What happens in the ear
Sound reaches the inner ear through a chain of three ossicles, the last of which, the stapes, is inserted into the oval window. With otosclerosis, a focus of rebuilt bone tissue forms around the base of the stapes, which gradually strengthens the bone. The mobility of the stapes decreases, and the sound wave loses strength: conductive hearing loss develops. In some cases, the process spreads deeper and affects the structures of the inner ear, then the neurosensory component joins, and hearing suffers more. At the same time, constant tinnitus often appears.
- Focus of pathological bone tissue in the capsule of the labyrinth
- Immobilization of the stirrup
- Conductive hearing loss
- Possible neurosensory component
- Tinnitus is a frequent companion
Symptoms
Hearing declines slowly over years, so a person takes a long time to adapt and applies late. At first it becomes difficult to understand quiet speech and whispers, then you have to increase the volume of the TV and ask again. Many patients notice an interesting feature: in a noisy environment, for example in transport, speech is perceived better than in silence. Tinnitus - buzzing, ringing or rustling - is often bothersome. There is no pain or discharge from the ear, the eardrum appears normal upon examination, which is often misleading.
- Gradual loss of hearing, usually in both ears
- Difficulty understanding quiet speech
- Better speech perception in noise
- Constant tinnitus
- Your own voice seems quiet
- No pain or discharge from the ear
- Worsening during and after pregnancy
Diagnostics
The ENT doctor examines the ear and makes sure that the eardrum is intact and there are no signs of inflammation. The basis of diagnosis is a hearing test: it shows a characteristic gap between the perception of sound through air and through bone, as well as specific changes when examining the mobility of the eardrum and auditory reflexes. Computed tomography of the temporal bones helps to see areas of restructuring, assess the anatomy and plan surgery. Be sure to exclude other causes of conductive hearing loss: cerumen plug, exudative otitis, rupture of the ossicular chain, consequences of chronic otitis.
- Examination of the ear and eardrum
- Hearing examination with assessment of air and bone conduction
- Study of eardrum mobility
- Assessment of auditory reflexes
- CT scan of the temporal bones
- Elimination of cerumen plug and otitis media
Treatment
The main method is stapedoplasty: the surgeon removes the immobilized part of the stapes and installs a prosthesis that restores sound transmission. The intervention is performed through the ear canal, without external incisions, and in most cases significantly improves hearing. They usually operate on one ear, the worse one in terms of hearing, and the second one later, if necessary. An alternative for those for whom surgery is not indicated or who refuse it is hearing aids, which well compensate for this type of hearing loss. Drug therapy is used to a limited extent and does not replace surgical treatment.
- Stapedoplasty with installation of a prosthesis
- Surgery through the ear canal without external incisions
- Step-by-step treatment for both ears
- Hearing aids as an alternative
- Observation for minor hearing loss
- Discussion of timing of surgery when planning pregnancy
- Protect your hearing from noise and injury
After surgery and prognosis
In the first days after the intervention, congestion, noise, slight dizziness and changes in taste are possible - usually these are temporary phenomena. The doctor gives recommendations on the regimen: limit straining, heavy lifting, blowing your nose with force, flying and scuba diving for a certain period. Hearing most often improves within the first weeks; the final result is assessed after a few months using a control study. Tinnitus decreases in some patients, but does not always disappear completely. If there is no complete effect, repeated intervention or selection of a hearing aid is possible.
- Follow-up hearing test after a few months
- Temporary restrictions on loads and flights
- Be careful when blowing your nose and straining
- Observation by an ENT doctor
- Selecting a hearing aid in case of incomplete results
- Regular hearing assessment in the second ear
