Incidence Of Otosclerosis Research Articles

The Case Against Stapedectomy as a Core Competency for General Practice: A Study of Care Patterns in the Department of Defense.

Stapedectomy remains a key indicator case reportable to the Accreditation Council of Graduate Medical Education despite the decline in the incidence of otosclerosis over the last half century. This study compared the rates of stapedectomy performed by otolaryngologists at academic and nonacademic centers. Retrospective review. Tertiary referral academic centers, nonacademic centers, and civilian purchased-care across the Department of Defense between 2015 and 2020. Department of Defense beneficiaries with otosclerosis near a military treatment facility with an otolaryngologist. Stapedectomy (Current Procedural Terminology codes 69,660, 69,661, and 69,662). Number of stapedectomies performed by setting. From 2015 to 2020, 426 stapedectomies were performed at or near a military treatment facility with an otolaryngologist (274 directly by military otolaryngologists, 152 by community providers). Military providers performed 94% of stapedectomies at or near military academic centers, versus only 30% at or near nonacademic centers ( p < 0.0001). Among the 60 stapedectomies performed at nonacademic centers, only 30 were performed by general otolaryngologists (7% of all stapedectomies performed; 11% of procedures by military providers) while the rest were performed by fellowship-trained otologist or neurotologist. Low stapes surgical volume by military general otolaryngologists reinforces recent epidemiologic trends and suggests that few general otolaryngologists graduate residency with sufficient competency to pursue independently performing stapedectomy or have difficulty maintaining competency after graduation.

Incidence of Congenital Stapes Footplate Fixation Since 1970: A Population-based Study.

Several reports have suggested that the incidence of otosclerosis is declining. However, due to the limitations of epidemiologic databases within the United States, little is known about the incidence of congenital stapes footplate fixation (CSFF), much less epidemiological trends over the past 50 years. The current study was conceived to characterize the epidemiology of CSFF over the past five decades using the unique resources of the Rochester Epidemiology Project (REP). Population-based study. The medical records of every resident of Olmsted County, Minnesota who was diagnosed with CSFF was reviewed from January 1, 1970 to December 12, 2017 using the REP. The population of Olmsted County on January 1, 2017 was 159,689 persons. Incidence of CSFF. Sixteen cases of CSFF were identified at a median age at diagnosis of 8 years (IQR, 6-17), eight of whom confirmed by exploratory tympanotomy. Three of the 16 (19%) cases were bilateral, and the median pure-tone average (500, 1k, 2k, 3k Hz) at time of diagnosis was 37 dB (IQR, 31-48). Two (13%) cases were identified in patients bearing a syndromic condition and one (6%) case demonstrated a malformed external ear on physical examination. The incidence rate of surgically confirmed cases among residents of Olmsted County was 0.31 per 100,000 person-years from 1970 to 1979 and 0.28 from 2000 to 2009. No incident cases among residents of Olmsted County were identified since 2010. CSFF constitutes a rare disease. Unlike epidemiological trends in otosclerosis, the incidence of surgically confirmed cases of CSFF remained stable over the past 50 years.

Otosclerosis Revisited

Introduction: Otosclerosis usually manifests as a progressive conductive or mixed hearing loss occurring clinically to varying degrees in 0.5% - 1% of the general population. Stapedectomy /stapedotomy is the current treatment of choice for conductive component of Otosclerosis.&#x0D; Materials and Methods: Sixty patients attending the department of ENT of a Medical College Hospital in Bangalore between October 2012 and October 2017 were included in the study.&#x0D; Results: The incidence of otosclerosis is highest in the 3rd and 4th decade. Bilateral symptoms were present in 25% and 75% had unilateral symptoms, right side being more common in our study. Tinnitus and vertigo with deafness are seen in 60% and 25 % of the patients respectively.&#x0D; Ninety percent of the patients presented with moderate to moderately severe hearing loss. Twenty four (40%) out of 60 audiograms studied showed Carhart's notch. Postoperativeclosure of a-b gap to within 10dB could be achieved in 65% cases. The p value calculated comparing pre and post op results is &lt;0.0001 and significant.&#x0D; Vertigo was found to be most common post-operative complication (35%) followed by sensorineural hearing loss (6.6%). Other complications observed during the study include - tympanic membrane tears, foot plate extrusion, lax long process of incus, perilymph leak.&#x0D; Conclusion: From the assessment of the postoperative hearing gain and postoperative complications, it can be concluded that small fenestra stapedotomy gives satisfactory post-operative outcome and may be appropriatein the Indian scenario.

The lack of 4-hydroxynonenal in otosclerotic bone tissue in Ethiopian population.

In Ethiopians, like in other Africans, the incidence of otosclerosis is lower than in Western and Asian populations. Unfortunately, due to the lack of available otorhinolaryngology specialists many patients are not treated and suffer the progression of the disease and severe hearing loss. This program of the Global ENT Outreach Organization (GEO) together with the Ethiopian partners was done to help some of these patients and in parallel to evaluate the presence of the oxidative stress bioactive marker 4-hydroxynonenal (HNE), which is known as major lipid peroxidation product and the second messenger of free radicals, in the otosclerotic bone specimens. Namely, we described recently that as HNE acts as a bone growth regulator associated with pathogenesis of otosclerosis. The prospective study conducted at the ENT Department of the Migbare Senay General Hospital, Addis Ababa, Ethiopia in June 2012, under the auspices of the Global ENT Outreach Organization, USA. Altogether 36 patients (male = 12, female = 24) underwent surgery due to the previous otosclerosis diagnosis based on the clinical and audiometric findings. The bone samples were harvested from patients with intraoperatively confirmed otosclerosis diagnosis. Immunohistochemistry for HNE-modified proteins was carried out on formalin-fixed paraffin-embedded specimens. The presence of HNE was found in almost all bone samples analyzed, without particular difference in the HNE distribution pattern between the otosclerotic and respective control bone specimens. Although there was no significant association between the HNE appearance and otosclerotic bone outgrowth observed, several cases have shown tendency of higher HNE expression in patients with more severe hearing loss. The results of the present study are in contrast with our previous findings obtained on European patients most likely due to the differences between studied population groups.

Cochlear Implantation in a Patient with Advanced Otosclerosis

The incidence of otosclerosis, especially the retrofenestral advanced type, is relatively low in Koreans compared to that of the Western population. A case is reported in which cochlear implantation was performed in a patient with advanced otosclerosis presenting with mixed profound hearing loss on one side and pure sensorineural hearing loss on the other side. Intraoperative or postoperative complications of cochlear implantation commonly encountered in patients with otosclerosis did not occur in our patient and successful auditory outcome could be achieved. The results are reported with the review of literature, and clinical considerations regarding cochlear implantation in otosclerosis are discussed. � Korean J Otorhinolaryngol-Head Neck Surg 2013;56:667-70 Key WordsZZCochlear implantation ㆍHearing loss ㆍOtosclerosis.

R436 – Association Between Chronic Otitis Media and Otosclerosis

Problem In a previous clinical study, the incidence of chronic otitis media in cases of otosclerosis was reported to be less than that observed in patients without otosclerosis. Histopathologically, we can detect minimal changes such as histological otosclerosis or silent otitis media which are not detected clinically. The purpose of this study is to reveal the association of otosclerosis and chronic otitis media by evaluating human temporal bones, histopathologically. Methods 1235 human temporal bones were reviewed for this study. In order to match patients with otosclerosis, patients with chronic otitis media were limited to 16 to 92 years of age. The incidence of otosclerosis (clinical otosclerosis, histological otosclerosis) and chronic otitis media, either clinical (tympanic membrane perforation) or silent (without perforation) were analyzed. Results There was no statistically difference between the incidence of chronic otitis media in temporal bones with and without otosclerosis. Conclusion The association of chronic otitis media and otosclerosis appears to be a coincidental. Significance The incidence of chronic otitis media in cases of otosclerosis is not less than that observed in cases of chronic otitis media in cases without otosclerosis. Support International Hearing Foundation, Hubbard Foundation, Starkey Foundation.

Incidence and characteristics of otosclerosis in the Japanese population

Objective: Otosclerosis is thought to be quite an uncommon disease in Japan. However, in recent years the incidence of this disease seems to have increased. Here we report about the characteristics and incidence of this disease in the Japanese population who underwent stapes surgery in our department. Methods: A total of 80 patients (115 ears), who underwent stapes surgery by a single surgeon in 21 years and 8 months were included in this study. Results: The incidence of clinical otosclerosis was found to be 0.22% among the outpatients with ear disease. During the first half of the period, the ratio of stapes surgery/tympanoplasty was less than 0.05. While, during the second half of this period, this ratio had increased to 0.08. The average number of stapes surgery performed in the first half period was 3.7 ears/year, and that in the second half was 6.8 ears/year. In contrast to otosclerosis in Caucasians, pure tone threshold in lower frequencies was much higher than that of higher frequencies (except for 8000 Hz). However, the improvement of the threshold after surgery was not so different from that reported in Caucasians. Conclusions: Taken together, the present results clearly demonstrate that the incidence of otosclerosis in Japan has been increasing. Moreover the rise in the slope of the conduction curve at higher frequencies may be a reflection of the pathological characteristics of otosclerosis in Japanese population, which is less invasive and has limited otosclerotic foci in the temporal bone.

Shift of the Distribution of Age in Patients with Otosclerosis

Morphological and biochemical investigations have shown evidence of an association between measles virus and otosclerosis. Epidemiological analysis of age and gender distributions in the 1960s and 1970s revealed a higher incidence of otosclerosis in women, the average age of onset of clinical disturbances and need for surgery being between 15 and 40 years. In the late 1960s and early 1970s a campaign to vaccinate children against measles was started in Germany. The aim of our study was to evaluate whether this campaign has had any influence on the distributions of the age and gender of patients affected by otosclerosis over the past 20 years. The study included patients suffering from clinical otosclerosis who had undergone stapedectomy between 1978 and 1999 and whose clinical data were complete (n=1351). Statistical analysis during the recruitment period indicated a significant increase in the average age of the otosclerosis patients (p=0.012). With regard to the gender distribution it was found that the increase of otosclerosis in women compared to men was statistically insignificant (p=0.418). These data strongly support the hypothesis of a measles virus involvement in otosclerosis and may reflect a decreased incidence of otosclerosis in the generation of patients vaccinated against measles virus.

日本人における組織学的耳硬化症の研究

Five hundred and forty five temporal bones from 273 individuals were studied histopathologically, to clarify the activity, gender ratio, predilection site and incide nce of otosclerosis among Japanese. The relation between otosclerosis and fissula ante fenestram or constituents in the area anterior to the oval window was also studied. Individua ls ranged in age from 6 to 89 y ears.1) Histological evidence of otosclerotic foci was found in 12 ears,10 individuals; 6 of 172males (7 of 344 ears) and 4 of 101 females (5 o f 201 ears) aged 48 to 84 years; all cases sho wed histologic otosclerosis without clinical otologic symptoms. The prevalence of histologic otosclerosis was calcul ated as 3.66% by individuals and 2.20%by ears. Females were not significantly predominant statistically. Unilaterality wa s 80%(8 of 10 individuals).2) The most frequent site of otosclerotic foci from data in this study conbined with that from reports published in Japan was the area anterior to the oval window in 52% of the cases. The percentage was about half that in Caucasians.3) The volume of the otosclerotic foci in the area anterior to the oval window was measured in 6 ears by three-dimensional computer graphic reconstruction. Volume rang ed from 0.079 to 4.023 mm3. In five ears, volume was less than 1 mm3.4) Otosclerotic foci involved in the area anterior to the oval window were separated from the fissula ante fenestram, but involved the tympanic side of the fissula ante fenestram. It was considered that otosclerosis might arise not from the fissula ante fenestram, but from the area on the tympanic side of the fissula ante fenestram.5) In the area anterior to the oval window, there were some constituents such as cartilage, new bone, adipose tissue and connective tissue. However, in the ear involving oto sclerosis in the area anterior to the oval window, these constituents were not observed. O tosclerosis may have no relation to these constituents.6) The lower incidence of clinical otosclerosis among Japanese compared to that among Caucasians was considered due to:1. the low prevalence of otosclerosis2. low activity3. the low rate of involvement of the area anterior to the oval window that causes earlier impaired hearing.

Otosclerosis: The University of Minnesota Temporal Bone Collection

A study of 1452 human temporal bones revealed a previously unpublished material of 144 bones with otosclerosis. After exclusion of infants and individuals of races other than white, the incidence of otosclerosis was 12.75%. Of the bones with otosclerosis, 56.1% belonged to men and 43.9% to women. The incidence of clinical and histologic otosclerosis was practically the same for men (44.7% to 55.3%) as for women (47% to 53%). However, the incidence of bilateral otosclerosis was higher in women (88.9%) than in men (65.2%). Bilateral otosclerosis was present in 75.6%, whereas it was unilateral in 24.4%. Sixty-six (66) ears (45.8%) had clinical otosclerosis, whereas 78 (54.2%) had histologic otosclerosis--frequently unifocal lesions. The most common site was anterior to the oval window (117 ears, 81.25%), followed by round window niche (52 ears, 36.11%), apical and medial cochlear wall (31 ears, 21.52%), and anterior wall of the internal auditory canal (27 ears, 18.75%). The activity of lesions was directly related to their size. Smaller lesions were predominantly inactive, whereas medium and larger lesions were predominantly active. There was a positive correlation when the size of the lesions, activity, and degree of cochlear endosteal involvement were compared with bone conduction thresholds (37 cases). Correlations between size and activity, and between activity and associated sensorineural hearing loss did not necessarily follow the sequence of an initial active stage (spongiotic) to a final inactive one (sclerotic). Comparison of cases of otosclerosis with equivalent age groups of the normal population yielded worse bone conduction thresholds for the otosclerosis cases only in the age group 60 to 69 years and older. Comparison of average bone conduction thresholds between bones with one site of endosteal involvement (28.26 dB HL) revealed no significant differences. Bones with two or more sites of endosteal involvement had significant differences. Bones with two or more sites of endosteal involvement had significantly worse bone conduction thresholds (62 dB HL). The overall results are not suggestive of an association of sensorineural hearing loss with otosclerosis without stapedial fixation.

Prevalence of otosclerosis in a highly fluoretic area

A door-fo-door survey was carried out at village Mansa, a highly fluoretic area of Punjab. The data of the present study has been compared with that of the survey carried out at village Raipur Rani, a low fluoride area in Haryana during year of 1972. Both these surveys were conducted on a similar pattern as advised by the bio-statistician. A higher, though not statistically significant, incidence of Otosclerosis and sensori-neural deafness was found in the high fluoride area.

Otosclerosis and the Diagnosis in Japan

The incidence of otosclerosis in Japanese is low and accordingly most of the otosclerotic ears have escaped attention.One of the authors (H. S.) studied the stapedectomized footplates from ears with fixed stapes syndrome and confirmed foci which belonged to the classification of a true otosclerosis.Detections of otosclerosis in Japan at the present time depends upon the physician actually looking for evidence of same. Tympanometry and stapedial reflex are particulary helpful in the diagnosis, in combination with conventional pure tone audiometry.

Otosclerosis in Japanese

The incidence of otosclerosis in Japanese is low and only a few authors have reported temporal bone findings in otosclerosis.In our experience, six surgically acquired specimens from ears with typical audiometric characteristics of stapes fixation revealed foci which belonged to a classification of a true otosclerosis.The specimens showed all stages of otosclerotic maturation:i) osteoclastic destruction and osteoblastic activities around the newly forming bone.ii) osteoid blue bone with osteoblasts, forming the “blue mantle”.iii) acidphilic remodeling bone with osteoblasts.iv) highly mineralized acidphilic bones with a mosaic-like appearance.In most of stapes fixation in tissues from Japanese patients, the same otosclerosis as is seen in Caucasians was evident.

A study on genetics and otosclerosis

It may be possible to reduce the incidence of Otosclerosis through eugenics. The studies required to be undertaken are described.

The incidence of otosclerosis as related to race and sex.

The incidence of otosclerosis as related to race and sex.

Investigations and treatment of deafness incidence and frequency of otosclerosis

1. Incidence of varying types of deafness from point of view of aetiology is reported in 307 cases. 2. Incidence of otosclerosis works out to be 17.9%. 3. Irradiation of nasopharynx has benefitted only 31.7% cases out of 142 cases so treated. 4. Fenestration operation was done on 14 cases for otosclerosis. On an average patients have 36.5 db. loss as tested by Western Electric Audiometer post-operatively. There were two failures in the series. 5. Operation is done for the first time in the history of our Institution and more cases will be done in very near future.