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Question answered:24/03/06 Warning! this question is over two years old.
Using TRIP, we were unable to find clinical guidelines for management of a patient with otosclerosis. We found two e-textbook entries, one of which is GP Notebook (1) which says of therapy:
“Treatment of otosclerosis is not essential, especially when hearing loss is unilateral and minor.
Hearing aids and lip-reading are of great benefit to patients with conductive deafness especially those with normal inner ear function. There are none of the risks of surgery, so in general, patients are encouraged to try a hearing aid before undergoing surgery.
Surgery involves a stapedectomy. The tympanic membrane is lifted to expose the middle ear. The stapes is then removed and replaced with a plastic prosthesis.
Stapedectomy produces dramatic improvement in 90% of cases.
However, there is a 2% chance of a deaf ear and balance problems, and these risks must be explained to the patient.”
While there appear to be no references attached to support this section, the figure of improvement with surgery is similar to a patient leaflet on otosclerosis by ENT UK, the British Association of Otorhinolaryngologists - Head & Neck Surgeons, which says of stapedotomy(2):
“The chances of obtaining a good result from this operation by experienced surgeons are over 80%”
The figure of a 2% risk of hearing loss after surgery also occurs in the eMedicine textbook for “Middle ear otosclerosis” (3), which may be worth reading as it has a section on treatment including surgery. It also mentions medical therapy including use of fluoride, but we were unable to find evidence that this is currently recommended by using Medline.
References
1. GP Notebook. “Otosclerosis: treatment”.
(http://www.gpnotebook.co.uk/simplepage.cfm?ID=2013659155&linkID=25408&cook=yes)
2. ENT UK. Patient leaflet: ‘Otosclerosis and stapedotomy’ (undated).
(http://www.entuk.org/patient_info/downloads/otosclerosis.pdf)
3. eMedicine. “Middle ear otosclerosis”, last updated Oct 04.
(http://www.emedicine.com/ent/topic218.htm#top)
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