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Post-stapedectomy cochlear otosclerosis.

A successful stapedectomy may, after some years, result in a disappointed patient because hearing has deteriorated and a hearing aid is again needed. This loss of hearing may be the result of otosclerosis involving the cochlea. If a patient with a normal bone conduction threshold, allowing for the Carhart notch, undergoes surgery, it is likely that any subsequent loss of auditory acuity is due to presbycusis or some other factor. However, the presence of even a small depression of the preoperative bone conduction threshold can indicate cochlear otosclerosis and the possibility that the hearing will continue to deteriorate in the postoperative years. (1)

Several uncontrolled orphan drug studies in this country and one placebo-controlled study in Europe have shown that the administration of sodium fluoride will slow or halt the progression of the hearing loss that occurs with otosclerosis. (2) Some physicians add calcium and vitamin D to the regimen. Thus, a patient undergoing stapedectomy who has a mixed hearing loss at the time of surgery should be followed with yearly or bi-yearly audiometric tests. If there is evidence of progression of the loss, fluoride therapy should be given and the patient retested at yearly intervals until there is ample evidence of cessation of the hearing deterioration.

Cochlear otosclerosis without stapes fixation, although rare, is a cause of progressive sensorineural hearing loss. (3) A family history of progressive hearing loss or of stapedectomy suggests the possibility of co chlear otosclerosis. Fifty percent of cases will exhibit a negative on/off stapedial reflex test? If the acoustic reflex is normal and there is still a suspicion of cochlear otosclerosis, a CAT scan is indicated?

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References

(1.) Ramsay HA, Linthicum FH Jr. Mixed hearing loss in otosclerosis: Indication for long-term follow-up. Am J Otol 1994;15(4):536-9.

(2.) Bretlau P, Salomon G, Johnsen NJ. Otospongiosis and sodium fluoride. A clinical double-blind, placebo-controlled study on sodium fluoride treatment in otospongiosis. Am J Otol 1989;10(1):20-2.

(3.) Balle V, Linthicum FH Jr. Histologically proven cochlear otosclerosis with pure sensorineural hearing loss. Ann Otol Rhinol Laryngol 1984;93(2 Pt 1):105-11.

(4.) Forquer BD, Sheehy JL. The negative on/off effect in cochlear and early stapedial otosclerosis. Ear Hear 1981;2(6):256-9.

(5.) Derks W, De Groot JA, Raymakers JA, Veldman JE. Fluoride therapy for cochlear otosclerosis? An audiometric and computerized tomography evaluation. Acta Otolaryngol 2001; 121 (2):174-7

Fred Linthicum Jr., MD

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Title Annotation:CLINICAL NUGGETS
Author:Linthicum, Fred, Jr.
Publication:Ear, Nose and Throat Journal
Geographic Code:1USA
Date:Apr 1, 2009
Words:405
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