Sodium fluoride therapy.

As a medical treatment for otospongiosis-otosclerosis, sodium fluoride influences the underlying bony changes in the labyrinth so as to arrest or prevent the onset of hearing loss. Sodium fluoride is an enzyme inhibitor and reduces osteoclastic bone resorption and, if the dosage is more than 60 mg a day, may rebuild pseudohaversian bone.

[Subcophosis and otosclerosis. Medical and surgical treatment]. / Subcophoses et otospongioses. Traitement médical et chirurgical.

The spiral ligament of the stria vascularis is nearly always damaged by otosclerotic foci when the patient is nearly totally deaf because of otosclerosis. Vascular drugs are to be prescribed in such a case, besides the Sodium Fluoride treatment. The Sodium Fluoride is, according to us, the best treatment to arrest the progression of the otosclerotic disease. Sodium fluoride will destroy the proteolytic enzymes damaging the inner ear membranes and the hair of the Corti hair cells.

Etiology of otospongiotic sensorineural losses.

The etiology of otospongiotic-otosclerotic disease is enzymatic; the proteolytic enzymes released by the otospongiotic-otosclerotic foci damage the inner ear and are also the basis of the bony rebuilding of the OW niche leading to stapedial fixation. The trigger may be an autoimmune process due to the reaction of the enchondral otic capsule against the embryonic cartilaginous remnants, genetically determined to be located in the otic capsule and mainly in the fissula antefenestram.

Vertigo in postoperative follow-up of otosclerosis.

Causes of vertigo after otosclerosis surgery were studied postoperatively and in long-term follow-up examinations. Pressure and mobility changes in the posterior labyrinth fluids, enzymatic process, and decrease in blood supply at the time of operation appear to be the major causes. Methods of detection, avoiding, and managing vertigo are presented.

[Sound injuries after surgery of otosclerosis]. / Traumatismes sonores après chirurgie de l'otospongiose.

Surgery for otosclerosis means that the sound protection due to the fixation of the footplate does not exist anymore. As the Corti hair cells have been fragilized by proteolytic enzymes, it is absolutely necessary to reconstruct the sound mechanism in order to maintain the vibration of the perilymph absolutely within acoustical physiologic limit of movement. The means to realize this reconstruction are presented in this paper, as well as the results.

[The development of tinnitus in the postoperative period of otospongiosis]. / Devenir des acouphènes en postopératoire de l'otospongiose.

Correlation between tinnitus and audiometric loss, modification of tinnitus by medical or surgical treatment, allow to suspect the origin of tinnitus due to otospongiosis and to give the patient a practically always confirmed prognosis. Audiometric localization of tinnitus is essential, as it is the best clue to etiology, treatment and prognosis of otospongiosis tinnitus. As far as irreducible tinnitus are concerned, as anxiety is the most pejorative parameter, not discouraging the patient is very important.

[Improvement in hearing as a function of type of platinectomy or platinotomy performed in the surgical treatment of otospongiosis]. / Amélioration de l'audition en fonction du type de platinectomie ou de platinotomie effectué dans la chirurgie de l'otospongiose.

The footplate fenestra should be performed in its posterior third part to avoid pressure of the piston on the membranous labyrinth, situated very close to the footplate in 2% of the cases in otosclerotic patients. Gain in bone conduction differs according to the size of the fenestra performed. Low frequencies improve most when the whole posterior third part of the footplate is removed; the audiometric gain is better for high frequencies when a 0.8 mm stapedotomy is performed. These findings demonstrate the interest of a more or less enlarged fenestra according to the language spoken by the patient, since the different languages use mainly high or low frequency phonemes.

[Prognosis for tinnitus after surgery for otospongiosis]. / Devenir des acouphènes en postopératoire de l'otospongiose.

Correlation between tinnitus and audiometric loss and modification of the former by both surgical and medical treatment provide sufficient data to suggest its origin and to give the patient a prognosis confirmed in practically every case. Audiometric localization of the tinnitus is essential, since this allows establishment of the etiology, treatment and prognosis of the symptom. When tinnitus is irreversible, the hope of a possible recovery must be given to the patient to avoid the inevitable anxiety produced.

Technique for otosclerosis.

The surgical technique described in this article consists of performing an 0.8-mm stapedotomy at the posterior third part of the footplate using a large 6 mm square vein graft interposition and performing a vigorous inflation of the middle ear as early as the twenty-fourth postoperative hour. This technique allowed the authors to perform a series of more than 5000 operations over the last five years without any dead ear and with remarkable hearing improvement.

[Means of fixing a transmission device to the center of a mobile footplate]. / Moyen de fixation d'une transmission au centre d'une platine mobile.

The authors present a new fixation device for any bony or prosthetic transmission system to the center of a mobile footplate in the absence of the stapes crura. It is a disc-shaped silicone sponge, with a central hole, fitting the bottom of the oval fossa and thus securing the maintenance of the bony or prosthetic transmission in the center of the mobile footplate, and reducing the risk of shifting of the transmission system, which is always possible in case of tympanic retraction. The silicone sponge allows as well a more physiological transmission, because the footplate will vibrate from top to bottom thanks to a central force vector, thus giving better audiometric results. The biocompatibility of the silicone sponge eradicates any phenomenon of intolerance from the tissues.

Otospongiosis as a genetic disease. Early detection, medical management, and prevention.

Extensive research into the inmost mechanism of otospongiotic disease and an extended study of otosclerotic patients' ancestry have led the authors to a plan for prevention of this disease, which appears to be a genetic deafness with autosomal dominant inheritance and about 40 percent penetrance of genes. Progress in impedance audiometry has permitted early detection of stapedial fixation by means of systematic audiometric investigations, particularly the elicitation of stapedius reflex showing a very special pattern called the "on-off effect." The evidence supporting an enzymatic origin of the sensoringeural component of hearing loss in otosclerotic families has led us to treat otospongiotic children with very low doses of sodium fluoride, with no risk of stunting growt. We have been applying this procedure for four years to the families of stapedectomized otosclerotic patients. We believe it would be advisable to extend this type of prevention to schoolchildren by means of systematic audiometric investigations, including the elicitation of stapedius reflex to detect a possible on-off effect. We also studied sodium fluoride therapy, which derives from the enzymatic origin of the otospongiotic disease. This treatment, based on enzymogenesis inhibitors, should be given to young otospongiotic/otosclerotic patients detected by systematic audiometric investigations. Sodium fluoride could even be prescribed for otospongiotic mothers to prevent disease in their newborn children, exactly as in dental prevention. Otospongiotic/otosclerotic disease can be easily controlled by medical treatment, combined with surgery if needed. This treatment is effective thanks to early detection.

[Result and treatment of tinnitus in our clinic]. / Bilan et traitement des acouphènes dans notre clinique.

The authors propose a test consisting in performing injections of Renovaine, a very strong anaesthetic drug, in the external ear duct in order to reduce momentarily severe and decompensated tinnitus. They discuss the usefulness of this test and develop two concepts to explain its action. They make a pragmatic approach of the tinnitus etiopathogeny.

Tympanometry and fistula test.

The 'fistula test' is performed when an abnormal opening between the vestibule and the middle ear cavity is suspected. The fistula is usually seen after stapedectomy, but may also occur after trauma to a normal ear when the round window membrane may rupture. Tympanometry with an electronystagmographic (ENG) tracing may show a positive result after stapedectomy in the absence of a fistula, and there may conversely be a normal ENG tracing after tympanometry when there is in fact a perilymph fistula. The authors explain the reasons for this paradoxical response. In no way does it detract from the value of the test, which only needs to be interpreted correctly.

Complications of stapedectomies.

The authors consider the consequences and treatment of any error during and after stapedectomy, and present the usually less developed complications of stapedectomies: postoperative cochlear drops, tinnitus, vertigo. They also mention the other complications of stapedial surgery, and they particularly advocate the half-posterior stapedectomy technique, associated with a sufficiently large venous interposition. The authors had no cases of severe permanent cochlear loss during the first postoperative month in a series of more than 4000 stapedectomies.

[Complications of stapedectomy]. / Complications des stapédectomies.

The authors present here the usually less developed complications of stapedectomies: postoperative cochlear drops, tinnitus, vertigo. They also mention the other complications of stapedial surgery. They insist particularly on the interest of half posterior platinectomy technique, associated with a sufficiently large venous interposition.

Early detection of otosclerosis by impedance-audiometry screening.

The basis of the early detection of otosclerosis is dual: first, a better knowledge of the mechanism of the disease itself, which is of enzymatic origin, and the starting point of which is an antigen-antibody conflict between the otic capsule and the embryonic cartilaginous remnants; - second, the fact that the otospongiotic disease appears to be a genetic deafness with an autosomal inheritance and about 40% of genes penetrance. Consequently an early detection is absolutely essential to combat the disease at its beginning and to assure its prevention. The early diagnosis of the otospongiotic/otosclerotic disease is twofold: first, the early detection of stapedial fixation is given by systematic impedance-audiometry screening on school-children by means of stapedius reflex elicitation in order to detect a possible diphasic impedance change (on-off effect); - second, the early diagnosis of progressive cochlear deterioration is yielded through systematic bone-conducted audiometry testing in young children in families with an otospongiotic/otosclerotic history.