Calcification of Ear Bones (Otosclerosis)

What is otoclerosis?
Otosclerosis disease can be defined as a decrease in mobility as a result of calcification that occurs at the junction of the stirrup with the inner ear, called the oval window. Depending on the degree of this calcification, hearing loss occurs in the patient because the sounds coming to the ear cannot be transmitted to the inner ear properly. This hearing loss is progressive, usually conductive, but to a lesser extent neurologic or a mixed type of both. In addition to hearing loss, tinnitus, dizziness and imbalance complaints may accompany the patient.

What is the cause of otosclerosis?
The cause of this disease is not known exactly, but it has been shown that it can be genetically transmitted. There is a family history of this disease in approximately 60% of the cases. Measles virus infections have been shown to trigger the disease. It has been reported that some hormonal factors may play a role and the progression of this disease accelerates in pregnant women. Women are affected by this disease about 2 times more often than men. The disease occurs, on average, between the ages of 15-45. Onset before age ten and after age 45 is rare.

How Otosclerosis Causes Hearing Loss?
In otosclerosis patients, new bone formation often settles at the base of the stapes (stirrup) ossicle, preventing it from moving and causing loss of sound transmission to the inner ear. In this case, the patient develops conductive hearing loss.

What Are the Symptoms of Otosclerosis?
In most patients, the complaint is unilateral or bilateral hearing loss. The loss develops slowly and the patient finds that at first he cannot hear only soft sounds (such as whispers). Some of the patients state that they can hear conversations better in noisy environments. The second most common complaint is tinnitus in the diseased ear.

How Is Otosclerosis Diagnosed?
In the examination of the patient by an otolaryngologist, the eardrums are usually normal. An examination instrument called tuning fork or hearing measurements made in sound-insulated cabinets with special devices called audiometry help to establish the diagnosis. With the result of hearing measurement called audiogram, it is also evaluated whether the disease has reached the stage that will be corrected by surgery.

How is otosclerosis treated?
There are 3 main treatments for this disease. These are rehabilitation with hearing aids, drug therapy and surgical treatment;
Hearing aids can be used in patients who do not want to have surgery or whose hearing loss is not suitable for surgery. These patients can benefit from the hearing aid very efficiently.
Drug therapy can be used mostly to reduce the rate of progression of the disease. The most commonly used drug here is sodium fluoride. In addition, vitamin D and calcium carbonate can also be used.
Surgical treatment is an operation called 'stapedotomy'. Although this surgery can be performed under local anesthesia, the more common and my preference is to perform the surgery under general anesthesia. Here, under the microscope, an incision is made from the external ear canal or the notch of the cartilage in front of the outer ear canal, and the eardrum is lifted. First of all, the movement of the ossicular chain is checked and it is confirmed that the problem is caused by calcification at the base of the stirrup. The stirrup is then separated from the anvil, the upper part of this ossicle is removed, and a hole is drilled in its base, where it articulates with the inner ear. This hole can be opened with a surgical instrument or using a laser. A prosthesis that will do the work of the stirrup is inserted into the anvil and placed in this hole. For this purpose, various prostheses made of many different materials can be used. At this point, it is important that the surgeon uses the type of prosthesis that he feels most comfortable with. Thus, the integrity and mobility of the ossicular chain is ensured, and the sounds are transmitted to the inner ear properly. The eardrum is placed in place, and medical sponges that dissolve into the ear canal are placed. Some precautions are taken after the operation. The patient is allowed to lie down with his head slightly elevated, sneezing medications if he has allergies, and anti-constipation medications if he has constipation can be counted among the measures to be taken to prevent the piston from displacing with pressure during the recovery process. The patient can be given drops to use on the dissolving sponges after the surgery and it is confirmed that the eardrum has healed in a healthy way in the control examinations.

What is the Post-Surgery Course?
Post-operative dizziness is common and may last for 7-10 days, gradually decreasing. Sometimes nausea and vomiting also accompany the dizziness. Pain is rare and mild. In the first days, the patient may need support from relatives while walking, driving should generally be considered after the 2nd week and after the complete recovery of the dizziness caused by head movements. Patients are advised not to do heavy physical work for 2 months, not to lift heavy loads, not to strain, not to take planes or land trips where they will be exposed to pressure changes. If the surgery is performed with local anesthesia, the patient will notice the improvement in hearing at that time. When the surgery is completed and the ear canal is closed, hearing decreases again and returns to its pre-operative state. After a while, hearing will gradually improve, but full recovery may take up to 2 months. During this 2-month period, the patient may hear crackling-like sounds in the ear, and the sounds may be perceived as metallic, as if they are coming from a broken speaker. Discomfort from loud noises is one of the complaints frequently expressed by patients in the first weeks. Most patients can return to work after 7-10 days.

What Are the Risks of the Surgery?
Taste changes on the operated ear side of the tongue, non-improvement of hearing, hole formation in the eardrum, worsening or even complete loss of hearing in the operated ear, facial paralysis (almost always temporary), inflammation in the middle ear can be counted.

As a result;
As you can see, the surgery of the stirrup, which is the smallest bone in the body, is definitely not a 'small' surgery! It is a microsurgery that requires extreme delicacy and experience. If the surgery is successful, very satisfactory results can be obtained in terms of hearing.