Otosclerosis

Otosclerosis is a hereditary condition of the ear whereby bony hardening occurs at the bottom of the third middle ear ossicle (bone) called the stapes. This bony process can, and often will, invade the capsule of the inner ear.

The result of otosclerosis is hearing loss, usually occurring in early adulthood with progressive deterioration. Hearing loss is primarily mechanical (conductive), often with a component of nerve hearing loss.

Treatment options

1. Do nothing
   If the hearing loss is mild or not troublesome.
   
   
2. Use a hearing aid
   A trial of hearing aid is generally available from various manufacturers. This is primarily recommended for those with nerve hearing loss, or in patients who do not want a surgical solution.
   
   
3. Surgery
   A stapedotomy is a surgery aiming to replace the stapes bone.

Stapedotomy

The aim of of a stapedotomy is to replace the stapes bone. To do so, the top half of the bone is removed, and a small opening is made through the footplate of the stapes. A Teflon piston-type prosthesis is used to reconstruct the defect.

Results of stapedotomy

• 85% of patients will have significant hearing improvement
• 5% of patients will have slight hearing improvement
• 5% of patients will have no hearing improvement
• 5% of patients will have worsening of hearing, sometimes deafness in the ear operated on, rendering it unaidable (to a hearing aid)

This operation does not alter the bony process itself and it does not prevent the ear from undergoing further nerve degeneration. 

Surgical risks

• Hearing loss from inner ear injury
  Infection, chemical irritation etc.
  
  
• Dizziness
  Mild dizziness lasting a few days is common in nearly all patients who undergo a stapedotomy. Severe dizziness can occur in those who suffer inner ear injury, and may last several weeks. 
  
  
• Taste disturbance
  Taste disturbance occurs because of manipulation of the taste nerve that travels through the middle ear. It is usually temporary.
  
  
• Inner ear fluid leak
  Inner ear fluid leak, also known as a gusher, occurs when brain fluid escapes from the inner ear due to an abnormal connection with the brain cavity. When this occurs, a lumbar drain may be needed. The occurance of inner ear fluid leak is rare.