A Systematic Review of the Diagnostic Value of CT Imaging in Diagnosing Otosclerosis.

OBJECTIVE: To evaluate the diagnostic value of computed tomography (CT) in detecting otosclerosis in patients with conductive hearing loss and a clinical suspicion of otosclerosis. DATA SOURCES: PubMed, Embase, and the Cochrane Library. STUDY SELECTION: A systematic search was conducted. Studies reporting original study data were included. DATA EXTRACTION: Relevance and risk of bias of the selected articles were assessed. Studies with low relevance, high risk of bias, or both were excluded. Prevalences, sensitivities, specificities, and post-test probabilities were extracted from the included articles. DATA SYNTHESIS: Seven studies characterized by a moderate to high relevance and moderate to low risk of bias were included for data extraction. The prevalence of otosclerosis was high (up to 100%) in the majority of the included studies. In those studies with a high prevalence of disease, both positive and negative post-test probabilities were (relatively) high: 99% and between 51% and 67% respectively. In one study with a low prevalence of disease (9%), both positive and negative post-test probabilities were low (23% and 3% respectively). Overall, reported sensitivities ranged between 60% and 95%. CONCLUSION: Preoperative CT has little to add in establishing otosclerosis and may not be necessary to confirm the diagnosis. We would recommend reserving CT for those patients with suspected additional abnormalities, for specific preoperative planning, or out of legal necessity.

Limited evidence for the effect of sodium fluoride on deterioration of hearing loss in patients with otosclerosis: a systematic review of the literature.

OBJECTIVE: To determine the protective effect of sodium fluoride on the deterioration of hearing loss in adult patients with otosclerosis. DATA SOURCES: PubMed, Embase, the Cochrane Library, and CINAHL. STUDY SELECTION: A systematic literature search was conducted. Studies reporting original study data on the deterioration of hearing loss in otosclerosis patients treated with sodium fluoride were included. DATA EXTRACTION: Directness of evidence (DoE) and risk of bias (RoB), using the Cochrane Collaboration's tool for assessing risk of bias, of the selected articles were assessed. Studies with low DoE, high RoB, or both were excluded. Absolute risks, mean deterioration of hearing in decibels, risk differences, and their 95% confidence intervals were extracted from the included studies. DATA SYNTHESIS: Our search yielded 168 original titles, of which, 2 placebo-controlled studies were eligible for data extraction. The results of these 2 studies were conflicting. One of the included studies, with high DoE and moderate RoB, reported an absolute risk reduction for deterioration of hearing loss of 18% [95% CI 17; 19] when treating with sodium fluoride. The other included study, with high DoE and moderate RoB, reported no clinically significant difference in mean deterioration of bone-conduction, air-conduction, or air-bone gap between the sodium fluoride group and the placebo group. CONCLUSION: There is weak evidence from one study with significant limitations that deterioration of hearing loss in otosclerosis patients receiving sodium fluoride treatment is less than in patients treated with a placebo.

The influence of measles vaccination on the incidence of otosclerosis in Germany.

The pathologic process of otosclerosis is characterized by an inflammatory lytic phase followed by an abnormal bone remodeling at very specific sites of predilection. There is a clear genetic predisposition with about half of all cases occurring in families with more than one affected member. Females are affected more frequently than males with an approximate 2:1 ratio. N, H, and F measles proteins as well as measles virus RNA have been demonstrated in osteoblasts, chondroblasts, and macrophages of the inflammatory phase of the disease. These observations merely show an association between measles viruses and otosclerosis. In the present study, we tried to prove that there is a causal relationship: voluntary measles vaccination has been available in Germany since 1974. In the absence of official data, we reconstructed the rate of vaccination coverage between 1974 and 2004 using information from the Robert Koch Institute (RKI, Berlin) and from the literature. From the German Federal Office of Statistics, we received the data of 64,112 patients who had been hospitalized between 1993 and 2004 and in whom otosclerosis (ICD-9: 387; ICD-10: H80) had been confirmed. We calculated the effect of measles vaccination on the incidence of hospital treatments for otosclerosis in the period from 1993 to 2004 in Germany. For this purpose, we divided the female and male otosclerosis patients treated as inpatients each year in the observation period into two age groups: those up to 25 years, who had in most cases been vaccinated (designated below as "vaccinated patients") and those over 25 years who mostly could not have been vaccinated (designated below as "unvaccinated patients"). We calculated the incidence of otosclerosis requiring inpatient treatment for the two age groups in each year in the period of observation. For external validation of the study results, the same analysis was carried out in all patients who received inpatient treatment for otitis media in the same period. Between 1993 and 2004 the incidence of hospital treatments for otosclerosis decreased to a significantly greater extent in the vaccinated patients than in the unvaccinated patients. The decline is much greater in men than in women. A comparable effect cannot be demonstrated in patients with otitis media. The results indicate that measles vaccination in Germany has resulted in a significant reduction in the number of hospital treatments for otosclerosis in the vaccinated age groups. We conclude that there is a causal relationship between measles viruses and the development of otosclerosis.

Effect of drinking water fluoridation on the prevalence of otosclerosis.

The effect of drinking water fluoridation on the prevalence of clinical otosclerosis was investigated in an area where the natural waters have a very low fluoride content. The methods included a retrospective chart review and a residential history questionnaire. Only subjects born between 1948 and 1962 were included. In this age group, the prevalence of clinical otosclerosis was found to be 0.35 per cent of persons exposed to fluoridated tap water and 0.32 per cent of those consuming fluoride-poor water. It seems that a sodium fluoride intake of 1 to 3 mg daily cannot prevent the development of clinical otosclerosis in a low-fluoride area.

Fluor in the treatment of osteoporosis. An overview of thirty years clinical research.

It has long been known that fluoride "hardens" mineralized tissues. Fluoride ingestion through drinking water in areas naturally rich in fluoride leads to osteosclerosis, known as endemic fluorosis. The first suggestion that fluoride be used in the treatment of osteoporosis was made in 1964. However, despite 30 years of research, the treatment remains controversial. Fluoride has a dual effect on osteoblasts. On the one hand, it increases the birthrate of osteoblasts at tissue level by a mitogenic effect on precursors of osteoblasts, while on the other hand it has a toxic effect on the individual cell with mineralization impairment and reduced apposition rate resembling osteomalacia. Fluoride has a positive effect on axial bone density, but the axial bone gain is not matched by similar changes in cortical bone. Furthermore, approximately one third of patients are non-responders. The effect of the addition of fluoride to the drinking water on fracture rate is not clear. It probably only has a small relative impact on total hip fracture rates. In two controlled fluoride therapy studies the incidence of vertebral fractures decreased, while in two other studies it increased. Experience teaches that denser bones are not necessarily better bones. The major side effects of fluor therapy are skeletal fluorosis, gastrointestinal intolerance, and painful lower extremity syndrome. Fluoride is the single most effective agent for increasing axial bone volume in the osteoporotic skeleton; however, its therapeutic window is narrow. The best candidates for fluoride therapy are patients with axial osteoporosis but with good peripheral bone density. They should have a good renal function and vitamin D status.(ABSTRACT TRUNCATED AT 250 WORDS)

Experimental tympanosclerosis following infection with Streptococcus pyogenes and vitamin D3 intoxication.

A rat animal model was used to study the ultrastructure of submucosal calcifications induced in the middle ear following inoculation with Streptococcus pyogenes and high doses of parenteral vitamin D3. The morphological changes present in affected animals resembled the classical picture of tympanosclerosis. While calcification occurred about bacterial remnants and myelin structures, the most important calcification centers were lysosomal and non-lysosomal matrix vesicles in the extracellular spaces. These formed band-like calcifications close to the basal membrane without affecting the epithelial layer. This animal model offers the possibility of studying the effect of various therapeutic regimens in the treatment of the dynamic tympanosclerotic process.

[Effects and side effects of hormonal contraceptives in the region of the nose, throat, and ear]. / Wirkung und Nebenwirkung hormonaler Antikonzeptiva im Bereich von Nase, Hals und Ohr.

The pathomechanism of diseases in the field of oto-rhino-laryngology caused by an hormonal contraceptive therapy are presented on base of a critical literature survey. Complications of oral contraception are proved only for the oral tissue (hyperplastic gingivitis) the larynx and the eustachian tube. Otological (otosclerosis, acute deafness, slowly progressive deafness) and rhinological diseases (Rhinopathia vasomotorica) in women under oral contraception cannot be attributed exclusively to this therapy.

[Hormonal contraception and hearing disorders (author's transl)]. / Hormonální antikoncepce a poruchy sluchu.

PIP: Significant hearing impairment occurred in 2 female patients after a long-term application of oral contraceptives (OCs). In 2 of them, surgical intervention was necessary, and in 1 sample of operative material, otosclerosis was found. The possible occurrence of such disorders may be assumed in the course of OC ingestion when we consider a similar otosclerosis manifestation recorded in pregnant women. The data about the presence of these complications during OC use, and especially about the activity of other factors (such as familial involvement, occurrence in previous pregnancies, smoking, obesity) are not equivocal. However, attention should be paid whenever prescription of OCs is proposed and then hearing disorders of this type must be considered as contraindications. (author's)^ieng

Oral contraceptive pills and clinical otosclerosis.

Clinical otosclerosis is a familial disease which is more frequent among women in their reproductive years. The condition usuallly is aggravated by pregnancy. Endocrinologic variables may influence the time of onset and the course of the disease. It is suspected that oral contraceptives (OCs) might stimulate the onset of the disease. Six hundred nulliparous women between the ages of 16 and 30, who used a variety of OCs for 12-36 months, were examined. The hearing of these women was thoroughly investigated. The first audiometric examination of the 600 women revealed three cases (0.5%) of clinical otosclerosis. This incidence is equal to that of the population as a whole, but lower than the incidence found in previously parous women. Audiometric examinations were normal in the remaining 597 women, and repeated examinations revealed no new cases of clinical otosclerosis, despite continuous OC use.