上海交通大学耳鼻咽喉科学英文版课件 otosclerosis.ppt

* Otosclerosis Otosclerosis Symptoms Slowly progressive hearing loss ipsilateral or bilateral Tinnitus in 75% Vestibular complaints 25% Histopathology lytic phase Increased osteoclastic activity results in perivascular bony resorption forming fibrotic spaces bone production phase osteoblasts within the fibrotic spaces producing immature bone remodeling phase cycling of resorption and bone formation results in otosclerotic bone Histopathology Epidemiology Hereditary in 70% of cases Autosomal dominant Incomplete penetrance 7-10% Caucasian temporal bones 1% Caucasians with symptoms Other races lesser incidence History 1704 Valsalva autopsy 1894 Politzer “otosclerosis” 1930s Lempert horizontal canal fenestration 1953 Rosen stapes mobilization 1955 Shea stapedectomy stapedotomy Diagnosis History Physical examination Audiogram Imaging Surgical exploration Physical examination Otomicroscopy normal Schwartze’s sign Tuning forks Differential diagnosis Tympanosclerosis OME incus/malleus fixation ossicular discontinuity congenital footplate fixation Systemic diseases Osteogenesis imperfecta stapes fixation blue sclera fractures Pagets disease crowding in epitympanum elevated alk phos skeletal bone involvement Differential diagnosis Imaging Multidirectional tomography CT MRI Audiology Tympanometry Acoustic Reflexes Pure tone audiogram Speech discrimination Tympanogram Normal type A Shallow type As Acoustic Reflexes Very sensitive precedes hearing loss “On-Off” phenomenon Pure tone audio Management Amplification Refuse surgery Poor surgical candidate Medical therapy Sodium fluoride Vitamin D Calcium carbonate Stapes surgery Stapes surgery Total Stapedectomy Partial Stapedectomy Anterior crurotomy Stapedotomy Thanks！