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Otosclerosis is a disease of the middle and inner ear, in which parts of the ear harden and ossify. This affects the sound transmission from the middle to the inner ear. The ossification usually begins in the middle ear and can spread in the further course to the inner ear. In later stages, ossification causes increased hearing loss. Even a humming and hum in the ear (tinnitus) can occur. Most otosclerosis first occurs in one ear only and later in the second.
About ten percent of the population has a change in the bony structures in the middle and inner ear. Symptoms of otosclerosis, however, only show in about one percent of the population. Women are about twice as likely to be affected as men. Otosclerosis is more noticeable between the ages of 20 and 40 years. However, changes in the ear can persist as early as childhood without symptoms.
In otosclerosis there is an increasing deterioration of the hearing, usually only at one ear. In about 70 percent of those affected, otosclerosis later develops in the second ear. In women, the first symptoms of otosclerosis often appear during pregnancy. With increasing ossification, the mobility of the ossicles is increasingly limited. This can eventually lead to complete hearing loss (deafness).
If the otosclerosis is not treated, the ossification increases steadily. Physicians speak of a progressive (progressive) course. Medically, a deterioration can not be stopped. Over a period of time injections of cortisone-containing preparations may help reduce hearing loss. In the long run, however, they can not prevent a deterioration in hearing. The only long-term promising treatment option for otosclerosis is surgery. There are two different methods: stapedectomy and stapedotomy.
Doctors talk about an "ectomy" when something is removed. In stapedectomy, the stapes is removed accordingly - either with the help of surgical instruments or with a laser. Subsequently, an artificial replacement (prosthesis) is used, a so-called stapes plastic. It is like the stirrup itself connected at one end to the anvil and at the other end with the membrane of the oval window. The prosthesis thus completely fulfills the function of the stirrup, so that the sound transmission is ensured.
Stapedotomy is the second possible surgical procedure in otosclerosis. In the past, stapedectomy was usually used. Due to lower risks but the stapedotomy is preferred today. Stapedotomy does not remove the entire stirrup but only the long leg. The stirrup plate, which is attached to the membrane of the inner ear, remains in place. In the plate a small hole is drilled. The prosthesis is now attached to the anvil on one side as on the stapedectomy and on the stirrup plate on the other side.
The operation is done under local anesthesia. The anesthetic is injected into the external auditory canal. The eardrum is detached on one side and made the stirrup so accessible. As a rule, the surgery does not last longer than half an hour. After the operation, the eardrum is folded back. At least up to two weeks after surgery, a special ear bandage (ear tamponade) must be worn. However, the success of the operation is evident - if not during the operation - at the latest in these two weeks.