Statistics show that otosclerosis is such a lesion of the bone tissue of the labyrinth of the inner ear, which occurs in women almost 4-5 times more often than in men (there are only 20-25% of them in the total number of cases). Moreover, among women entering puberty, menopause, as well as among pregnant and breastfeeding women, the number of cases is growing. This suggests a connection between pathological changes and hormonal, metabolic and endocrine factors. However, today several alternative theories are being considered to explain the causes of otosclerosis of the ear.
Specificity of the disease
Despite the consonance of the term "otosclerosis" with the well-known "atherosclerosis", the nature of these diseases is completely different, and for the name of ossification of the sound-transmitting bones of the inner ear, the name otospongiosis is considered more accurate.
Otospongiosis is characterized by abnormal growth of bone tissue in the bone capsule of the labyrinth of the inner ear, as a result of which one of the auditory ossicles - the stirrup - loses mobility and is physically unable to transmit a sound signal from the incus.
There is ankylosis of the stirrup (immobility of the joint) and, as a result, hearing loss.
This condition is defined as conductive otosclerosis. It provokes a disorder of the functional of the sound-receiving apparatus with subsequent sensorineural hearing loss, that is, a cochlear otosclerotic process.
With the development of the disease in different parts of the bone labyrinth, it starts:
- first, the process of formation of immature spongy vascular-penetrated bone tissue (active focus),
- then the process of formation of sclerosed mature bone, into which the tissue of the focus is transformed.
Such foci are found in different areas:
- 15% - in semicircular canals,
- 35% - in a snail capsule,
- 50% - in the area of the vestibule window, where the base of the stirrup is involved in the pathological process, which leads to its immobility and disruption of the sound-conducting function.
About 1% of the population suffers from this disease. At risk are fair-skinned, fair-haired and blue-eyed women 20-40 years old during periods of hormonal changes.
At the same time, the most famous patient with characteristic hearing loss remains a man - the great composer L. Beethoven, who, according to modern doctors, by the age of 36, completely lost his hearing precisely because of the development of otospongiosis.
Also, risk factors include:
- long-term, leading to necrosis of the auditory ossicles, inflammation of the middle ear,
- Paget's disease
- congenital immobility of the stapes and other anomalies of the organs of hearing.
The disease begins with a pathology in one ear, gradually, over several months or years, turning into a bilateral process. In connection with pregnancy, the symptoms of otospongiosis are aggravated: in 30% of cases - after the first pregnancy, in 60% - after the second and in 80% of cases after the third pregnancy.
Causes of pathology
Until the end, the causes of the disease have not been studied, but there are a number of theories, including:
- hereditary, which is confirmed by the family nature of the disease, as well as defects and variations in the RELN gene (40% of patients),
- endocrine, in confirmation of which the dysfunction of the thyroid gland is indicated, as well as disruption of the parathyroid glands,
- infectious, in which the infection becomes a trigger for activating a genetic predisposition to otospongiosis (for example, after measles),
- the theory of acoustic trauma, according to which the onset of the disease is influenced by constant near-threshold sound stimulation or transcendental short-term sound intensity.
Classification and symptoms
Since the disease can occur with a violation of both sound conduction and sound perception, there are three forms of it:
- Conductive. It is characterized by a violation of only sound conduction, and the audiogram demonstrates an increase in the thresholds for sound conduction through the air and the invariability of bone conduction.
- Mixed. This form is characterized by a violation of both sound conduction and sound perception with an increase in the thresholds of both types of conduction.
- Cochlear. This form is characterized by impaired sound perception, and the bone conduction threshold exceeds 40 dB.
In the classification according to the nature of the manifestations, the slow type (in 68% of cases), spasmodic (21%)
and rapid type of disease (11%). Depending on the specifics of otosclerosis, treatment is prescribed and the symptoms of various forms of the disease are determined.
In the histological initial stage, which usually lasts 2-3 years, the disease is asymptomatic, despite the already begun pathological changes in the tissue of the labyrinth. Rapid development of sensorineural hearing loss is rarely noted, but basically this stage is manifested only by mild tinnitus. The next manifestation is unilateral weak hearing loss.
Hearing loss is initially subtle and concerns the perception of low tones (male voices). In this case, high tones (children's and female voices) can be perceived even better than before. There is an apparent improvement in auditory function in a noisy environment, where the interlocutors speak louder, while the noise itself does not interfere with the patient (Willis paracusis). Another sign is a decrease in the quality of speech perception with a parallel symptomatic transmission of sounds spreading through the patient's soft tissues (for example, chewing sounds) - Weber's paracusis. In the future, the hearing loss progresses without the possibility of regression, reaching 3 degrees. The patient ceases to clearly hear sounds of any frequency, but complete deafness does not occur.
In 80% of cases, patients have a noise in the ear, reminiscent of rustling or "white noise", the degree of which does not correlate with the degree of hearing loss.
It has been suggested that it may be associated with metabolic and circulatory changes in the cochlea.
During periods of activation of the otosclerotic process, an ear pain of a bursting character occurs with localization in the mastoid process. After its appearance, even greater hearing impairment is often noted. Hearing loss and the resulting difficulties in social interaction can provoke neurasthenic syndrome.
Diagnostics
Diagnostics carried out with the help of otoscopy aims to exclude ear diseases similar in symptomatology: cochlear neuritis, Meniere's disease, labyrinthitis, some types of otitis media and external otitis media.
In combination with microscopy, otoscopy reveals the Holmgren triad typical of otospongiosis:
- dryness,
- lack of earwax,
- atrophy of the skin of the ear canal, characterized by its reduced sensitivity.
The tympanic membrane with otospongiosis most often remains unchanged, however, in the case of its atrophy, the reddened mucous membrane of the tympanic cavity, which is translucent in the area of atrophy (Schwartz's spot), becomes an indirect indicator of the disease. The similarity with chronic exudative otitis media and its consequences occurs with hypertrophy of the membrane.
Audiometry as a diagnostic method identifies problems with the perception of whispered speech.
Tuning tuning fork diagnostics demonstrates a decrease in air sound conductivity with normal or increased sound conductivity through tissues. To distinguish between cochlear neuritis and otospongiosis, ultrasound examinations are performed. Confirmation of the first assumption will be a decrease in the perception of ultrasound by two to three times and the invariability of this indicator during the otosclerotic process.
As an auxiliary method, acoustic impedance measurement is performed, which includes the methods of tympanometry (to determine the mobility of the auditory ossicles) and acoustic reflexometry (to assess the nature of the contraction of the intra-aural muscles).
Otosclerotic changes in bone tissue can be detected by the results of CT scan of the skull and targeted radiography, where computed tomography is considered a more informative method. Vestibular disorders can indirectly indicate otospongiosis, however, in 21% of cases, the disease proceeds without them.
Treatment with surgical and folk remedies
Surgical intervention is considered the main treatment strategy. However, with two forms of the otosclerotic process - cochlear and mixed - a supplement or alternative to surgery is hearing aid or the use of various hearing aids, with the help of which hearing defects are corrected in the later stages, when the operation is impossible for various reasons.
Surgical intervention
Surgery is considered appropriate after an examination that shows a decrease in bone and air conduction. However, if the otosclerotic process continues actively, despite the indicators of hearing loss, the operation is not prescribed.
Surgical intervention can take place according to three types of scenarios:
- Fenestration of the labyrinth presupposes the creation of a new "clean" window in the wall of the vestibule.
- Mobilization of the stapes describes the process of freeing the stapes from adhesions that impede the movement of the bone.
- Stapes prosthetics - stapedoplasty - is aimed at replacing the auditory bone with a titanium, ceramic, Teflon prosthesis, or a prosthesis from the patient's cartilage (bone). The first operation is performed on the side of the ear that hears worse. On the second ear, the operation is performed at least six months later, after the previous one.
The effectiveness of stapedoplasty is much higher than that of other techniques, the effect of which lasts for several years, after which a rapidly progressive hearing loss occurs. With stapedoplasty, 80% of patients experience a stable improvement in hearing. However, this surgical intervention does not stop the otosclerotic process either. In addition, a variety of complications are possible after the operation.
As a still experimental tactic for the treatment of otosclerosis without surgery, a conservative method of therapy using a combination of three components is considered: sodium fluoride, vitamin D3 and calcium preparations.
It is assumed that their joint influence should limit the expansion of foci by stopping the demeralization of the periphery of the affected area. Folk remedies for the treatment of otosclerosis are not considered as an alternative therapy by medicine, however, despite this, home therapists know how to treat otosclerosis. In this direction, tinctures, decoctions and self-massage techniques are popular,
improves blood circulation in the parotid regions and the back of the head.
Folk remedies
The self-massage technique involves the following five movements:
- With light pressure, knead the auricles and move from them to the back of the neck.
- In the reverse order, thoroughly rub the neck, lobes, auricle until a feeling of warmth.
- With the index fingers, simulate the screwing of a corkscrew along the line of the ear canal.
- Pull the auricles in different directions, pinching the peripheral areas with your fingers.
- Slowly smooth the ears with palms.
Recipes for the preparation of mixtures and decoctions for ingestion are common:
- Two tablespoons of a mixture of calendula, string, eucalyptus, licorice root and yarrow in a ratio of 4: 4: 3: 2: 2 are poured with 0.5 liters of boiling water and kept in a water bath for 30 minutes. It is drunk daily before meals for 1/3 cup. The course lasts 1 month.
- Angelica rhizomes at the rate of 20 grams per 0.5 liters are poured with boiling water and infused for about half an hour. It is taken three times a day before meals, 20 ml.
- Dill seeds at the rate of 20 grams per 0.5 liters are infused in boiling water. It is used when tinnitus is warm before meals in a volume of 100 ml.
- 30 drops of tincture of ginseng or schisandra chinensis are dissolved in 100 ml of water and drunk 30 minutes before meals.
Ear drop recipes include berries and herbs:
- lemon balm leaves in a ratio of 1: 6 are poured with alcohol, and after 2-3 days cotton swabs are soaked in this infusion and placed in the ears overnight,
- steamed ivan tea is applied to the ear for 20 minutes,
- mint juice is diluted with honey water and buried,
- drops of burdock juice, juniper berries are also buried.
