The stirrup bone is a bone that has a great role in hearing. Hearing occurs as a result of the vibration of this bone in the ear. Hearing loss in this disease can be seen as a result of abnormal bone growth, blocking the passage of sound, that is, vibrations, to the inner ear, the part of the ear that is responsible for the actual hearing. In other words, as a result of abnormal growth of the bones in the ear, the stirrup is prevented from vibrating, so the hearing of the ear is also prevented.
How Does Hearing Occur?
Our ears are our organs located on both sides of our head that are responsible for converting the vibrations produced by certain substances circulating in the air, that is, sound waves, into messages that our brain can process. Clear transmission of sounds to the brain and good perception of them indicate the quality of hearing in the ears, that is, the ears work well. There are 3 main parts in the ear, namely the outer ear, the middle ear and the inner ear, and these 3 main parts have different tasks from each other.
Our ears are the organs on both sides of our head that are responsible for converting vibrations, sound waves, produced by certain substances circulating in the air, into messages that our brain can process. The clear transmission of sounds to the brain and their good perception indicate the quality of hearing, that is, the ears are working well. There are 3 main parts in the ear, namely the outer ear, middle ear and inner ear, and these 3 main parts have different functions from each other..
The 3 bones found in the middle ear are as follows:
* Hammer (malleus): It is the bone located at the outermost, attached to the eardrum.
* Anvil (incus): It is the bone located in the middle of the two bones and is responsible for transmission.
* Stirrup (stapes): It is the bone that is responsible for transmitting vibrations transmitted from the anvil bone to the fluids in the inner ear.
The sound vibrations transmitted by the stirrups (stapes) to the oval window and the inner ear fluids lead to fluctuations in the inner ear fluids. These fluctuations are also converted into electrical signals, that is, messages that the brain can perceive, by sensory organs in the structure of the inner ear, which is the part related to hearing and called the snail (cochlea). These signals are transmitted to the brain stem, which is connected to the auditory nerve, and from there to the brain. In this way, hearing is realized.
What Are the Types of Hearing Loss?
After examinations called audiometric tests, hearing loss is divided into 5 types. These:
1.Conductive hearing loss: It is observed in the form of hearing sounds more weakly due to any pathology in the sound transmission pathway. If the patient has a pathology/rupture of the middle ear and/or eardrum, the sound is perceived weaker in pathologies of the Eustachian tube.
2.Neural (sensorineural) hearing loss: These are losses that occur as a result of damage to the auditory nerves in the inner ear.
3.Mixed (mixed) type hearing loss: In addition to conductive hearing loss, sensorineural hearing loss is called mixed-type hearing loss. In patients, both ears are usually affected by this disease, but the levels of exposure to these two ears may not always be the same. In fact, it is often seen that the level of one ear is affected more than the other.
4.Functional hearing loss: These are losses that are not an organic pathology that will explain hearing loss at the bottom. It is usually assessed as emotional (emotional) hearing loss. This condition is called pseudohypacusis.
5.Central hearing loss: It develops as a result of damage to the hearing center in the brain.
How Does Otosclerosis Lead to Hearing Loss?
Abnormal new bone formation in otosclerosis patients is often observed in the stirrup (stapes) bone. This newly formed abnormal bone structure prevents the stirrup from moving, so there are problems with the transmission of sound waves, that is, sound vibrations transmitted to the middle ear from the outside, to the fluids in the inner ear, and hearing loss occurs. This type of hearing loss is called conductive hearing loss.
New abnormal bone formation caused by this disease sometimes settles on the inner ear wall. By affecting the snail (cochlea) located in the inner ear directly or indirectly, it can also cause neural hearing loss caused by the inner ear, as well as the middle ear. This type of hearing loss is also called neural (sensorineural) hearing loss.
What are the Causes of Otosclerosis?
The cause of otosclerosis disease still cannot be stated unequivocally. However, there is a hereditary (familial) transition feature in the disease. For example, in some cases, such as the presence of the measles virus, pregnancy, worsening of the course of otosclerosis disease may be observed. In some cases, such as these, the disease otosclerosis may have connections in this way. It is recommended to get information from your doctor about these situations.
If this disease is left untreated, hearing loss increases until late middle age. That is why otosclerosis disease is defined as a progressive (progressive) disease.
Although the disease is most common in women in the middle age period, it can also be seen in men and children.
What Are the Symptoms of Otosclerosis?
The main two symptoms of otosclerosis are hearing loss and tinnitus (tinnitus). In patients, hearing loss is observed in one ear or in two ears at once. Hearing loss develops slowly, and the patient notices that at first he cannot hear only low-pitched, light sounds (such as whispers). Over time, this problem also begins to worsen due to the fact that the disease is a progressive disease. There are also symptoms of otosclerosis, such as dizziness, balance problems, which are not seen as often, but can be seen at some times.
How is Otosclerosis Diagnosed?
Otosclerosis can be diagnosed by otolaryngologists by performing some examinations, tests, taking into account the symptoms in the patient. In examinations performed by otolaryngologists, it is found that the eardrums usually have a normal appearance
A hearing test performed with special devices also evaluates at what stage otosclerosis is, whether it can be treated surgically. This hearing test is performed with an examination instrument called a diaposon or special devices called an audiometer. These tests are carried out in sound-insulated cabins.
If otosclerosis is at a very initial stage, sometimes surgery may not work in the treatment, but in some cases, surgery can prevent the progression of otosclerosis disease. For this reason, the level of otosclerosis disease determined in hearing tests performed by physicians with special devices is important for treatment.
What is a Diaposon Audiogram (Otosclerosis Audiogram)?
Despite all the tests aimed at diagnosing the patient before being treated with surgery, a definitive diagnosis can only be made during surgery in patients with conductive hearing loss. Since otosclerosis has been diagnosed, it can be understood that the cause that leads to hearing loss is other than otosclerosis in some patients who are taken to surgery when middle ear control is performed during surgery.
This is the reason why a definitive diagnosis can be made during surgery in patients with conductive hearing loss. In these cases, it becomes more difficult to correct this hearing loss surgically, and sometimes even no improvement can be made depending on the cause of hearing loss.
How is Otosclerosis Treated? How is Otosclerosis Surgery Performed?
In order for otosclerosis to be treated with surgery, the level of otosclerosis must have reached a certain level. Otherwise, surgery is not an effective method of treatment for otosclerosis. This operation for the treatment of otosclerosis is called "stapedectomy".
In otosclerosis surgery, the stirrup (stapes) bone, whose movement is restricted due to abnormal new bones formed due to the cause of the disease, is removed and a prosthesis is inserted in its place. As is known, the stirrup bone is one of the smallest bones in the body. This operation performed on the stirrup bone, which is about 3 mm long, requires special skills due to the small size of the bone and is performed using advanced surgical devices, that is, advanced surgical microscopes.
Those who have otosclerosis surgery may experience effects such as dizziness, nausea, and sometimes pain. In the first days, the patient may need help walking, and over time, these effects gradually decrease. Otosclerosis patients are asked not to lift heavy loads for 2 months after surgery, not to travel by plane due to the pressure difference, not to do activities that will create a pressure difference such as diving, not to push. Complete recovery of hearing after surgery can only happen within 2-3 months.
If the hearing loss is not at the level to be operated on, the patient does not want to be operated on for reasons such as surgery cannot be performed, other treatment options may come to the agenda. In such cases, in order to minimize hearing loss, the treatment method is tried with special devices that can amplify the sound and deliver it to the ear canal. This method is not a method that slows down the progression of the disease.
The use of medication can also be preferred in the treatment of otosclerosis so that the disease does not progress, but the use of this method of treatment is very limited.
There is another treatment method called sodium fluoride, which some doctors use when surgery cannot be performed. Oral intake of sodium fluoride orally is considered to slow the progression of otosclerosis.