EpistemisWillis Paracusia
Specialty: Otolaryngology.
Why it occurs
- Otosclerosis (fixation of the stapes plate in the oval window)
- Chronic conductive hearing loss due to sequelae of otitis media with rigidity of the ossicular chain
- Congenital fixation of the ossicular chain of the middle ear without malformations of the external ear
Initial workup
Liminal tonal audiometry via air and bone conduction to document the characteristic transmissive gap, speech audiometry in a comparative noisy environment, tympanometry with stapedial reflexes (absence of stapedial reflex in otosclerosis), and high-resolution CT of petrous bones to assess active foci of otic bone demineralization.
red flags
Sudden sensorineural hearing loss associated recently unilaterally, presence of repetitive acute rotatory vertigo, intense persistent refractory otalgia, otorrhagia or discharge of purulent secretion with a foul odor from the affected ear.
Standard management
- There are no curative pharmacological treatments for otosclerosis or chain stiffness
- In incipient active otosclerosis, the use of sodium fluoride in doses closely controlled by the specialist has been suggested to stop osteoclastic progression.
- The definitive treatment is stapes replacement surgery (stapedotomy) or the adaptation of a conventional hearing aid.
Educational guidance for study. It is NOT a prescription recommendation. The actual choice depends on the cause, the patient, and current guidelines.
- Area
- Otolaryngology
- Listed causes
- 3
- Treatment options
- 3