoraria Consulting; GYRUS ACMI Honoraria Consulting

References

  1. Toynbee J. Pathological and surgical observations of the diseases of the ear. Trans Med Chir Soc Lond. 1841;24:190-196.

  2. Jack FL. Remarkable improvement of hearing by removal of the stapes. Trans Am Otol Soc. 1893;284:474-89.

  3. Holmgren J. The surgery of otosclerosis. Ann Otol Rhinol Laryngol. 1937;46:3-12.

  4. Sourdille M. New technique in the surgical treatment of severe and progressive deafness from otosclerosis. Bull NY Acad Med. 1937;13:673.

  5. Lempert J. Improvement in hearing in cases of otosclerosis: A new, one-stage surgical technic. Arch Otolaryngol. 1938;28:42-97.

  6. Rosen S. Restoration of hearing in otosclerosis by mobilization of the fixed stapedial footplate; an analysis of results. Laryngoscope. Apr 1955;65(4):224-69. [Medline].

  7. Shea JJ Jr. A personal history of stapedectomy. Am J Otol. Sep 1998;19(5 Suppl):S2-12. [Medline].

  8. Kashio A, Ito K, Kakigi A, Karino S, Iwasaki S, Sakamoto T, et al. Carhart Notch 2-kHz Bone Conduction Threshold Dip: A Nondefinitive Predictor of Stapes Fixation in Conductive Hearing Loss With Normal Tympanic Membrane. Arch Otolaryngol Head Neck Surg. Mar 2011;137(3):236-40. [Medline].

  9. McCabe BF. Otosclerosis and vertigo. Proc Trans Pacific Oto-Ophth Soc. 1966;47:37.

  10. Thomeer HG, Kunst HP, Cremers CW. Congenital stapes ankylosis associated with another ossicular chain anomaly: surgical results in 30 ears. Arch Otolaryngol Head Neck Surg. Sep 2011;137(9):935-41. [Medline].

  11. Canalis RF. Valsalva's contribution to otology. Am J Otolaryngol. Nov-Dec 1990;11(6):420-7. [Medline].

  12. Frattali MA, Sataloff RT. Far-advanced otosclerosis. Ann Otol Rhinol Laryngol. Jun 1993;102(6):433-7. [Medline].

  13. Ghorayeb BY, Linthicum FH Jr. Otosclerotic inner ear syndrome. Ann Otol Rhinol Laryngol. Jan-Feb 1978;87(1 Pt 1):85-90. [Medline].

  14. Gordon MA, Silverstein H, Willcox TO, et al. A reevaluation of the 512-Hz Rinne tuning fork test as a patient selection criterion for laser stapedotomy. Am J Otol. Nov 1998;19(6):712-7. [Medline].

  15. Karosi T, Konya J, Petko M, et al. Histologic otosclerosis is associated with the presence of measles virus in the stapes footplate. Otol Neurotol. Nov 2005;26(6):1128-33. [Medline].

  16. Lesinski SG. Causes of conductive hearing loss after stapedectomy or stapedotomy: a prospective study of 279 consecutive surgical revisions. Otol Neurotol. May 2002;23(3):281-8. [Medline].

  17. Poe DS. Laser-assisted endoscopic stapedectomy: a prospective study. Laryngoscope. May 2000;110(5 Pt 2 Suppl 95):1-37. [Medline].

  18. Pulec JL. The cause of otosclerosis. Ear Nose Throat J. Dec 1998;77(12):941. [Medline].

  19. Silverstein H. Laser stapedotomy minus prosthesis (laser STAMP): a minimally invasive procedure. Am J Otol. May 1998;19(3):277-82. [Medline].

  20. Silverstein H, Hester TO, Rosenberg SI, et al. Preservation of the stapedius tendon in laser stapes surgery. Laryngoscope. Oct 1998;108(10):1453-8. [Medline].

 
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A tympanomeatal flap is incised along the posterior external auditory canal.
The fibrous tympanic annulus is elevated with the tympanomeatal flap to expose the middle ear.
Scutal bone is curetted to allow visualization of the pyramidal process, tympanic segment of the facial nerve, and the stapedial footplate.
The incudostapedial joint is disarticulated after measurements have been made.
The stapedial tendon is sectioned either with a laser or scissors and then the posterior crus of the stapes is sectioned either with a drill as shown or a laser.
The stapes superstructure has been down-fractured and removed. The footplate remains and may now be removed completely as in a total stapedectomy or a stapedotomy hole may be made with a laser or microdrill.
A stapedotomy has been performed. A prosthesis may now be placed.
A piece of tissue (fascia, perichondrium, or vein) is placed over the stapedectomy/stapedotomy.
A Robinson bucket handle prosthesis is placed over the stapedotomy and looped over the incus.
A stapedotomy procedure with a bucket handle prosthesis positioned over the footplate.
Video of laser stapedotomy with SMart piston prosthesis.
Video of bucket handle prosthesis positioning.
 
 
 
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