Otosclerosis
Otosclerosis is the most common cause of progressive conductive hearing loss (CHL) in adults. Inherited in an autosomal dominant fashion with variable penetrance, the hearing loss often presents in the third and fourth decades of life. Sporadic otosclerosis accounts for 40% to 50% of cases. Women are twice as likely to be affected as men. Management of hearing loss associated with otosclerosis includes hearing aids, stapes surgery, and, rarely, cochlear implants. Options for surgical treatment of otosclerosis include total stapedectomy, partial stapedectomy, and small fenestra stapedotomy procedures. Stapedotomy has become increasingly favored due to its minimal invasiveness and less potential for trauma to the inner ear. Various techniques are used for creating the stapedotomy fenestra, including micropicks, microdrills and lasers. Hearing outcomes are equivalent regardless of technique. Although stapes surgery is considered a safe and effective treatment, it is not without risks, and the most significant complication remains severe to profound sensorineural hearing loss occurring in 0.2% of patients. Patients therefore should be counseled on all treatment options prior to deciding on therapy.
