1、OtosclerosisOtosclerosisSymptoms Slowly progressive hearing lossipsilateral or bilateralTinnitus in 75%Vestibular complaints 25%Histopathologyo lytic phaseo Increased osteoclastic activity results in perivascular bony resorption forming fibrotic spaces o bone production phaseo osteoblasts within the
2、 fibrotic spaces producing immature bone o remodeling phaseo cycling of resorption and bone formation results in otosclerotic boneHistopathologyEpidemiology Hereditary in 70%of cases Autosomal dominant Incomplete penetrance 7-10%Caucasian temporal bones 1%Caucasians with symptoms Other races lesser
3、incidenceHistory 1704 Valsalva autopsy 1894 Politzer “otosclerosis”1930s Lempert horizontal canal fenestration 1953 Rosen stapes mobilization 1955 Shea stapedectomy stapedotomyDiagnosis History Physical examination Audiogram Imaging Surgical explorationPhysical examination Otomicroscopy normal Schwa
4、rtzes sign Tuning forksDifferential diagnosis Tympanosclerosis OME incus/malleus fixation ossicular discontinuity congenital footplate fixationo Systemic diseases Osteogenesis imperfecta stapes fixation blue sclera fractures Pagets diseasencrowding in epitympanumnelevated alk phosnskeletal bone invo
5、lvementDifferential diagnosisImaging Multidirectional tomography CT MRIAudiology Tympanometry Acoustic Reflexes Pure tone audiogram Speech discriminationTympanogram Normal type A Shallow type AsAcoustic Reflexes Very sensitive precedes hearing loss“On-Off”phenomenonPure tone audioManagement Amplification Refuse surgery Poor surgical candidate Medical therapy Sodium fluoride Vitamin D Calcium carbonate Stapes surgeryStapes surgery Total Stapedectomy Partial Stapedectomy Anterior crurotomy StapedotomyThanks！
