Unit 1 OTOSCLEROSIS PRESENTED BY: REVIEWED BY: - PowerPoint Presentation

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Unit 1

OTOSCLEROSIS

PRESENTED BY: REVIEWED BY:

Ms. Pavithra K Mr.

Jobin

Lecturer, MSN dept Asst. Professor, MSN dept

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LEARNING OBJECTIVES

At the end of the class students will be able to

define OtosclerosisEnlist the causes of Otosclerosisdescribe the patho-physiology of Otosclerosis

list down the clinical features of

Otosclerosis

enumerate the management of Otosclerosis

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Otospongiosis

Otosclerosis

is a primary disease of the ossicles and bony otic capsule characterized by abnormal removal of mature bone by osteoclasts and replacement with woven bone of greater thickness, cellularity and

vascularity

.

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a primary disease of the

ossicles and bony

otic capsule in which irregular spongy bone replaces the normal layer which is characterized by footplate of the stapes and cause conductive hearing loss Cochlea and cause sensory neural hearing loss

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Incidence

0.5-1% of total population

Female: Male (2:1)20-30 years of ageUsually bilateral (85%)

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Etiology

Exact cause is unknown

Remnants of embryonic cartilage Genetic / heriditary Hormonal – Pregnancy and menopause Osteogenesis Imperfecta

Pagets

Disease

Imbalance in trypsin / Antitrypsin in the inner ear

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Anatomical anomalies in the temporal bone

Viral infection – measles Autoimmune disorders

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Types

Stapedial

otosclerosisCochlear otosclerosisMalignant otosclerosisCombined otosclerosis

Histological

otosclerosis

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Stapedial

otosclerosis

Stapes is involved Sites:Fissula ante fenestrumFissula post fenestrum

Circumferential

Biscuit type

Obliterative

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Cochlear

otosclerosis

Round window and labyrinth is involved Stapes fixationMalignant otosclerosisSevere type of cochlear otosclerosisStarts in the early life

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Combined

otosclerosis

Both stapes and cochlear Histological otosclerosis9-12%Foot plate of stapesMeaseles virus

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Phases

Early

spongiotic phase Late or sclerotic phase

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Early spongiotic

phase

Otospongiosisosteoclasts and histiocytesActive reabsorption of bone

Dialated

blood vessels

Schwartze’s sign – red blush seen over the ear drum

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Late Sclerotic phase

Formation of new bone in

resorption areasNew bone – dense and scleroticInitially starts in the stapes area Then to membranous labyrinth

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Pathophysiology

Due to etiological Destruction of the normal bone

Abnormal enzymatic activity Osteoclastic activity Osteoblastic -----Calcification Fixation of stapes Alters the conduction of sound Conductive hearing loss

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Otitic

capsuleBony labyrinth and nerve

Sensori neural hearing loss

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Clinical manifestations

slow, progressive , conductive or

sensori –neural hearing lossTinnitusOtalgiaVertigoDizziness Balance problems

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Paracusis

of willis

Ability to hear a conversation better in a noisy environment than in a quiet one Schwartze signRinne test - BC>ACWeber test – Affected ear

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Diagnostic Evaluation

History collection

Physical examinationOtoscopy -Schwartze signRinne test - BC>ACWeber test – Affected ear Audiometry

CT scan

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Management

Goals

Reduction of the osteoblastic activityInhibit proteolytic enzymes actionSlows the progression of sensori neural hearing loss

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Medical Management

Tab sodium fluoride with

vit D and calcium carbonateDose- 50-75 mg/day3 months – 2 yearsUses:Arrest the further progression of cochlear lossAnti-enzymatic action on proteolytic enzymes

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Bisphosphonates

Alendronate

, IbandronateReduced the bone resorptionAnalgesicsAntibioticsHearing aids

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Surgical Management

Stapedectomy

partial removal of the stapes Stapedotomy opening in the stapes footplate followed by prosthesis insertion

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Prosthesis Placement

Cup piston prosthesis

Teflon piston

prosthesis

House wire prosthesis

McGee/Fisch-type piston prosthesis

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Nursing Management

Do not blow the nose for three weeks following surgery.

Keep the mouth open during sneezing or coughing Avoid any heavy lifting straining or bending for three weeks following surgeryKeep the head elevated on 2-3 pillows if possible.place a cotton wool ball coated in Vaseline in the car canal to prevent getting wet during head bath.

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Replace the cotton wool ball daily for one week

Take oral antibiotic as prescribed.If there is a separate incision a small amount of drainage may occur . If the drainage is profuse or develops a foul

odour it should be reported.Popping sounds, a plugged sensation, ringing or fluctuating hearing may be occur during healing

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Avoid travel by air for three weeks following surgery.

notice any swelling, redness or excessive pain

Some dizziness may occur after surgery. If severe or is associated with nausea or vomiting should be reported .Teach the use of hearing aids

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Nursing diagnosis

Disturbed Sensory Perception Auditory related to decreased sensory reception as evidenced by decreased hearing

Impaired Verbal Communication related to hearing lossAcute Pain related to the abnormal bone growth or surgical procedureSelf-esteem disturbance related to changes in body function.

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Risk for Injury related to the vertigo.

Activity intolerance related to the vertigo.

Deficient knowledge related to disease condition or therapeutic regimen

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EVALUATION

What is

Otosclerosis.What are the causes of Otosclerosis.Eneumerate the pathophysiology of

Otosclerosis

.

Enlist the clinical features of Otosclerosis.Explain the management of

Otosclerosis.

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REFERENCE

Smeltzer – Brunner & Suddharth Textbook of Medical Surgical Nursing, Wolters kluwer publishers, 12th edition 2009.

Black – Medical Surgical Nursing, Elsevier publishers, 8

th

edition 2009.Nettina – Lippincott manual of Nursing Practice, Wolters

kluwer publishers, 7

th

edition 2014.

Lewis – Medical Surgical Nursing, Elsevier publishers, 10

th

edition, 2017