Otospongiosis and sodium fluoride. A blind experimental and clinical evaluation of the effect of sodium fluoride treatment in patients with otospongiosis

The effect of sodium fluoride treatment in patients with otospongiosis has been evaluated blindly in a morphological and microchemical element analysis of otospongiotic specimens together with a prospective clinical double-blind, placebo-controlled study. The results show that using the calcium/phosphorus ratio as an indication for bone maturity, the sodium fluoride treatment can stabilize otospongiotic lesions in retaining calcium relative to phosphorus. The clinical double-blind, placebo-controlled study of 95 patients showed a statistically significant worse deterioration of the hearing loss in the placebo group than in the active treated (40 mg sodium fluoride daily) group, supporting the view that sodium fluoride can change otospongiotic, active lesions to more dense, inactive otosclerotic lesions. We have postulated in the past that the actual mechanism of the cochlear loss is toxic enzymes produced by histiocytes at the periphery of the microfoci, and it may be that sodium fluoride has some effect on these enzymes.

CT densitometry of the cochlear capsule in otosclerosis

Cochlear otosclerosis can be recognized in most cases by high-definition axial and coronal CT images. However, routine technique does not allow a quantitative measurement of the changes. Reported here is a study of cochlear CT densitometry. The densitometric profile of the cochlear capsule was obtained in 10 ears with normal hearing and 50 ears in 27 patients with known clinical otosclerosis and progressive mixed-type hearing loss. Patients with hearing loss had decreased absorption of as much as 60% in comparison to the normal range. In 42 ears with abnormal densitometric profiles, the changes were visibly apparent on the CT images, whereas in eight others, the densitometric profile alone demonstrated decreased absorption.

Middle ear disease in samples from the general population. II. History of otitis and otorrhea in relation to tympanic membrane pathology. The study of men born in 1913 and 1923

A study of 1371 men 20, 30, 50 and 60 years old and living in the city of Göteborg was performed to obtain information on otitis media infections in the general population. In addition to anamnestic data, a thorough examination of the ENT status was made by one observer. In this second report a sizable proportion of the men reported a history of otitis or otorrhea but had normal tympanic membranes. However, overall there was a close correlation between a positive history of otitis and otorrhea, and findings of pathological tympanic membranes in all the age groups, and the longer the duration of the otitis with or without otorrhea, the more frequent were the pathological findings. Men with a history of both otitis and otorrhea of long duration had generally more serious pathological findings than men with otitis but no longterm otorrhea.

Gamma-carboxyglutamate in normal and pathological human middle ear bones

The presence of the amino acid gamma-carboxyglutamate (GLA) was established in human middle ear bones. Proteins containing GLA have been described as being associated with normal as well as pathological calcifications. The GLA content of human incus, malleus, and stapes with 1-2 nmol/mg bone is in the range previously reported for a variety of bone. A limited number of samples with middle ear pathology, including otosclerosis, did not show altered GLA levels.

Collagen fibres in otosclerosis and in osteogenesis imperfecta tarda. A light and electron microscopic study

Skin biopsies taken from patients with osteogenesis imperfecta tarda and otosclerosis were compared blind by light- and electron microscopy with similar biopsies taken from normal volunteers in an effort to find common pathological features in the collagen fibres from the two patient groups, thus corroborating the theory that osteogenesis imperfecta and otosclerosis might be due to a common genetic anomaly in the form of a mesenchymal hypoplasia. We were not able to find differences in structure or quantity of the collagen-, elastic- or reticular fibres between normals and the two patient groups. We cannot, on the basis of our previous work and on the present morphological investigation, give support to the above-mentioned theory.

Otosclerosis and Meniere's syndrome: diagnosis and treatment

Occasionally a patient with otosclerosis and a conductive hearing loss will develop typical findings of Meniere's syndrome in the involved ear, years later. A review of clinical and pathological studies in the literature and in our laboratory and clinic indicates a likely cause-and-effect relationship for these cases. The pathology and pathogenesis of the syndrome of otosclerosis and Meniere's syndrome is discussed. A stapedectomy/sacculotomy was used to treat 17 patients, 13 of whom acquired a satisfactory result in terms of improvement of hearing and control of vertigo. This technique and findings are described and discussed.

Otosclerosis in a black child: diagnostic acoustic impedance studies

Otosclerosis classically describes an osteodystrophic change in the bony labyrinth and stapes footplate, of autosomal dominant inheritance, reported rare under the age of 5, extremely "rare" in the Oriental and Black race, "non-existent" in the American Indian, and with a clinical incidence of 5 per 1000 Caucasians. The differential diagnosis of a non-effusion conductive hearing loss in a child should include otosclerosis, congenital malleus or footplate fixation, tympanosclerotic fixation, congenital cholesteatoma, lysis of the incus long process, Paget's disease, osteogenesis imperfecta, and fibromuscular hyperplasia of the renal artery. Presented is a case report of a 14-year-old black male with bilateral clinical otosclerosis and a persistent stapedial artery. Preoperative multiple-frequency tympanometry and Zwislocki acoustic reactance and resistance analysis demonstrated absence of the "W" resonance pattern on high-frequency tympanometry and the classic friction and stiffness patterns of otosclerotic fixation. Repeat multiple-frequency tympanometry testing post-stapedectomy demonstrated prosthesis articulation. Prosthesis position can be monitored postoperatively by these acoustic impedance studies.

Otosclerosis and endolymphatic hydrops

It has been postulated that otosclerosis may produce vertigo by several mechanisms. One mechanism is by causing endolymphatic hydrops. We present six temporal bones in which otosclerosis and endolymphatic hydrops coexist. We consider that there is a spectrum-like interrelationship between these two entities. At one end of the spectrum the relationship is coincidental, while at the other end of the spectrum we consider the massive amount of active otosclerosis to be a causative factor in the development of the endolymphatic hydrops.

Histological investigation of skin biopsies in otosclerosis and osteogenesis imperfecta

Histological investigation of skin biopsies in four patients with osteogenesis imperfecta, nine patients with otosclerosis and 13 sex- and age-matched normal controls was carried out blindly. The dermal thickness was markedly reduced in osteogenesis imperfecta and slightly reduced in otosclerosis. Minor degenerative changes in the elastic fibres were seen in otosclerosis, while the elastic fibres were found to be more degenerated and more numerous in osteogenesis imperfecta. Our study does not support the hypothesis of otosclerosis being a localized form of osteogenesis imperfecta. The minor changes in the elastic fibres in otosclerosis indicate that further studies of the elastic fibres and of collagen will be necessary to determine whether otosclerosis is a localized disease or part of a general connective tissue disorder.

Otosclerosis and otospongiosis: clinical and histological comparisons

The simultaneous occurrence of otosclerosis and otospongiosis in the same lesion is well documented. The logical sequence of events would seem to be softening and destruction of the bone by the otospongiotic lesion, which is subsequently converted to otosclerosis. Examination of 46 temporal bones has led us to further classify the lesion as: 1. an active lesion, both otospongiotic and otosclerotic, 2. an inactive lesion, also both otosclerotic and otospongiotic, or 3. a fibrous lesion. Hyalinization of the spiral ligament only occurs adjacent to active otospongiotic or very large otosclerotic lesions. If the lesion adjacent to the spiral ligament is inactive, there is no hyalinization. It seems illogical that a hyalinized spiral ligament will return to normal when the lesion changes from active otospongiosis to inactive otosclerosis. Otospongiotic and otosclerotic lesions are found side by side at the periphery of lesions, and both are adjacent to normal bone. These findings have implications concerning the mode of action of sodium fluoride and other medications that are under evaluation for the control of the sensorineural hearing loss due to otosclerosis.

Histomorphometric analysis of iliac trabecular bone in otosclerosis

With the aim of investigating whether patients with otosclerosis suffer from a generalized bone disorder, a histomorphometric analysis of trabecular bone from the iliac crest was performed. Iliac crest biopsies from 10 patients with otosclerosis and 20 normal controls were obtained after tetracycline double labelling and examined by histomorphometry. No significant differences were found in the estimates of density and remodeling of bone between patients and sex and age-matched normal controls. Qualitatively the bone specimens showed no signs of any generalized bone disorder.

Histologically proven cochlear otosclerosis with pure sensorineural hearing loss

This paper discusses cochlear otosclerosis without stapedial fixation as a cause of sensorineural hearing loss. Because many cases of cochlear otosclerosis may remain undiagnosed, we believe that patients with a progressive sensorineural hearing loss and a family history of cochlear otosclerosis should be suspected of having cochlear otosclerosis. A positive stapedial reflex on-off effect or polytomographic findings help make the diagnosis. We prescribe sodium fluoride, calcium, and vitamin D for these patients in an effort to prevent progression of the loss.

Central corneal thickness in osteogenesis imperfecta and otosclerosis

The central corneal thickness was measured in 53 patients with osteogenesis imperfecta. The average thickness was found to be 0.443 +/- 0.003 (SEM) mm. This value was significantly lower than the central corneal thickness in 35 patients with otosclerosis (0.515 +/- 0.004 mm) and in 35 sex- and age-matched normal control subjects (0.522 +/- 0.004 mm). No difference in corneal thickness between otosclerosis and controls was observed. Measurements of the central corneal thickness may be of great value in the diagnosis of osteogenesis imperfecta.

Microscopic characteristics of round window problems in otology

Round window membrane ruptures and perilymph leakage can present the complication or concomitant of sudden deafness and barotrauma. Pathological involvement of the round window membrane can occur in many otological diseases such as otosclerosis, otitis media, tumors, etc. Microscopic manipulations might result in an inadvertent round window membrane lesion and cochlear deafness. In recent years purposeful surgical lesions, including procedures for vertigo and cochlear implant surgery, are being made in the round window membrane. Examples of pathology involving the round window in human temporal bones are described. To understand better the clinical features of early round window rupture in humans,, controlled punctuate lesions were made in 36 chinchilla ears and studied sequentially. Round window membrane healing occurred as early as 3 days post-lesion, and was complete in all ears but 1 of the combined 7, 9 and 11-day group. Healing occurred primarily as a result of middle ear epithelial ingrowth and mesothelial cell reaction in the adjacent perilymphatic space of the scala tympani. These cellular events are described and discussed from an histological and clinical point of view.

Histopathology of the stapes in otosclerosis

A histopathological examination was made of 60 stapes obtained during surgery for clinical otosclerosis. The findings, correlated with the clinical history and macroscopic appearances of the stapes, led to the following observations. The histological extent of the focus of otosclerosis agrees well with the macroscopic appearance of the footplate lesion seen under the operating microscope. The earlier the age of onset of hearing loss the greater the probability of active, severe and diffuse otosclerotic involvement of the footplate. Two-thirds of the cases with diffuse and severe footplate otosclerosis had signs of active disease. A late age of onset of clinical otosclerosis tends to be associated with lesions that are limited to the anterior pole of the stapes footplate. Active otosclerosis is rare in these cases. The case for macroscopic increase in extent of the lesion with time could not be established by the data. The evidence supports the view that the severity and extent of otosclerotic disease in the footplate is determined more by age at onset than by duration of symptoms. Healing of the active focus of otosclerosis may not always occur despite a long duration of symptoms. A highly active focus in the stapes footplate can remain active for many years.

Histopathology of fenestration operation for otosclerosis

The author describes the histopathology of fenestration operation in five temporal bones of the Massachusetts Eye and Ear Infirmary collection. The four subjects underwent the intervention more than 18 years before their death. One of the patients was operated bilaterally by Lempert himself in 1950. Special attention is given to the effect on hearing results of the otosclerotic disease; the condition of the middle ear, mastoidectomy cavity, and fenestra; and the lateral and posterior membranous semicircular canals. Also the patency of the three fenestrae (the oval, the round, and the new fenestra) in respect to the resulting hearing function, is considered.

Otosclerotic lesions in the inbred LP/J mouse

Inbred LP/J mice develop abnormal bony lesions that are grossly and histologically similar to the lesions of human otosclerosis. This is the first known occurrence of spontaneous otosclerosis-like lesions in an animal. As in the human disease, these lesions impair audition by immobilizing the ossicles of the middle ear. The LP/J mouse may be an animal model for this common human disease.

The natural history of otosclerosis. A correlation of the volume and activity of the otosclerotic lesion with age

Two-hundred and fifty years after Valsalva's discovery that fixation of the stapes could be a cause of deafness, there is still a lack of knowledge about the etiology and pathogenesis of otosclerosis. The purpose of this study was to obtain more information about the natural history of this disease by correlating the volumes and activity of otosclerotic lesions within the temporal bone to the patient's age and sex. Fifty temporal bones from 33 patients (19 females and 14 males) with otosclerotic lesions were reviewed microscopically. The degrees of activity of these foci were assessed and, using a computer based technique known as "digitizing", the volumes of each otosclerotic lesion were calculated. The results of this study indicate that there is no statistical difference in volumes between males and females. From the results obtained, it is suggested that there appear to be two growth patterns of the otosclerotic lesion: one pattern grows for a very short period and then becomes dormant or inactive. The other type of otosclerosis shows a continuing growth and progression throughout life.

Pregnancy and otosclerosis

A retrospective study has been made of a sample of 479 women with deafness from otosclerosis, classified according to the number of pregnancies they have had and whether there had been a subjective impression of deterioration of hearing during or immediately after at least 1 pregnancy. The study confirms previous reports that pregnancy does involve a risk of aggravating deafness in clinical otosclerosis. The chance of female patients with bilateral otosclerosis reporting a subjective deterioration of hearing in pregnancy can be accurately described by a simple mathematical model and varies from about 33% after 1 pregnancy to about 63% after 6 pregnancies. In women with unilateral otosclerosis pregnancy-related deterioration of hearing is much less commonly perceived. There is no strong evidence that pregnancies cause any alteration to the actual footplate pathology of female patients.

Otosclerosis: relationship of spiral ligament hyalinization to sensorineural hearing loss

The sensorineural component of a mixed hearing loss due to otosclerosis is generally accepted as due to the otosclerotic lesion. The existence of pure cochlear otosclerosis without stapes fixation has been questioned. However, we are documenting 7 such cases in a separate publication. Results of this study, which evaluates 46 temporal bones with clinical or cochlear otosclerosis, demonstrate that the degree of sensorineural loss is directly related to the amount of hyalinization of the spiral ligament. The hyalinization occurs adjacent to active otospongiotic lesions but not next to inactive otosclerotic lesions. Both types of lesions may involve the cochlear endosteum. Small channels through the endosteal bone from the lesion to the spiral ligament have been found. The hyalinization spreads laterally from these channels. The hyalinization is presumably a result of the passage of toxic substances (proteolytic enzymes) from the lesion to the ligament. Strial atrophy is most pronounced on ligaments with the greatest degree of hyalinization. Hyalinization in only one ear produces decreased hearing compared to the other ear.

The effect of stapedectomy on hearing of patients with otosclerosis and Meniere's disease

To determine new guidelines for stapedectomy in patients with both Meniere's disease and otosclerosis, we studied the position of the saccular membrane and Reissner's membrane in relation to the stapes footplate in eight temporal bones from patients with Meniere's disease. We also reviewed charts of four patients with both otosclerosis and Meniere's disease who had stapedectomy. Histologic and clinical findings were compared with preoperative bone conduction levels at 500 Hz and at high frequencies. We found that the saccular and Reissner's membranes did not contact the stapes footplate ain bones of patients with preoperative bone conduction levels of 35 dB or better at 500 Hz and no high-frequency loss. We also found that stapedectomy was successful in patients with the same criteria. We therefore conclude that stapedectomy does not increase the risk of sensorineural hearing loss for patients with otosclerosis and Meniere's disease who have bone conduction levels of 35 dB o better at 500 Hz and no high-tone loss, but it is contraindicated for patients with 45 dB at 500 Hz or worse and with high-tone loss.