1
|
Gogoulos PP, Sideris G, Nikolopoulos T, Sevastatou EK, Korres G, Delides A. Conservative Otosclerosis Treatment With Sodium Fluoride and Other Modern Formulations: A Systematic Review. Cureus 2023; 15:e34850. [PMID: 36923175 PMCID: PMC10008770 DOI: 10.7759/cureus.34850] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/10/2023] [Indexed: 02/13/2023] Open
Abstract
Otosclerosis, also known as otospongiosis, is a primary osteodystrophy of the otic capsule of the inner ear and one of the leading causes of deafness in adults. The rationale for medical therapy for otospongiosis is to slow down and eventually stop the phase of bone resorption. Conservative treatments include sodium fluoride (NaF), bisphosphonates, and other modern medicines. A systematic review of the existing and published articles and books until April 2021 has been conducted in Medscape, Google Scholar, PubMed, and other databases using appropriate terms. According to the results of the research, the administration of NaF for a period of at least six months stabilizes hearing thresholds (HTs), improves vestibular symptoms, and delays the worsening of tinnitus. The administration of bisphosphonates for a period of at least six months showed significant percentage differences in the improvement of hearing loss, dizziness, and tinnitus remission. In the already existing double-blind studies that were evaluated, groups of patients treated with bisphosphonates for at least 24 months showed greater stabilization of the mean air and bone conduction thresholds than groups of patients treated with a placebo. The new modern medications have not yet been widely administered clinically to draw useful conclusions, although the test results of some of their use are quite encouraging.
Collapse
Affiliation(s)
- Panagiotis P Gogoulos
- Second Ear, Nose, and Throat (ENT) Department, Attikon University Hospital, National and Kapodistrian University of Athens, Athens, GRC
| | - Giorgos Sideris
- Second Ear, Nose, and Throat (ENT) Department, Attikon University Hospital, National and Kapodistrian University of Athens, Athens, GRC
| | - Thomas Nikolopoulos
- Second Ear, Nose, and Throat (ENT) Department, Attikon University Hospital, National and Kapodistrian University of Athens, Athens, GRC
| | | | - George Korres
- Second Ear, Nose, and Throat (ENT) Department, Attikon University Hospital, National and Kapodistrian University of Athens, Athens, GRC
| | - Alexander Delides
- Second Ear, Nose, and Throat (ENT) Department, Attikon University Hospital, National and Kapodistrian University of Athens, Athens, GRC
| |
Collapse
|
2
|
A Systematic Review of the Effectiveness of Bisphosphonates for Otosclerosis. Otol Neurotol 2022; 43:530-537. [PMID: 35213475 DOI: 10.1097/mao.0000000000003510] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To systematically review the evidence for the use of bisphosphonate therapy in otosclerosis through clinically relevant outcomes. DATABASES REVIEWED MEDLINE, EMBASE, PubMed, and CINAHL databases were searched up to July 12, 2021. METHODS RCTs and cohort studies investigating the effect of bisphosphate therapy on adults or children diagnosed with otosclerosis were included. The risk of bias within trials was examined using the ROB2 tool for RCTs, and the ROBINS-I for non-RCTs. RESULTS Three studies reported over five publications were included in the systematic review. Data from one RCT at 6 months did not demonstrate any improvement nor deterioration in audiological outcomes in participants treated with Sodium Alendronate. Data from MRI in this group demonstrated improvements in the SI of the otosclerotic foci at the RAOW compared to participants taking placebo. In another RCT, improvements in audiological outcomes were seen at 12 and 24 months in individuals treated with Etidronate Sodium. Long-term data from a retrospective cohort study demonstrated stabilisation of hearing in individuals with otosclerosis and progressive SNHL. CONCLUSION There is insufficient evidence to recommend the routine use of bisphosphonates in otosclerosis patients at present. Long-term retrospective data has suggested a role for bisphosphonates in the subset of patients with deteriorating sensorineural hearing loss with the aim of hearing stabilisation. Adequately powered RCTs with long term follow up will be required to evaluate this further.
Collapse
|
3
|
Zimmerer RE, Africa RE, Westenhaver ZK, McKinnon BJ. Bisphosphonate therapy in otosclerosis: A scoping review. Laryngoscope Investig Otolaryngol 2022; 7:242-249. [PMID: 35155804 PMCID: PMC8823176 DOI: 10.1002/lio2.729] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2021] [Revised: 11/03/2021] [Accepted: 12/29/2021] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE Otosclerosis, a leading cause of deafness in adults, results from defective bone remodeling of the otic capsule. Bisphosphonates have been used to decrease bone remolding in many diseases, including otosclerosis. This study analyzes whether current literature supports bisphosphonate therapy as an effective treatment for otosclerosis. DESIGN Scoping review. METHODS A search was performed in three electronic databases; PubMed, Scopus, and Cochrane Control Trials. Articles were screened independently by two masked reviewers based on prespecified inclusion and exclusion criteria. After unmasking, the two reviewers resolved discrepancies through discussion. RESULTS From the search, 35 unique articles were identified for analysis. The dates of these publications range from 1982 to 2018. Further title and full-text review identified six articles for inclusion in this review. Three of the studies included are randomized controlled trials (RCT)s, and three are retrospective case reviews. These studies analyzed bisphosphonate therapy regimens, but dose and study length varied, making direct comparisons difficult. Only one RCT study was able to show a statistically significant change between patients treated with bisphosphonates compared to a control group. CONCLUSIONS The efficacy of bisphosphonates for halting bone remodeling in otosclerosis remains unclear. Reviewing the literature, we found significant variations in experimental design and few studies of high-level evidence. Future RCTs investigating therapies for otosclerosis are needed before a firm conclusion about bisphosphonates efficacy as a pharmacological treatment of otosclerosis.Level of Evidence: 3a.
Collapse
Affiliation(s)
- René E Zimmerer
- School of Medicine The University of Texas Medical Branch at Galveston Galveston Texas USA
| | - Robert E Africa
- School of Medicine The University of Texas Medical Branch at Galveston Galveston Texas USA
| | - Zack K Westenhaver
- School of Medicine The University of Texas Medical Branch at Galveston Galveston Texas USA
| | - Brian J McKinnon
- Department of Otolaryngology-Head and Neck Surgery The University of Texas Medical Branch at Galveston Galveston Texas USA
| |
Collapse
|
4
|
Is there any association between calcium values and otosclerosis? JOURNAL OF SURGERY AND MEDICINE 2019. [DOI: 10.28982/josam.561379] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
|
5
|
Ikeda AK, Hong P, Ishman SL, Joe SA, Randolph GW, Shin JJ. Evidence-Based Medicine in Otolaryngology, Part 8: Shared Decision Making—Impact, Incentives, and Instruments. Otolaryngol Head Neck Surg 2018. [DOI: 10.1177/0194599818763600] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
In our previous installment, we introduced shared decision making (SDM) as a collaborative process in which patients, families, and clinicians develop a mutually optimized treatment plan when more than 1 reasonable treatment option exists. In this subsequent installment of our Evidence-Based Medicine in Otolaryngology Series, we expand on the topic of SDM, including the related current state of clinical decision making, the impact of SDM on health care utilization and patient satisfaction, the potential role of system and society changes, the experience with SDM as it relates to race and ethnicity, existing financial incentives, and the validated instruments that assess the extent to which SDM occurs.
Collapse
Affiliation(s)
| | - Paul Hong
- Division of Otolaryngology–Head and Neck Surgery, Department of Surgery, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Stacey L. Ishman
- Divisions of Pediatric Otolaryngology–Head and Neck Surgery and Pulmonary Medicine, Cincinnati Children’s Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Stephanie A. Joe
- Department of Otolaryngology–Head and Neck Surgery, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Gregory W. Randolph
- Department of Otolaryngology, Harvard Medical School, Boston, Massachusetts, USA
| | - Jennifer J. Shin
- Department of Otolaryngology, Harvard Medical School, Boston, Massachusetts, USA
| |
Collapse
|
6
|
Vestibular Disorders after Stapedial Surgery in Patients with Otosclerosis. Int J Otolaryngol 2016; 2016:6830648. [PMID: 26904127 PMCID: PMC4745872 DOI: 10.1155/2016/6830648] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2015] [Accepted: 12/29/2015] [Indexed: 12/23/2022] Open
Abstract
Introduction and Objectives. Vertigo is a described complication of stapedial surgery. Many studies have been conducted to assess the improvement of hearing loss, but there are few studies that assess vestibular function after stapedial surgery. The aim of this study was to evaluate the presence and characterize the vertigo after stapedial surgery. Methods. We conducted a prospective observational study. Patients undergoing stapedial surgery in our hospital between October 2013 and December 2014 were invited to participate. The vertigo was assessed before and 4 months after surgery, using the Dizziness Handicap Inventory. Results. We included 140 patients in the study. 12 patients (8.6%) reported vertigo before surgery, and all of them denied vertigo after surgery. 36 patients (25.7%) reported vertigo four months after surgery, and none of them had vertigo before surgery. Postoperative total scores in patients with vertigo ranged between 2 and 18 points. Conclusion. The study shows that vestibular disorders may remain after the immediate postoperative period and reinforces the need for clarification of the patient in the informed consent act.
Collapse
|
7
|
Perspectives of pharmacological treatment in otosclerosis. Eur Arch Otorhinolaryngol 2012; 270:793-804. [PMID: 22843095 DOI: 10.1007/s00405-012-2126-0] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2012] [Accepted: 07/17/2012] [Indexed: 12/20/2022]
Abstract
To review our current knowledge of the pathologic bone metabolism in otosclerosis and to discuss the possibilities of non-surgical, pharmacological intervention. Otosclerosis has been suspected to be associated with defective measles virus infection, local inflammation and consecutive bone deterioration in the human otic capsule. In the early stages of otosclerosis, different pharmacological agents may delay the progression or prevent further deterioration of the disease and consecutive hearing loss. Although effective anti-osteoporotic drugs have become available, the use of sodium fluoride and bisphosphonates in otosclerosis has not yet been successful. Bioflavonoids may relieve tinnitus due to otosclerosis, but there is no data available on long-term application and effects on sensorineural hearing loss. In the initial inflammatory phase, corticosteroids or non-steroidal anti-inflammatory drugs may be effective; however, extended systemic application may lead to serious side effects. Vitamin D administration may have effects on the pathological bone loss, as well as on inflammation. No information has been reported on the use of immunosuppressive drugs. Anti-cytokine targeted biological therapy, however, may be feasible. Indeed, one study on the local administration of infliximab has been reported. Potential targets of future therapy may include osteoprotegerin, RANK ligand, cathepsins and also the Wnt-β-catenin pathway. Finally, anti-measles vaccination may delay the progression of the disease and potentially decrease the number of new cases. In conclusion, stapes surgery remains to be widely accepted treatment of conductive hearing loss due to otosclerosis. Due to lack of solid evidence, the place of pharmacological treatment targeting inflammation and bone metabolism needs to be determined by future studies.
Collapse
|
8
|
Dahlin Redfors Y, Möller C. Otosclerosis: Thirty-Year Follow-Up After Surgery. Ann Otol Rhinol Laryngol 2011; 120:608-14. [DOI: 10.1177/000348941112000909] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objectives: The aims of this study were to evaluate the hearing outcomes 28 to 30 years after stapedectomy in patients with surgically confirmed otosclerosis, and to evaluate inner ear involvement. Methods: A retrospective clinical study was performed. Sixty-five consecutive patients who underwent stapedectomy at a tertiary referral center between 1977 and 1979 were included in the study. Medical records, including preoperative and postoperative audiograms, were reviewed, and a long-term follow-up clinical examination and pure tone audiometry were performed. The hearing outcome was compared with that of a reference population (ISO 7029) in terms of age and gender. Results: Thirty years after stapedectomy, 66% of the patients' ears studied showed a moderate to profound hearing loss. The deterioration was mainly caused by a sensory hearing loss. The hearing loss was significantly greater than that in the reference population for both air and bone conduction thresholds at the early and late stages of the disease. A large majority of the patients (88%) had bilateral otosclerosis. Conclusions: Patients with otosclerosis have a sensorineural hearing loss that cannot be explained by age. Otosclerosis should be regarded as a middle and inner ear disease. Almost all patients with otosclerosis are in need of ongoing audio-logical rehabilitation and hearing aids.
Collapse
Affiliation(s)
- Ylva Dahlin Redfors
- Department of Otolaryngology, Department of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Audiology, Örebro University Hospital, School of Health Science, Örebro University/Swedish Institute of Disability Research, Örebro, Sweden
| | - Claes Möller
- Department of Audiology, Örebro University Hospital, School of Health Science, Örebro University/Swedish Institute of Disability Research, Örebro, Sweden
| |
Collapse
|
9
|
Current world literature. Curr Opin Endocrinol Diabetes Obes 2010; 17:568-80. [PMID: 21030841 DOI: 10.1097/med.0b013e328341311d] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
10
|
Current Opinion in Otolaryngology & Head and Neck Surgery. Current world literature. Curr Opin Otolaryngol Head Neck Surg 2010; 18:466-74. [PMID: 20827086 DOI: 10.1097/moo.0b013e32833f3865] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
11
|
Abstract
The surgical management for otosclerosis has evolved from stapes mobilisation to total extraction of the footplate, the so called 'stapedectomy', to a small hole in the stapes footplate, the 'stapedotomy'. The aim of stapes surgery is to restore the vibration of fluids within the cochlear canal. Revision stapedectomy should be approached with caution. Stapedectomy can lead to some minor and other more serious complications.
Collapse
Affiliation(s)
- Y Bajaj
- Department of ENT, York Hospital, York, UK.
| | | | | | | |
Collapse
|