Cause Of Conductive Hearing Loss Research Articles

Atrophy of the long process of the incus with unknown origin – a rare cause of acquired conductive hearing loss: A clinical case report and mini-review of the literature

Introduction: Among the pediatric population, the most common cause of conductive hearing loss is exudative otitis media. If fluid is not present in the tympanic cavity, an assessment of the middle ear transmission system is recommended. Aim: To present a clinical case of atrophy of the long process of the incus in a 17-year-old patient with a 10-year history of conductive hearing loss, exhibiting an air-bone gap of 30 to 50 dB in the right ear qualified for exploratory tympanotomy. Literature review of internet databases to identify similar clinical cases. Material and methods: CARE guidelines were used to standardize the description of the clinical case. Surgical treatment included an exploratory tympanotomy using an endaural approach, visualizing atrophy of the long process of the incus and the connective tissue band connecting the stapes head to the lateral wall of the tympanic cavity. The eardrum was preserved. An ossiculoplasty was performed using autogenic materials – interposition of the incus. Internet databases PubMed and Scopus were searched using the search string „Incus atrophy” OR „Incus necrosis” AND NOT „Stapedectomy”. Results: On follow-up one month after surgery a hearing improvement was observed with a reduction in air-bone gap to 10–15 dB. No complications were observed. Discussion: Atrophy of the long process of unknown origin is a very rare cause of acquired conductive hearing loss. A review of literature revealed 8 manuscripts describing similar cases, which are presented and discussed in the manuscript. Ossiculoplasty in such cases might be performed using autogenic or artificial materials as partial ossicular prostheses or bone cement. Conclusions: Careful evaluation of imaging studies and hearing tests can often identify a defect in the conductive system; exploratory tympanotomy is often required. In cases such as the one presented, interposition of the incus might be a viable option.

Imaging in children with hearing loss.

Since the introduction of hearing screening in Germany in 2009, pediatric hearing disorders are detected at an early stage. Early therapy is essential for language development. Imaging plays a central role in diagnosis and therapy planning. Imaging findings of the most relevant causes of pediatric hearing disorders are presented. Specific attention is given to the method used in each case - CT or MRI. While CT is the method of choice for conductive hearing loss, a combination of CT and MRI with high-resolution T2-3D sequences has been established as the best diagnostic method for sensorineural hearing loss. The most common causes of conductive hearing loss in childhood are chronic inflammation and cholesteatoma. Congenital malformations of the outer or middle ear are less frequent. In the case of sensorineural hearing loss, the cause is located in the inner ear and/or the cochlear nerve or the cerebrum. In these cases, congenital malformations are the most common cause. · CT and MRI are necessary to identify morphological causes of hearing disorders and to clarify the possibility of hearing-improving ear surgery or cochlear implantation.. · Contraindications for surgical procedures must be excluded.. · Anatomical variants that may be risk factors for surgery must be described.. · Sorge I, Hirsch F, Fuchs M et al. Imaging diagnostics for childhood hearing loss. Fortschr Röntgenstr 2023; 195: 896 - 904.

Stapes surgery for otosclerosis: Comparison of two techniques

Abstract BACKGROUND. Otosclerosis is a primary disease of the human otic capsule and stapes stage, being a frequent cause of conductive hearing loss in our country. The surgical treatment of choice is stapes surgery and prosthesis placement, performed in a conventional way, with a surgical microscope, for 30 years in our hospital. Recently, the option of performing stapes surgery endoscopically was introduced in our centre. OBJECTIVE. To evaluate the results in stapes surgery for otosclerosis between the conventional microscopic versus endoscopic procedure. MATERIAL AND METHODS. An observational, analytical and retrospective study on patients undergoing stapes surgery with microscopic and endoscopic technique was conducted. Data such as age, sex, state of origin, affected ear, as well as the technique used, duration of surgical intervention, hearing gain and postsurgical complications were taken. Data were taken from the records of patients admitted to the hospital. Descriptive statistics, Mann-Whitney U and Pearson’s Ji2, were used, considering a value of p≤ 0.05 as significant. RESULTS. No significant differences were found in surgical time or postoperative hearing between the two surgical techniques. The female sex was the most intervened. There was no significant difference between the post-surgical complications of both groups. CONCLUSION. Both procedures appear to be effective, with similar risks and postoperative results for the surgical treatment of otosclerosis.

Comparison of Short-Term Hearing Outcome in Stapedotomy Using either Vein or Fat (Adipose Tissue) as Sealing Material.

Introduction Otosclerosis is a common cause of conductive hearing loss in the adult population that is caused by fixation of the stapes footplate. Cochlear otosclerosis may also present with sensorineural or mixed hearing loss. Surgery is the definitive treatment of choice and, during the procedure, sealing of the oval window with autologous tissue graft around the stapes prosthesis has been routinely done to improve hearing outcome and to mitigate postoperative complications. Objective To evaluate the efficacy of two different types of autologous tissue (vein or fat) grafts as oval window sealing materials in stapedotomy in improving short-term hearing outcomes. Methods In our study, 70 patients with otosclerosis who underwent primary stapedotomy were included. They were divided into group 1 (vein graft) and group 2 (fat graft) based on the type of sealing material used. All patients were followed-up at the end of 3 months, undergoing an audiometric examination to assess the hearing outcome. Results A total of 80% ( n = 28) of the patients in group1 had an air-bone gap (ABG) closure < 10dB, and, in group 2, 85.7% had an ABG closure < 10 dB; this difference was found to be statistically insignificant. A total of 42.9% ( n = 15) of the patients in group 1 and of 31.4% ( n = 11) in group 2 had a significant improvement in bone conduction, while 14.3% ( n = 5) of the patients in group 1 and 17.1% ( n = 6) in group 2 had worsening of average bone conduction postoperatively, which was found to be statistically insignificant. Conclusion Both vein and fat grafts had comparable effects on hearing outcomes when used as sealing materials in stapedotomy.

Genome-wide screen of otosclerosis in population biobanks: 27 loci and shared associations with skeletal structure

Otosclerosis is one of the most common causes of conductive hearing loss, affecting 0.3% of the population. It typically presents in adulthood and half of the patients have a positive family history. The pathophysiology of otosclerosis is poorly understood. A previous genome-wide association study (GWAS) identified a single association locus in an intronic region of RELN. Here, we report a meta-analysis of GWAS studies of otosclerosis in three population-based biobanks comprising 3504 cases and 861,198 controls. We identify 23 novel risk loci (p < 5 × 10−8) and report an association in RELN and three previously reported candidate gene or linkage regions (TGFB1, MEPE, and OTSC7). We demonstrate developmental stage-dependent immunostaining patterns of MEPE and RUNX2 in mouse otic capsules. In most association loci, the nearest protein-coding genes are implicated in bone remodelling, mineralization or severe skeletal disorders. We highlight multiple genes involved in transforming growth factor beta signalling for follow-up studies.

The Impact of Surgical Expertise on the Cost-Effectiveness of Stapes Surgery

Introduction: Otosclerosis is the primary cause of conductive hearing loss with normal otoscopy. As the condition worsens, certain patients may develop a sensorineural component. Patients with successful surgeries may still need hearing aids, which creates a dilemma for health professionals as there are insufficient data to make informed decisions. This study investigated the influence of the surgeon’s proficiency level, individual patient factors (e.g., age at the time of intervention and survival rates), and surgery costs on the cost-effectiveness of stapes surgery. Methods: We performed a cost-effectiveness analysis using an adapted Markov model incorporating annual all-cause mortalities. In addition, we introduced sensitivity analyses to address the effects of surgical expertise on adults with bilateral conductive hearing loss due to otosclerosis. A model was developed based on a decision tree with treatment options and complication scenarios for otosclerosis patients undergoing stapes surgery or receiving hearing aids. Annual all-cause mortality was considered. A sensitivity analysis was performed assigned to different training levels (“experts” and “less experienced”) to simulate the effects of surgical experience on the cost-effectiveness of surgical outcomes. Successful surgery was defined as closing of the air-bone gap to 10 dB or less. Based on published data, “experts” were simulated with a 93.7% success rate, and “less experienced” were manufactured with a 68.9% success rate. Results: Stapes surgery provides improved quality of life (QoL) compared to hearing aids with lower cumulative costs up to 87 years of age in the case of “expert” surgeons and up to 78 years of age, when performed by “less experienced” surgeons. Conclusions: Primary stapes surgery is highly cost-effective and delivers improved QoL compared to hearing aids with lower cumulative costs. Additionally, undergoing stapes surgical training remains highly cost-effective.

Association of Preoperative Audiological and Radiological Ossicular Findings with Peroperative Findings in Patients with Chronic Otitis Media- A Prospective Clinical Study

Introduction: Chronic Otitis Media (COM) refers to a chronic infection of mucosa lining the middle ear cleft and is the leading cause of conductive hearing loss in adults. The erosion or disruption of ossicular chain is determined while during the surgery. Complete disruption of ossicular chain can lead up to 60 dB hearing loss. Preoperative High-Resolution Computed Tomography (HRCT) scan of temporal bone can give a clue of ossicular integrity. Aim: To determine the association of preoperative audiological and radiological findings with the peroperative findings in cases of chronic otitis media. Material and Methods: This prospective clinical study was conducted in the Department of Otorhinolaryngology at Subharti Medical College and associated Chhatrapati Shivaji Subharti Hospital, Meerut, Uttar Pradesh, India, from October 2019 to August 2021. Seventy five patients of unilateral uncomplicated chronic otitis media (mucosal or squamosal), with conductive hearing loss, aged between 10 to 50 years were included in the study. Audiological assessment was done in form of pure tone audiometry using Alps 2100 instrument to measure hearing loss in decibels (dB). Radiological assessment was done using bilateral X-ray mastoid Schuller’s view, and HRCT temporal bone. Association of audiological and radiological findings was determined with intraoperative findings using Statistical Package for Social Sciences (SPSS) version 24.0. Results: The mean age of the study population was found to be 26.34±9.14 years. Females 42 (56%) were found to be affected more than males 33 (44%). Significant association was found between severity of hearing loss and necrosed ossicles seen peroperatively as p-value &lt;0.05 in mucosal type of CSOM. Chances of peroperative ossicular necrosis (mucosal) were more in sclerosed (76.47%) and diploic (84.61%) mastoid as compared to pneumatized mastoid (7.69%) with statistically significant difference as p-value&lt;0.01. Maximum accuracy of reporting for HRCT was found for the involvement of part of Incus. Conclusion: There was a significant association of audiological findings and number of ossicles necrosed peroperatively. hence, it can be concluded that greater the degree of hearing loss, more the chances of ossicular necrosis peroperatively.

An uncommon “third window” in retrofenestral otosclerosis

Otosclerosis is an otologic disease characterized by disordered resorption and deposition of the otic capsule bone. It can lead to progressive conductive, mixed or sensorineural Hearing Loss (HL). In rare cases, it manifests itself with a tendency for massive bone resorption with subsequent formation of cavities (“cavitating otosclerosis”). Cavities can sometimes realize communication between the Cerebrospinal Fluid (CSF) at the Internal Auditory Canal (IAC) and the cochlear duct. In these uncommon cases, a “third-window” phenomenon may be established as a concomitant cause of conductive HL. Therefore, the feasibility of stapes surgery should be evaluated, without underestimating the risk of gusher complications. In this report, we discuss the case of a female patient affected by cavitating otosclerosis realizing a connection between IAC and cochlear duct, with mixed hearing loss.

Evaluation of outcome of ossiculoplasty with and without an intact malleus

&lt;p class="abstract"&gt;&lt;strong&gt;Background: &lt;/strong&gt;CSOM is commonly encountered in the clinical practice as a cause of conductive hearing loss. Preoperative evaluation of hearing becomes mandatory for proper management. Ossiculoplasty is usually done in conductive hearing loss due to ossicular chain abnormality in CSOM. The aim of the evaluation of outcome of ossiculoplasty with and without an intact malleus.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods: &lt;/strong&gt;Total 40 patients greater than 18 years with mucosal type of CSOM with good cochlear reserve and Eustachian tube function, requiring intact canal wall mastoidectomy onlywere taken. All cases were planned ossiculoplasty with tympanoplasty or tympanomastoidectomy and postoperative follow-up done with measurement of Pure-tone average air-bone gap Ossiculoplasty Outcome Parameter Staging (OOPS) index and complications. Simple random sampling technique is used to calculate the size during the study.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; Ossiculoplasty was done in all cases in which 50% of patients (n=20) had malleus and 50% (n=20) with no malleus and AB gap in both group have almost similar result.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; Ossiculoplasty techniques using neo malleus struts combined with assembly prostheses, in middle ear reconstruction was studied and was non-significant.&lt;/p&gt;

Tympanic Membrane Perforation among Patients Presenting to Department of Otorhinolaryngology of a Tertiary Care Hospital: A Descriptive Cross-sectional Study.

Intact tympanic membrane acts as a partition between the external ear and middle ear. Tympanic membrane perforation is one of the commonest causes of conductive hearing loss. Perforation size is the most important determination of hearing loss. The aim of this study was to find out the prevalence of tympanic membrane perforation among patients presenting to the otorhinolaryngology department of a tertiary care hospital. A descriptive cross-sectional study was carried out in the Department of Otorhinolaryngology and Head Neck Surgery of a tertiary care hospital from March 2021 to August 2021. Ethical approval was taken from Institutional Review Committee (Reference number: 57112021). Convenience sampling was done and data was collected from 414 patients presenting to the department. Collected data were entered, analyzed in Statistical Package for the Social Sciences version 21.0 and documented for study. Point estimate at 95% Confidence Interval was calculated along with frequency and percentage for binary data. Among 414 patients, tympanic membrane perforation was seen in 100 (24.15%) (20.02-28.27 at 95% Confidence Interval). Among 100 patients with a total of 153 perforated eardrums, mild hearing loss was seen in the majority of the cases. Posterior perforation had a mean hearing loss of 40.41±5.96 dB, central had 39.09±3.13 dB, and anterior had 35.15±5.88 dB. Our study showed the prevalence of tympanic membrane perforation to be high when compared to other similar studies. Hearing loss was observed in all cases; the majority with mild hearing loss. The degree of hearing loss was more in larger and posterior perforation. eardrum perforation; hearing loss; otitis media.

ТИМПАНОСТОМИЯ ПРИ ЭКССУДАТИВНОМ СРЕДНЕМ ОТИТЕ У ДЕТЕЙ

Acute and chronic otitis media remain the leading causes of conductive hearing loss. Every second child by the age of 3 years and by the age of 5 years up to 70% of children had acute otitis media. Chronic otitis media with effusion is detected during mass examinations of children aged from 2 to 7 years in 30.2% of cases. The starting point in the development of otitis media with effusion both acute and chronic forms is a violation of the ventilation and drainage functions of the auditory tube. Elimination of effusion from the tympanic cavity after nasopharynx therapy and rehabilitation of the function of the auditory tube occurs in 75% of cases. Tympanostomy is indicated where the function of the auditory tube is not restored after adenotomy or conservative treatment. Tympanostomy is widely introduced as a method of surgical treatment for otitis media with effusion both acute and chronic forms in a number of countries. However, there is no consensus on the method of intervention and further management of patients among specialists. The article provides an overview of the opinions and results of tympanostomy using in case of otitis media with effusion in children.

Right Incus Osteoma in a Child: A Differential Diagnosis of Middle Ear Malformations.

Osteomas of the temporal bone, especially those involving the incus, are rare, unilateral, benign osseous tumors. The clinical presentation is usually isolated conductive hearing loss, and the diagnosis is confirmed by a temporal computed tomography scan. Osteomas of the incus represent a differential diagnosis of congenital middle ear malformations in children, which are the most frequent cause of conductive hearing loss with a normal eardrum in the pediatric population. In case of disabling symptomatology, surgery seems to be a safe way to recover normal hearing.

Parameter Identification From Normal and Pathological Middle Ears Using a Tailored Parameter Identification Algorithm.

Current clinical practice is often unable to identify the causes of conductive hearing loss in the middle ear with sufficient certainty without exploratory surgery. Besides the large uncertainties due to interindividual variances, only partially understood cause-effect principles are a major reason for the hesitant use of objective methods such as wideband tympanometry in diagnosis, despite their high sensitivity to pathological changes. For a better understanding of objective metrics of the middle ear, this study presents a model that can be used to reproduce characteristic changes in metrics of the middle ear by altering local physical model parameters linked to the anatomical causes of a pathology. A finite-element model is, therefore, fitted with an adaptive parameter identification algorithm to results of a temporal bone study with stepwise and systematically prepared pathologies. The fitted model is able to reproduce well the measured quantities reflectance, impedance, umbo and stapes transfer function for normal ears and ears with otosclerosis, malleus fixation, and disarticulation. In addition to a good representation of the characteristic influences of the pathologies in the measured quantities, a clear assignment of identified model parameters and pathologies consistent with previous studies is achieved. The identification results highlight the importance of the local stiffness and damping values in the middle ear for correct mapping of pathological characteristics and address the challenges of limited measurement data and wide parameter ranges from the literature. The great sensitivity of the model with respect to pathologies indicates a high potential for application in model-based diagnosis.

Comparative Evaluation of Hearing in Cartilage Umbrella, Boomerang and Torp in Chronic Otitis Media Cases with Absent Stapes Suprastructure: Our Experience.

Ossicular discontinuity is one of the most common causes of conductive hearing loss. Ossicular chain reconstruction improves conductive hearing loss. With no additional cost, cartilage ossiculoplasty is easy to perform, and also the cartilage is well tolerated being an autograft. In this study we compared the audiological outcome in ossiculoplasty done by cartilage umbrella, cartilage boomerang and alloplastic TORP. 75 patients of age group 10-50years clinically diagnosed with chronic otitis media with conductive hearing loss and an air bone gap (ABG) of at least 20dB posted for surgery were included. Ossiculoplasty was done in three groups with autologous cartilage boomerang, cartilage umbrella and alloplastic TORP. In mucosal disease hearing gain was better in umbrella technique (17.66 ± 1.1) dB than Boomerang (16.9 ± 0.8) dB and TORP (10.68 ± 0.9) dB. ABG closure was higher in Boomerang and TORP. Hearing improvement in patients with squamosal disease managed by canal wall up surgery was 25.01 ± 1.1dB, 27.73 ± 3.1dB and 20.12 ± 1.8dB in Boomerang, Umbrella and TORP group respectively showing that umbrella method gave maximum improvement. ABG closure was better in TORP group. In canal wall down surgery patient's maximum improvement was seen in Boomerang (29.51 ± 0.9) dB followed by Umbrella (26.67 ± 1.2) dB and TORP (25.27 ± 0.8) dB group. ABG closure was higher in Boomerang group. Cartilage ossiculoplasty is a reliable and effective method of ossicular chain reconstruction for both mucosal and squamosal disease. Cartilage ossiculoplasty has the added advantage of reduced chances of prosthesis extrusion as compared to TORP.

Stapedial reflex evaluation after preservation of stapedial tendon during stapedectomy

Background:Otosclerosis is one of the leading causes of conductive hearing loss with an intact tympanic membrane in adults. The stapedius tendon is routinely transected during stapes surgery. This study aimed to evaluate the success rates of stapedectomy with preservation of stapedial muscle tendon compared to stapedectomy without preservation of stapedial muscle tendon in the operative management of otosclerosis. Main text:This is a retrospective study. It was conducted in the Otorhinolaryngology Department, Faculty of Medicine, Zagazig University during the period from October 2018 to January 2021. The sample size is 36 cases were arranged into two groups the first group with preservation and the second group with cut of stapedial tendon and the size of each group is 18 cases. There was no significant difference between both groups in hearing improvement, but there was a significant difference between both groups in post-operative tinnitus improvement and acoustic reflex preservation.Conclusions: Preservation of the stapedial tendon in the surgical treatment of otosclerosis is associated with improvement in functional outcomes, as well as provide the patient with a stapedial reflex that had a primary protective effect against strong acoustic stimuli.Keywords: otosclerosis, stapedectomy, stapedial tendon.

Study on Hearing Impairment in Bangladesh

Background : Hearing impairment is one of the leading causes of disability in Bangladesh. Since half the cases can be prevented through public awareness, early detection and timely management, planning of public health interventions become necessary. To achieve this, a nationwide level of evidence is required. This survey was conducted with the aim of determining the prevalence of hearing impairment in Bangladesh.&#x0D; Materials and methods : The study was a cross-sectional one, conducted between January to May 2013, where a multistage, geographically clustered sampling approach was used. A total of 52 primary sampling units were selected, and from each unit households were selected at random followed by random selection of an individual from each household. In total, 5,220 people were targeted out of which data collection could be completed from 4260 individuals. (82%). Following clinical assessment of study subjects, hearing status was assessed by pure tone audiometry and otoacoustic emission test.&#x0D; Results : The mean age was 32 years among which 58% were females. Among men, there were 29% students, 28% agriculture workers and 14% business men. A major portion of females (63%) were home makers. On clinical examination, 11.5% respondents had impacted ear wax, 6.2% had chronic middle ear infections with eardrum perforation, and 5.3% had otitis media with effusion.On hearing assessment, 34.6% respondents had some form of hearing loss (&gt;25dB in better ear). Conductive hearing loss was found in 12.0%, sensorineural in 4.5% and mixed in 3.8%, where the latter two increased in prevalence with age. Out of the total respondents, 9.6% had disabling hearing loss according to WHO criteria, with a higher prevalence in adults &gt; 60 years(37%). Logistic regression analysis showed age, socioeconomic status, presence of ear wax, chronic suppurative otitis media, otitis media with effusion and otitis externa were significant predictors of disabling hearing loss.&#x0D; Conclusion : The major causes of conductive hearing loss are chronic suppurative otitis media and otitis media with effusion.&#x0D; Chatt Maa Shi Hosp Med Coll J; Vol.20 (1); January 2021; Page 72-76

Comparative study between Teflon and Robinson stainless steel Prostheses in ototsclerosis surgery

BACKGROUND: The main cause of conductive hearing loss in the presence of a completely normal tympanic membrane is otosclerosis. There are different types of prostheses that could be used in the operation with different materials, designs, and shapes. The prostheses utilized in this study including both Teflon and Robinson are assessed. The aim of our work is to match and determine the surgical steps, postoperative results, and surgical complications of both Teflon piston and Robinson titanium prosthesis in line with the improvement in hearing and therefore the ability to decrease the air-bone gap.Results: stapedotomy done for 40 patients with Teflon piston and Robinson stainless steel piston prosthesis, 20 patients for each type. Both groups were matched based on age and preoperative bone-conduction scores. Follow up for all patients were done up to 6 months postoperatively. We have excluded all revision cases. A comparison between both prostheses was assessed by differences in the Air Bone (AB) Gap and surgical difficulties and complications. Both groups showed no significant difference either in hearing improvement or postoperative decrease of an air-bone gap. The Robison titanium piston needs more surgical skills than Teflon one. Both groups had no surgical complications.Conclusions: There is an equal benefit to patients with the use either of Teflon piston or Robinson protheses and there is no statistically significant difference between both of them. We need a long time of follow up the results to be analyzed.Keywords: Teflon prosthesis, Robinson prostheses, otosclerosis, stapedectomy.

Decreased miRNA-320e correlates with allergy in children with otitis media with effusion

ObjectiveOtitis media with effusion (OME) is a common childhood disease and the main cause of conductive hearing loss in this age group. Many factors predispose to OME but allergy is still widely disputed. The answer may lay in the molecular mechanisms of ear exudate formation and the recent studies showed miRNAs might take part in it. MiRNAs are also potent regulators of allergic response. As miRNAs are present in the middle ear, we hypothesized their expression differs between allergic and non-allergic patients and reflects the difference in pathomechanism of effusion formation between these two groups. Materials and methodsThis study aimed to establish the expression of 5 different miRNAs (miR-223-3p, miR-451a, miR-16-5p, miR-320e, miR-25-3p) in ear exudates in children diagnosed with OME. The allergy group consisted of 18 patients whereas the non-allergic group had 36 patients. MicroRNA was isolated from the middle ear fluid collected during myringotomy and transcribed into cDNA. MiRNA expression was measured with TaqMan™ MicroRNA Assays and analyzed with DataAssist software. The comparative CT method was used for calculating the relative quantification of gene expression based on the endogenous control gene expression (U6 snRNA-001973). ResultsMiR-320e expression was significantly decreased in allergic children with OME. Other studied miRNAs also showed reduced expression in allergic children, but the decrease was not significant. ConclusionsMiRNA expression differs between children with and without allergy in the course of OME, but further studies are needed to explain the exact role of miR-320e and its target genes in OME pathology in allergic patients.

The Stapes in Otosclerosis: Osteoarthritis of an Ear Ossicle.

Otosclerosis is a pagetoid proliferation of bone remodeling, vascular proliferation, bone resorption and new bone formation in the tympanic region of the temporal bone. The resulting anklyosis of the stapes footplate as it articulates with the oval window is the most common cause of conductive hearing loss in young to middle aged, predominantly Caucasian individuals. The characteristic histologic features have been well documented by autopsy studies of the temporal bone. Although stapedectomy is the surgical treatment for otosclerosis, the stapes specimen may be submitted for gross examination only or not examined at all. A retrospective study of 73 stapedectomy specimens (2008-2019) not including the stapes footplate. Clinical features from the electronic medical record as well as standard histologic sections from surgical specimens were reviewed. Neither the stapedal head nor crura showed histologic features of otosclerosis. There was mild osteoarthritis affecting the head, possibly as a consequence of persistent ossicular vibration superimposed on the ankylosed rigidity. The most common changes were surface fissuring (65%), cartilaginous erosion (49%) and irregularity of the osteochondral interface (51%). An occasional osteophyte (8%) was observed. The ear ossicles, embryologically analogous to long bones of the extremities, develop via endochondral ossification and exhibit articular surfaces of hyaline cartilage. The present observations suggest that a consequence of otosclerotic ankylosis is osteoarthritis of the stapedal head. In this study, the histological features could not be correlated with the severity of hearing loss or duration of clinical disease.

Isolated middle ear anomalies: unfamiliar causes of conductive hearing loss: a case series

&lt;p class="abstract"&gt;In this paper, we highlighted on the various types of isolated congenital middle ear ossicular anomalies we had seen and managed. This is significant as these are rare and go undiagnosed for long period of time. The mainstay of managing these conditions includes proper and timely diagnosis and correction of conducting hearing loss. This was a retrospective case series study done over period of 3 years from July 2016 to June 2019 at a tertiary referral otology centre. The study comprised of 9 patients diagnosed with isolated middle ear anomalies and in total 11 operated ears for the same as two patients underwent bilateral treatment. Each case was handled differently according to the intra operative middle ear findings. We found that in all of our cases the HRCT findings were in correlation with our intra operative findings. All cases had excellent post-operative hearing outcomes. Isolated middle ear deformity even though rare to identity, with recent advancement it is possible to diagnose and treat it on time and hence reduce the disability experienced by the patient. Whatever the type of abnormalities, most of them could be corrected with appropriate ossicular reconstruction by preserving the normal existing anatomy and bypassing the anomalous part.&lt;/p&gt;&lt;p&gt; &lt;/p&gt;