introduction examination aetiology pathology … lectures/ent/otosclerosis.pdfpathology hereditary...
TRANSCRIPT
![Page 1: Introduction Examination Aetiology Pathology … lectures/ENT/Otosclerosis.pdfPathology Hereditary disease Disease of otic capsule Phases of bone resorption & bone formation Removal](https://reader031.vdocument.in/reader031/viewer/2022040523/5e873768fac5144f874f1b5b/html5/thumbnails/1.jpg)
Otosclerosis
Introduction Aetiology Pathology Clinical Picture
Examination Audiological Tests Differential Diagnosis Treatment
![Page 2: Introduction Examination Aetiology Pathology … lectures/ENT/Otosclerosis.pdfPathology Hereditary disease Disease of otic capsule Phases of bone resorption & bone formation Removal](https://reader031.vdocument.in/reader031/viewer/2022040523/5e873768fac5144f874f1b5b/html5/thumbnails/2.jpg)
Otosclerosis
Oto, sclerosis Mature lamellar bone is replaced by
unorganized spongy bone of greater thickness and vascularity
Common disease, 1: 200Frequently in fair femalesProgressive hearing lossFamilial tendency
![Page 3: Introduction Examination Aetiology Pathology … lectures/ENT/Otosclerosis.pdfPathology Hereditary disease Disease of otic capsule Phases of bone resorption & bone formation Removal](https://reader031.vdocument.in/reader031/viewer/2022040523/5e873768fac5144f874f1b5b/html5/thumbnails/3.jpg)
Aetiology Unknown aetiology Disorder affecting growth of collagen Many theories:-
Genetic RaceSex Age of onsetPregnancy InfectionImmune disorder TraumaMetabolic VascularAnat./Histological abn of temporal bone
![Page 4: Introduction Examination Aetiology Pathology … lectures/ENT/Otosclerosis.pdfPathology Hereditary disease Disease of otic capsule Phases of bone resorption & bone formation Removal](https://reader031.vdocument.in/reader031/viewer/2022040523/5e873768fac5144f874f1b5b/html5/thumbnails/4.jpg)
Pathology Hereditary disease Disease of otic capsule Phases of bone resorption & bone
formation Removal of mature bone by osteoclasts Replacement by woven bone of more
cellularity, vascularity and thickness
![Page 5: Introduction Examination Aetiology Pathology … lectures/ENT/Otosclerosis.pdfPathology Hereditary disease Disease of otic capsule Phases of bone resorption & bone formation Removal](https://reader031.vdocument.in/reader031/viewer/2022040523/5e873768fac5144f874f1b5b/html5/thumbnails/5.jpg)
SITES
Any part of temporal bone
Fistula ante fenestrum Fistula Post fenestrum Oval window
Round window Promontory Cochlea B/L sym. Affection
![Page 6: Introduction Examination Aetiology Pathology … lectures/ENT/Otosclerosis.pdfPathology Hereditary disease Disease of otic capsule Phases of bone resorption & bone formation Removal](https://reader031.vdocument.in/reader031/viewer/2022040523/5e873768fac5144f874f1b5b/html5/thumbnails/6.jpg)
![Page 7: Introduction Examination Aetiology Pathology … lectures/ENT/Otosclerosis.pdfPathology Hereditary disease Disease of otic capsule Phases of bone resorption & bone formation Removal](https://reader031.vdocument.in/reader031/viewer/2022040523/5e873768fac5144f874f1b5b/html5/thumbnails/7.jpg)
![Page 8: Introduction Examination Aetiology Pathology … lectures/ENT/Otosclerosis.pdfPathology Hereditary disease Disease of otic capsule Phases of bone resorption & bone formation Removal](https://reader031.vdocument.in/reader031/viewer/2022040523/5e873768fac5144f874f1b5b/html5/thumbnails/8.jpg)
![Page 9: Introduction Examination Aetiology Pathology … lectures/ENT/Otosclerosis.pdfPathology Hereditary disease Disease of otic capsule Phases of bone resorption & bone formation Removal](https://reader031.vdocument.in/reader031/viewer/2022040523/5e873768fac5144f874f1b5b/html5/thumbnails/9.jpg)
![Page 10: Introduction Examination Aetiology Pathology … lectures/ENT/Otosclerosis.pdfPathology Hereditary disease Disease of otic capsule Phases of bone resorption & bone formation Removal](https://reader031.vdocument.in/reader031/viewer/2022040523/5e873768fac5144f874f1b5b/html5/thumbnails/10.jpg)
Physiologic Effect
Before After
![Page 11: Introduction Examination Aetiology Pathology … lectures/ENT/Otosclerosis.pdfPathology Hereditary disease Disease of otic capsule Phases of bone resorption & bone formation Removal](https://reader031.vdocument.in/reader031/viewer/2022040523/5e873768fac5144f874f1b5b/html5/thumbnails/11.jpg)
SymptomsDeafness TinnitusParacusis willisi Family history Low modulated voice Vertigo
![Page 12: Introduction Examination Aetiology Pathology … lectures/ENT/Otosclerosis.pdfPathology Hereditary disease Disease of otic capsule Phases of bone resorption & bone formation Removal](https://reader031.vdocument.in/reader031/viewer/2022040523/5e873768fac5144f874f1b5b/html5/thumbnails/12.jpg)
Examination
External Ear Examination - Normal Tympanic Membrane normal Flemingo pink blush Eustachian Tube patent Blue sclera & fragile bone as part of Von-
der Hoeve syndrome
![Page 13: Introduction Examination Aetiology Pathology … lectures/ENT/Otosclerosis.pdfPathology Hereditary disease Disease of otic capsule Phases of bone resorption & bone formation Removal](https://reader031.vdocument.in/reader031/viewer/2022040523/5e873768fac5144f874f1b5b/html5/thumbnails/13.jpg)
![Page 14: Introduction Examination Aetiology Pathology … lectures/ENT/Otosclerosis.pdfPathology Hereditary disease Disease of otic capsule Phases of bone resorption & bone formation Removal](https://reader031.vdocument.in/reader031/viewer/2022040523/5e873768fac5144f874f1b5b/html5/thumbnails/14.jpg)
Tuning Fork test
Rinne’s test Negative
Weber test Lateralized to deafer ear
ABC Normal
![Page 15: Introduction Examination Aetiology Pathology … lectures/ENT/Otosclerosis.pdfPathology Hereditary disease Disease of otic capsule Phases of bone resorption & bone formation Removal](https://reader031.vdocument.in/reader031/viewer/2022040523/5e873768fac5144f874f1b5b/html5/thumbnails/15.jpg)
![Page 16: Introduction Examination Aetiology Pathology … lectures/ENT/Otosclerosis.pdfPathology Hereditary disease Disease of otic capsule Phases of bone resorption & bone formation Removal](https://reader031.vdocument.in/reader031/viewer/2022040523/5e873768fac5144f874f1b5b/html5/thumbnails/16.jpg)
Audiological test
Pure tone audiometeryConductive loss dip at 2KMixed lossSensory loss
![Page 17: Introduction Examination Aetiology Pathology … lectures/ENT/Otosclerosis.pdfPathology Hereditary disease Disease of otic capsule Phases of bone resorption & bone formation Removal](https://reader031.vdocument.in/reader031/viewer/2022040523/5e873768fac5144f874f1b5b/html5/thumbnails/17.jpg)
Conductive Deafness
![Page 18: Introduction Examination Aetiology Pathology … lectures/ENT/Otosclerosis.pdfPathology Hereditary disease Disease of otic capsule Phases of bone resorption & bone formation Removal](https://reader031.vdocument.in/reader031/viewer/2022040523/5e873768fac5144f874f1b5b/html5/thumbnails/18.jpg)
Mixed Deafness
![Page 19: Introduction Examination Aetiology Pathology … lectures/ENT/Otosclerosis.pdfPathology Hereditary disease Disease of otic capsule Phases of bone resorption & bone formation Removal](https://reader031.vdocument.in/reader031/viewer/2022040523/5e873768fac5144f874f1b5b/html5/thumbnails/19.jpg)
Sensori-neural Deafness
![Page 20: Introduction Examination Aetiology Pathology … lectures/ENT/Otosclerosis.pdfPathology Hereditary disease Disease of otic capsule Phases of bone resorption & bone formation Removal](https://reader031.vdocument.in/reader031/viewer/2022040523/5e873768fac5144f874f1b5b/html5/thumbnails/20.jpg)
Impedance AudiometryHelps to diff. from other causes of
conductive lossType As curveType “B” curve in SOMType “C” In E. T. catarrhType “Ad” in Ossicular discontinuity
![Page 21: Introduction Examination Aetiology Pathology … lectures/ENT/Otosclerosis.pdfPathology Hereditary disease Disease of otic capsule Phases of bone resorption & bone formation Removal](https://reader031.vdocument.in/reader031/viewer/2022040523/5e873768fac5144f874f1b5b/html5/thumbnails/21.jpg)
Normal Impedance
![Page 22: Introduction Examination Aetiology Pathology … lectures/ENT/Otosclerosis.pdfPathology Hereditary disease Disease of otic capsule Phases of bone resorption & bone formation Removal](https://reader031.vdocument.in/reader031/viewer/2022040523/5e873768fac5144f874f1b5b/html5/thumbnails/22.jpg)
Ossicular Discontinuity
![Page 23: Introduction Examination Aetiology Pathology … lectures/ENT/Otosclerosis.pdfPathology Hereditary disease Disease of otic capsule Phases of bone resorption & bone formation Removal](https://reader031.vdocument.in/reader031/viewer/2022040523/5e873768fac5144f874f1b5b/html5/thumbnails/23.jpg)
“As” Curve
![Page 24: Introduction Examination Aetiology Pathology … lectures/ENT/Otosclerosis.pdfPathology Hereditary disease Disease of otic capsule Phases of bone resorption & bone formation Removal](https://reader031.vdocument.in/reader031/viewer/2022040523/5e873768fac5144f874f1b5b/html5/thumbnails/24.jpg)
Differential Diagnosis
Otitis media with effusion Ossicular discontinuity Adhesive ottitis media Cong. Footplate fixation
Tympanosclerosis Cong. Cholesteatoma CSOM Vender Hoeve syndrome
![Page 25: Introduction Examination Aetiology Pathology … lectures/ENT/Otosclerosis.pdfPathology Hereditary disease Disease of otic capsule Phases of bone resorption & bone formation Removal](https://reader031.vdocument.in/reader031/viewer/2022040523/5e873768fac5144f874f1b5b/html5/thumbnails/25.jpg)
Treatment
Medical treatmentSurgical treatmentHearing rehabilitation
![Page 26: Introduction Examination Aetiology Pathology … lectures/ENT/Otosclerosis.pdfPathology Hereditary disease Disease of otic capsule Phases of bone resorption & bone formation Removal](https://reader031.vdocument.in/reader031/viewer/2022040523/5e873768fac5144f874f1b5b/html5/thumbnails/26.jpg)
Medical Treatment
Sodium flouride50mg-75 mg daily x 2 yrs
Decreases osteoclastic activity Increases osteoblastic bone formation
![Page 27: Introduction Examination Aetiology Pathology … lectures/ENT/Otosclerosis.pdfPathology Hereditary disease Disease of otic capsule Phases of bone resorption & bone formation Removal](https://reader031.vdocument.in/reader031/viewer/2022040523/5e873768fac5144f874f1b5b/html5/thumbnails/27.jpg)
Indications Positive Schwartz sign Progressive SN loss with surgically confirmed otosclerosis SN loss with positive family history Positive Radiological Evidence
Contra indication Chronic Nephritis Rheumatoid arthritis Pregnant & lactating mother Age < 18 yrs Allergy to Sod. Fluoride Skeltal flourosis Peptic ulcer
![Page 28: Introduction Examination Aetiology Pathology … lectures/ENT/Otosclerosis.pdfPathology Hereditary disease Disease of otic capsule Phases of bone resorption & bone formation Removal](https://reader031.vdocument.in/reader031/viewer/2022040523/5e873768fac5144f874f1b5b/html5/thumbnails/28.jpg)
Surgical Treatment
FenestrationStapes mobilisationStapedectomyStapedotomy
![Page 29: Introduction Examination Aetiology Pathology … lectures/ENT/Otosclerosis.pdfPathology Hereditary disease Disease of otic capsule Phases of bone resorption & bone formation Removal](https://reader031.vdocument.in/reader031/viewer/2022040523/5e873768fac5144f874f1b5b/html5/thumbnails/29.jpg)
Criteria for Stapedectomy
Conductive loss not < 30dbGood cochlear reserve Good speech discriminationConductive loss not > 60 db
![Page 30: Introduction Examination Aetiology Pathology … lectures/ENT/Otosclerosis.pdfPathology Hereditary disease Disease of otic capsule Phases of bone resorption & bone formation Removal](https://reader031.vdocument.in/reader031/viewer/2022040523/5e873768fac5144f874f1b5b/html5/thumbnails/30.jpg)
Indications for Stapedectomy
Otosclerosis Tympanosclerosis Paget’s disease Congenital foot plate fixation
![Page 31: Introduction Examination Aetiology Pathology … lectures/ENT/Otosclerosis.pdfPathology Hereditary disease Disease of otic capsule Phases of bone resorption & bone formation Removal](https://reader031.vdocument.in/reader031/viewer/2022040523/5e873768fac5144f874f1b5b/html5/thumbnails/31.jpg)
Contra indications
Active diseasePregnancyPoor cochlear reserveOnly hearing earGeneral medical diseaseVertigo
![Page 32: Introduction Examination Aetiology Pathology … lectures/ENT/Otosclerosis.pdfPathology Hereditary disease Disease of otic capsule Phases of bone resorption & bone formation Removal](https://reader031.vdocument.in/reader031/viewer/2022040523/5e873768fac5144f874f1b5b/html5/thumbnails/32.jpg)
Procedure
Local Infiltration
![Page 33: Introduction Examination Aetiology Pathology … lectures/ENT/Otosclerosis.pdfPathology Hereditary disease Disease of otic capsule Phases of bone resorption & bone formation Removal](https://reader031.vdocument.in/reader031/viewer/2022040523/5e873768fac5144f874f1b5b/html5/thumbnails/33.jpg)
INCISION
![Page 34: Introduction Examination Aetiology Pathology … lectures/ENT/Otosclerosis.pdfPathology Hereditary disease Disease of otic capsule Phases of bone resorption & bone formation Removal](https://reader031.vdocument.in/reader031/viewer/2022040523/5e873768fac5144f874f1b5b/html5/thumbnails/34.jpg)
Flap elevation
![Page 35: Introduction Examination Aetiology Pathology … lectures/ENT/Otosclerosis.pdfPathology Hereditary disease Disease of otic capsule Phases of bone resorption & bone formation Removal](https://reader031.vdocument.in/reader031/viewer/2022040523/5e873768fac5144f874f1b5b/html5/thumbnails/35.jpg)
Lifting Annulus
![Page 36: Introduction Examination Aetiology Pathology … lectures/ENT/Otosclerosis.pdfPathology Hereditary disease Disease of otic capsule Phases of bone resorption & bone formation Removal](https://reader031.vdocument.in/reader031/viewer/2022040523/5e873768fac5144f874f1b5b/html5/thumbnails/36.jpg)
Exposure of Stapes
![Page 37: Introduction Examination Aetiology Pathology … lectures/ENT/Otosclerosis.pdfPathology Hereditary disease Disease of otic capsule Phases of bone resorption & bone formation Removal](https://reader031.vdocument.in/reader031/viewer/2022040523/5e873768fac5144f874f1b5b/html5/thumbnails/37.jpg)
![Page 38: Introduction Examination Aetiology Pathology … lectures/ENT/Otosclerosis.pdfPathology Hereditary disease Disease of otic capsule Phases of bone resorption & bone formation Removal](https://reader031.vdocument.in/reader031/viewer/2022040523/5e873768fac5144f874f1b5b/html5/thumbnails/38.jpg)
Stapedial Tenotomy
![Page 39: Introduction Examination Aetiology Pathology … lectures/ENT/Otosclerosis.pdfPathology Hereditary disease Disease of otic capsule Phases of bone resorption & bone formation Removal](https://reader031.vdocument.in/reader031/viewer/2022040523/5e873768fac5144f874f1b5b/html5/thumbnails/39.jpg)
Supra structure Removal
![Page 40: Introduction Examination Aetiology Pathology … lectures/ENT/Otosclerosis.pdfPathology Hereditary disease Disease of otic capsule Phases of bone resorption & bone formation Removal](https://reader031.vdocument.in/reader031/viewer/2022040523/5e873768fac5144f874f1b5b/html5/thumbnails/40.jpg)
![Page 41: Introduction Examination Aetiology Pathology … lectures/ENT/Otosclerosis.pdfPathology Hereditary disease Disease of otic capsule Phases of bone resorption & bone formation Removal](https://reader031.vdocument.in/reader031/viewer/2022040523/5e873768fac5144f874f1b5b/html5/thumbnails/41.jpg)
![Page 42: Introduction Examination Aetiology Pathology … lectures/ENT/Otosclerosis.pdfPathology Hereditary disease Disease of otic capsule Phases of bone resorption & bone formation Removal](https://reader031.vdocument.in/reader031/viewer/2022040523/5e873768fac5144f874f1b5b/html5/thumbnails/42.jpg)
Piston in Place
![Page 43: Introduction Examination Aetiology Pathology … lectures/ENT/Otosclerosis.pdfPathology Hereditary disease Disease of otic capsule Phases of bone resorption & bone formation Removal](https://reader031.vdocument.in/reader031/viewer/2022040523/5e873768fac5144f874f1b5b/html5/thumbnails/43.jpg)
Stapedotomy
![Page 44: Introduction Examination Aetiology Pathology … lectures/ENT/Otosclerosis.pdfPathology Hereditary disease Disease of otic capsule Phases of bone resorption & bone formation Removal](https://reader031.vdocument.in/reader031/viewer/2022040523/5e873768fac5144f874f1b5b/html5/thumbnails/44.jpg)
Sound Conduction After Surgery
![Page 45: Introduction Examination Aetiology Pathology … lectures/ENT/Otosclerosis.pdfPathology Hereditary disease Disease of otic capsule Phases of bone resorption & bone formation Removal](https://reader031.vdocument.in/reader031/viewer/2022040523/5e873768fac5144f874f1b5b/html5/thumbnails/45.jpg)
Post op Advise Not to blow nose forcefully Not to sneeze with closed mouth Avoid loud noises Not to climb mountains, Not to board non
pressurized aircraft. Report to Surgeon for Vertigo/Decreased
hearing Diving when swimming Lifting heavy weights
![Page 46: Introduction Examination Aetiology Pathology … lectures/ENT/Otosclerosis.pdfPathology Hereditary disease Disease of otic capsule Phases of bone resorption & bone formation Removal](https://reader031.vdocument.in/reader031/viewer/2022040523/5e873768fac5144f874f1b5b/html5/thumbnails/46.jpg)
Hearing rehabilitation
Hearing Aids Pocket ModelBTE ITC