Hearing loss limits social interaction and employment opportunities. Hearing impairment in babies and young children has profound implications that affect language development, school success and economic independence in adulthood.
According to the World Health Organization (2021), globally over 1.5 billion people are affected to some degree by hearing loss.
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Causes of otosclerosis
The causes of the occurrence of otosclerosis are not yet fully elucidated, but up to now many possible etiological factors have been investigated:
- Genetics
- Family history of otosclerosis, patients with a family history of otosclerosis have a higher risk of developing the condition.
- Human leukocyte antigens (HLA – Human Leukocyte Antigens) – certain HLA variants have been associated with an increased risk of pathology.
- Autoimmunity – the immune system “attacks” its own tissues that are part of the middle ear, triggering pathological bone remodeling.
- Some viruses – such as howler viruses (which cause infectious epidemic parotiditis or mumps) and rubella could trigger otosclerosis through the inflammatory and autoimmune reactions they produce.
- Inflammation it can stimulate bone growth in the middle ear, thus contributing to the progression of the disease.
- The hormones – hormonal fluctuations, such as those specific to pregnancy, have been associated with bone remodeling in the middle ear.
The incidence rates of otosclerosis are higher among women and Caucasian (white) race.
Hearing loss – risk factors
Hearing capacity evolves throughout life, from birth to old age, being influenced by non-modifiable risk factors (genetic characteristics), biological factors (health problems, certain pathologies), behavioral factors (lifestyle and environmental factors ):
- Syndromes associated with progressive hearing loss, for example Usher syndrome
- Genetic mutations.
- Intrauterine infections (eg toxoplasmosis, rubella, herpes simplex virus types 1 and 2)
- Perinatal morbidities (asphyxia at birth, low birth weight, hyperbilirubinemia)
- Medical conditions (otitis media, otosclerosis)
- Chronic conditions (hypertension, diabetes and abdominal obesity)
- Age-related sensorineural degeneration.
- Smoking
- Nutritional deficiency
- Ototoxic drugs
- Trauma to the ear or head.
- Exposure to noise/loud sounds
- Exposure to ototoxic chemicals at work.
Otosclerosis symptoms
Progressive hearing loss is the most common symptom of otosclerosis. Deterioration of auditory acuity occurs gradually, gradually, until the complete loss of hearing. Initially, people with otosclerosis notice that they can no longer hear whispers or low tones.
Frequent, hearing loss affects both earsapproximately 10 – 15% of patients with otosclerosis have hearing impairment in one ear.
Other symptoms that may appear in the evolution of the pathology are:
Diagnosis of otosclerosis
If you notice a decrease in auditory acuity, contact your ENT doctor. In addition to the physical examination and the information obtained from the anamnesis, the doctor can recommend investigations such as:
- Hearing tests as is the audiogram – hearing testing is used to measure the patient’s ability to hear sounds at certain frequencies and different intensities.
- Tympanogram – evaluates the function of the eardrum.
- In some cases, imaging testssuch as CT (Computer Tomography) or MRI (Nuclear Magnetic Resonance) to examine in detail the bones and tissues inside the ear.
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Otosclerosis treatment
The treatment of otosclerosis is dictated by the location of the abnormal bone growth, as well as the severity of the condition.
Among the treatment options available are:
- Hearing aids – for many patients, the use of hearing devices that amplify sound are sufficient to improve hearing.
- Surgical intervention (stapedectomy) it assumes that the small bone in the middle ear affected by otosclerosis is removed and replaced with a device called a stapedian prosthesis.
- The cochlear implant involves the use of an implantable medical device to treat severe hearing loss. Through the cochlear implant, the physiological structures of the inner ear are “bypassed” and a new path is created through which sound vibrations are transmitted to the brain. Cochlear otosclerosis requires a cochlear implant.
Otosclerosis surgery
Stapedectomy it is an extremely precise procedure that involves monitoring the patient post-intervention and a recovery period that varies from patient to patient between a few days and a few weeks.
If otosclerosis affects both ears, the intervention will NOT be carried out simultaneously. As a rule, after completing the first intervention, the patient waits at least 6 months until the next operation.
During the recovery period after otosclerosis surgery it is essential that the patient follow the doctor’s instructions regarding ear hygiene and the administration of prescribed medications.
After the scarring and healing stage is completed, the patient will notice an improvement in hearing. A few weeks or even months are necessary for the complete stabilization of hearing.
How can we prevent hearing damage?
Unlike other hearing conditions, there are no controllable risk factors for otosclerosis, therefore there are no ways to prevent otosclerosis. Some people are genetically more prone to developing the disease.
Regarding hearing impairment, gender and race are unmodifiable and uncontrollable risk factors, while smoking or listening to loud music are modifiable risk factors.
Among the strategies to prevent the deterioration of hearing capacity and hypoacusis throughout life counts:
- Vaccination of girls and women in the prenatal and perinatal period, balanced maternal nutrition during pregnancy and during breastfeeding.
- Good ear hygiene
- Avoid using ear sticks with cotton tips, inserting or dripping any objects/liquids into the ear
- Avoid home remedies and treatments for common ear conditions
- Avoid swimming or washing yourself in/with dirty water
- See your doctor to treat ear infections and common colds.
- Vaccination, early identification and medical therapy in the case of otitis media during childhood and adolescence.
- Healthy lifestyle
- Good nutrition – reduces sensorineural degeneration associated with noise exposure and aging and protects against purulent ear infections that occur in childhood (eg, otitis media)
- Avoid smoking, drinking alcohol or substance abuse
- The rational use of medicines in order to prevent hypoacusis due to ototoxicity
- Audiological monitoring of ototoxicity – in situations where ototoxic drugs are essential (eg, management of cancer, tuberculosis and other diseases), audiological monitoring is vital
- Protection against head injuries or ear injuries
- The use of protective helmets when driving two-wheeled vehicles
- Avoiding slapping, especially over the ear
- Hearing in safe conditions and reducing exposure to loud sounds/loud noise
- Avoid exposure to loud sounds in occupational and recreational environments (including ambient noises)
- Wear hearing protection to reduce the noise perceived by the ears, such as ear defenders and earplugs
- Keeping the volume of personal audio devices below 80 dB.
- Reduce the time spent in noisy environments.
- Hearing control tests for newborns, babies and adults
- Early identification of hearing loss and ear diseases is essential for effective management.
Hearing loss has a major impact on the quality of life. Hearing impairments can lead to social isolation, depression and the development of adjacent medical conditions, such as dementia. Any change in auditory acuity requires a specialized medical consultation. Certain pathologies of the ear, such as otosclerosis, do not improve or heal by themselves without therapeutic intervention.
References:
- Genetic factors in otosclerosis, AW Morrison
- Otosclerosis, NHS
- Otosclerosis – An update on diagnosis and treatment, Lora Batson, Denise Rizzolo
- The pathophysiology of otosclerosis: Review of current research, M. Rudic, I. Keogh, R. Wagner, E. Wilkinson, N. Kiros, E. Ferrary, O. Sterkers, A. Bozorg Grayeli, K. Zarkovic, N. Zarkovic
- World report on hearing, World Health Organization (WHO)
