486
SENSORINEURAL HEARING LEVEL IN UNILATERAL OTOSCLEROSIS I. M.
YOUNG,
MD
BY INVITATION
D. O.
MIKAElIAN,
MD
and
I. M.
TROCKI,
MD
BY INVITATION
PHILADElPHIA, PENNSYlVANIA
Preoperllive bone conduction threshold meiSurementJ were made In the otosclerotic and opposite elrs of 25 patlents with unllatera] otosclerosis to tabulate the sensorineurll helrIng impilrment In this diseise. Middle ear otosclerosis WIS confirmed It surgery In III Cises. The bone conduction thresholds It III frequencies measured were simllir In the otoKlerotic Ind opposite ears, Adequlte mlsklng WII Ipplied to the nontest elr to melsure In accurate bone conduction threshold In the test el' without produdng overmlSklng.
INTRODUCTION MUCH controversy has been created since 1899, when Slebenmann! conjectured that otosclerosis could cause sensorineural hearing loss. In 1926, Shambaugh- presented the first case of pure cochlear otosclerosis diagnosed during life. Many have speculated on the mechanism through which the otosclerotic focus causes this impairment. Siebenmann] suggested in 1912 that toxic sub-
Submitted for publication Feb 7, 1979. From the Department of Otolaryngology, Jeller~n Medical College, Thomas Iefferson University, Philadelphia. Presented at the Basic Research Forum at the 1978 Annual Meeting of the American Academy of Otolaryngology, Las Vegas, Sept 10-13.
stances from this focus could damage the hair cells of the organ of Corti. Ruedf proposed that vascular shunting and new lamellar bone invading the inner ear could be factors in this loss. Causse and Chevance! advanced the theory that proteolytic enzymes released from the histiocytes of the osteospongiotic microfoci are the most important factors in sensorineural impairment in cochlear otosclerosis. Sataloff et al 6 concluded that otosclerosis can cause sensorineural hearing impairment in the unilateral otosclerotic cases. linthicum and lalanF suggested in 1969 that physical pressure from otosclerotic bone on the basilar membrane could be a factor in the postoperative otosclerotic cases. Schuknecht! studied the cases of sensorineural loss in which histopathologic examination failed to show significant damage in the cochlea or the eighth nerve. Other investigators have denied any significant increase in sensorineural loss in otosclerosis. Glorig and Gallo? compared bone conduction threshold levels in patients with otosclerosis with those of normal patients. They concluded that otosclerosis does not cause a sensorineural loss greater than that seen in the general population. Guild,lo in a histologic study of temporal bones, concluded that atrophy of the organ of Corti or the
Oto/aryngol Head Neck Surg 87:486-490 (July-Aug) 1979 Downloaded from oto.sagepub.com at UNIV NEBRASKA LIBRARIES on June 5, 2016
487
UNILATERAL OTOSCLEROSIS cochlear nerve fibers does not occur more frequently in otosclerotic ears than in ears free of otosclerosis.
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The purpose of this study is to tabulate the sensorineural hearing impairment in surgically proved unilateral middle ear otosclerotic cases. Patients with unilateral otosclerosis were selected so that their opposite ear could be used as the control.
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SUBJECTS
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Twenty-five patients with unilateral otosclerosis had unilateral stapedectomy at Jefferson Medical College between 1964 and 1973. These were surgically proved cases of middle ear otosclerosis. There were 16 men and nine women. The ages ranged from 19 years to 69 years with the majority in the 40- to 50-year range. In the otosclerotic ear, there was a median air-bone gap range of 25 to 45 dB (Table 1). In the opposite ear, both median air and bone conduction threshold levels ranged from 10 to 20 dB.
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SENSORINEURAL HEARING LEVEL IN UNILATERAL OTOSCLEROSIS I. M.
YOUNG,
MD
BY INVITATION
D. O.
MIKAElIAN,
MD
and
I. M.
TROCKI,
MD
BY INVITATION
PHILADElPHIA, PENNSYlVANIA
Preoperllive bone conduction threshold meiSurementJ were made In the otosclerotic and opposite elrs of 25 patlents with unllatera] otosclerosis to tabulate the sensorineurll helrIng impilrment In this diseise. Middle ear otosclerosis WIS confirmed It surgery In III Cises. The bone conduction thresholds It III frequencies measured were simllir In the otoKlerotic Ind opposite ears, Adequlte mlsklng WII Ipplied to the nontest elr to melsure In accurate bone conduction threshold In the test el' without produdng overmlSklng.
INTRODUCTION MUCH controversy has been created since 1899, when Slebenmann! conjectured that otosclerosis could cause sensorineural hearing loss. In 1926, Shambaugh- presented the first case of pure cochlear otosclerosis diagnosed during life. Many have speculated on the mechanism through which the otosclerotic focus causes this impairment. Siebenmann] suggested in 1912 that toxic sub-
Submitted for publication Feb 7, 1979. From the Department of Otolaryngology, Jeller~n Medical College, Thomas Iefferson University, Philadelphia. Presented at the Basic Research Forum at the 1978 Annual Meeting of the American Academy of Otolaryngology, Las Vegas, Sept 10-13.
stances from this focus could damage the hair cells of the organ of Corti. Ruedf proposed that vascular shunting and new lamellar bone invading the inner ear could be factors in this loss. Causse and Chevance! advanced the theory that proteolytic enzymes released from the histiocytes of the osteospongiotic microfoci are the most important factors in sensorineural impairment in cochlear otosclerosis. Sataloff et al 6 concluded that otosclerosis can cause sensorineural hearing impairment in the unilateral otosclerotic cases. linthicum and lalanF suggested in 1969 that physical pressure from otosclerotic bone on the basilar membrane could be a factor in the postoperative otosclerotic cases. Schuknecht! studied the cases of sensorineural loss in which histopathologic examination failed to show significant damage in the cochlea or the eighth nerve. Other investigators have denied any significant increase in sensorineural loss in otosclerosis. Glorig and Gallo? compared bone conduction threshold levels in patients with otosclerosis with those of normal patients. They concluded that otosclerosis does not cause a sensorineural loss greater than that seen in the general population. Guild,lo in a histologic study of temporal bones, concluded that atrophy of the organ of Corti or the
Oto/aryngol Head Neck Surg 87:486-490 (July-Aug) 1979 Downloaded from oto.sagepub.com at UNIV NEBRASKA LIBRARIES on June 5, 2016
487
UNILATERAL OTOSCLEROSIS cochlear nerve fibers does not occur more frequently in otosclerotic ears than in ears free of otosclerosis.
8 lG
cD
8~ ~
The purpose of this study is to tabulate the sensorineural hearing impairment in surgically proved unilateral middle ear otosclerotic cases. Patients with unilateral otosclerosis were selected so that their opposite ear could be used as the control.
..,.'
8~ N' Ill:
...... ~~ Vi ... -e
I-
...o
SUBJECTS
15
Twenty-five patients with unilateral otosclerosis had unilateral stapedectomy at Jefferson Medical College between 1964 and 1973. These were surgically proved cases of middle ear otosclerosis. There were 16 men and nine women. The ages ranged from 19 years to 69 years with the majority in the 40- to 50-year range. In the otosclerotic ear, there was a median air-bone gap range of 25 to 45 dB (Table 1). In the opposite ear, both median air and bone conduction threshold levels ranged from 10 to 20 dB.
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