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Monday, February 21, 2005

AIPG 2003 ENT Otosclerosis

Question. 71.
A 31-year-old female patient complaints of bilateral impairment of hearing for the past 5 years. On examination, tympanic membrance is normal and audiogram shows a bilateral conductive deafness. Impedance audiometry. Shows as type of curve and acoustic reflexes are absent. All constitute part of treatment, except:
1. Hearing aid.
2. Stapedectomy.
3. Sodium Fluoride.
4. Gentamicin.
4. Gentamicin.
Fundamentals of Ear, Nose, Throat and Head and Neck Surgery – S.K.De – 7th Edition Page 141
Diseases of Ear, Nose and Throat. – P.L.Dhingra - 2nd Edition Page 91
It needs just Basic ENT knowledge to understand that this is a case of Otosclerosis. And Otosclerosis is managed by Stapedectomy, which is the treatment of choice. Few patients who refuse surgery or are unfit for surgeries are managed by Hearing Aid. Sodium Flouride is used to arrest the progress of the disease
1. Hearing aid is used for those who refuse surgery or those who are unfit for surgery.
2. Stapedectomy is the treatment of choice.
3. Sodium Fluoride is used in the medical management to arrest further Otoscleosis but is not curative
4. Gentamicin has no role to play.
Let us see a Few points about Stapedectomy. In fixed Otosclerosis, the stapes is removed and a prosthetic is inserted between Incus and Oval Window. The prosthesis can be Teflon piston, stainless steel piston, tefwire or fat and stainless steel wire. In 90 % there is good improvement
The indications are
1. AB Gap > 30 dB
2. Rinne Negative for 256 Hz and 512 Hz
3. Good cochlea
The Steps of Stapedectomy are
1. Meatal Incision and Elevation of Tympanomeatal Flap
2. Exposure of Stapes – Removal of Posterosuperior bone overhanging of canal
3. Removal of Stapes superstructure
4. Creation of hole in Stapes foot plate – Stapedotomy or Removal of a part of foot plate – Stapedectomy
5. Placement of Prosthesis
6. Repositioning of Tympanomeatal Flap
Few more points
1. 2 % there may be sensorineural loss
2. Stapes Mobilisation gives temporary results
3. Fenestration operation is an outdated procedure in which a window is created in the lateral semicircular canal
Another theme couple where two questions are asked from the same topic - Otosclerosis

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