Tympanosclerosis

Tympanoesclerosis
Other namesMyringosclerosis, intratympanic tympanosclerosis
SpecialtyENT surgery

Tympanosclerosis is a condition caused by hyalinization and subsequent calcification of subepithelial connective tissue of the tympanic membrane and middle ear, sometimes resulting in a detrimental effect to hearing.[1][2]

Signs and symptoms

Myringosclerosis rarely causes any symptoms.[3] Tympanosclerosis, on the other hand, can cause significant hearing loss[3] or chalky, white patches on the middle ear or tympanic membrane.[1]

Causes

The aetiology for tympanosclerosis is not extensively understood. There are several probable factors which could result in the condition appearing, including:

  • Long term otitis media (or 'glue ear')[2]
  • Insertion of a tympanostomy tube.[4][5][6] If aspiration is performed as part of the insertion, the risk of tympanosclerosis occurring increases.[7] Risk also increases if a larger tube is used,[8] or if the procedure is repeated.[9]
  • Atherosclerosis[10]
  • There is ongoing research as to whether or not cholesteatoma is associated with tympanosclerosis. If there is an association, it is likely that the two conditions co-exist.[2]

Pathophysiology

Increased fibroblast activity results in deposition of collagen. Calcium phosphate plaques then form in the lamina propria of the tympanic membrane.[1][2]

Diagnosis

If lesions are typical, non-extensive and with no detriment to hearing, investigation into the condition is rarely required. Audiometry is used to determine the extent of hearing loss, if any.[3] Tympanometry produces tympanograms which can be different when tympanosclerosis is present.[11] Computerised tomography (CT) can be used to determine if disease is present in the middle ear.[12] Whilst hearing loss is a common symptom in many diseases of the ear, for example in otosclerosis (abnormal bone growth in the ear),[3] the white, chalky patches on the tympanic membrane are fairly characteristic of tympanosclerosis. Cholesteatoma is similar in appearance but the whiteness is behind the tympanic membrane, rather than inside.[citation needed]

Classification

Myringosclerosis refers to a calcification only within the tympanic membrane and is usually less extensive than intratympanic tympanosclerosis, which refers to any other location within the middle ear such as the ossicular chain, middle ear mucosa or, less frequently, the mastoid cavity.[3]

Treatment

Hearing aids are a common treatment for hearing loss disorders. A more specific treatment is surgical, involving excision of the sclerotic areas and then further repair of the ossicular chain. There are several techniques, sometimes involving two surgeries;[2][13] success rates are, however, variable.[14] Damage to the inner ear as a result of surgical procedures is a possible and serious concern, as it can result in forms of sensorineural deafness.[15]

Prognosis

In most cases, tympanosclerosis does not cause any recognisable hearing loss up to ten years after the initial disease onset.[5][16] Sclerotic changes seem to stabilise, but not resolve or dissolve, after 3 years.[9][17]

Epidemiology

Myringosclerosis seems to be more common than tympanosclerosis.[2] Most research has not been conducted upon the general, healthy population, but rather those with otitis media or patients who have had tympanostomy tubes in prior procedures. Of the children studied who had 'glue ear', and who were treated with tympanostomy tubing, 23-40% of cases had tympanosclerosis.[4][9][18] One study suggested that people with atherosclerosis were more likely to have tympanosclerosis than otherwise healthy individuals.[10]

References

  1. ^ a b c Forséni M, Bagger-Sjöbäck D, Hultcrantz M (May 2001). "A study of inflammatory mediators in the human tympanosclerotic middle ear". Archives of Otolaryngology–Head & Neck Surgery. 127 (5): 559–64. doi:10.1001/archotol.127.5.559. PMID 11346433. Archived from the original on 2011-08-10. Retrieved 2010-01-26.
  2. ^ a b c d e f Asiri S, Hasham A, al Anazy F, Zakzouk S, Banjar A (December 1999). "Tympanosclerosis: review of literature and incidence among patients with middle-ear infection". The Journal of Laryngology and Otology. 113 (12): 1076–80. doi:10.1017/s0022215100157937. PMID 10767919.
  3. ^ a b c d e Isaacson JE, Vora NM (September 2003). "Differential diagnosis and treatment of hearing loss". American Family Physician. 68 (6): 1125–32. PMID 14524400.
  4. ^ a b Kay DJ, Nelson M, Rosenfeld RM (April 2001). "Meta-analysis of tympanostomy tube sequelae". Otolaryngology–Head and Neck Surgery. 124 (4): 374–80. doi:10.1067/mhn.2001.113941. PMID 11283489.
  5. ^ a b Johnston LC, Feldman HM, Paradise JL, et al. (July 2004). "Tympanic membrane abnormalities and hearing levels at the ages of 5 and 6 years in relation to persistent otitis media and tympanostomy tube insertion in the first 3 years of life: a prospective study incorporating a randomized clinical trial". Pediatrics. 114 (1): e58–67. doi:10.1542/peds.114.1.e58. PMID 15231974. Retrieved 2010-01-26.
  6. ^ Browning, George G.; Rovers, Maroeska M.; Williamson, Ian; Lous, Jørgen; Burton, Martin J. (2010-10-06). "Grommets (ventilation tubes) for hearing loss associated with otitis media with effusion in children". The Cochrane Database of Systematic Reviews (10): CD001801. doi:10.1002/14651858.CD001801.pub3. ISSN 1469-493X. PMID 20927726.
  7. ^ McRae D, Gatland DJ, Youngs R, Cook J (August 1989). "Aspiration of middle ear effusions prior to grommet insertion an etiological factor in tympanosclerosis". The Journal of Otolaryngology. 18 (5): 229–31. PMID 2769837.
  8. ^ Hampal S, Flood LM, Kumar BU (March 1991). "The mini-grommet and tympanosclerosis". The Journal of Laryngology and Otology. 105 (3): 161–4. doi:10.1017/s0022215100115269. PMID 2019798.
  9. ^ a b c Maw AR (August 1991). "Development of tympanosclerosis in children with otitis media with effusion and ventilation tubes". The Journal of Laryngology and Otology. 105 (8): 614–7. doi:10.1017/s0022215100116822. PMID 1919311.
  10. ^ a b Ferri M, Faggioli GL, Ferri GG, Pirodda A (June 2004). "Is carotid stenosis correlated with tympanosclerosis". International Angiology. 23 (2): 144–6. PMID 15507892. Retrieved 2010-01-26.
  11. ^ Onusko E (November 2004). "Tympanometry". American Family Physician. 70 (9): 1713–20. PMID 15554489.
  12. ^ Swartz JD, Goodman RS, Russell KB, Marlowe FI, Wolfson RJ (August 1983). "High-resolution computed tomography of the middle ear and mastoid. Part II: Tubotympanic disease". Radiology. 148 (2): 455–9. doi:10.1148/radiology.148.2.6867342. PMID 6867342.
  13. ^ Bayazit YA, Ozer E, Kara C, Gökpinar S, Kanlikama M, Mumbuç S (May 2004). "An analysis of the single-stage tympanoplasty with over-underlay grafting in tympanosclerosis". Otology & Neurotology. 25 (3): 211–4. doi:10.1097/00129492-200405000-00001. PMID 15129093.
  14. ^ Vincent R, Oates J, Sperling NM (November 2002). "Stapedotomy for tympanosclerotic stapes fixation: is it safe and efficient? A review of 68 cases". Otology & Neurotology. 23 (6): 866–72. doi:10.1097/00129492-200211000-00010. PMID 12438848.
    - Albu S, Babighian G, Trabalzini F (September 2000). "Surgical treatment of tympanosclerosis". The American Journal of Otology. 21 (5): 631–5. PMID 10993449.
    - Teufert KB, De La Cruz A (March 2002). "Tympanosclerosis: long-term hearing results after ossicular reconstruction". Otolaryngology–Head and Neck Surgery. 126 (3): 264–72. doi:10.1067/mhn.2002.122701. PMID 11956534.
  15. ^ Bellucci RJ (August 1985). "Cochlear hearing loss in tympanoplasty". Otolaryngology–Head and Neck Surgery. 93 (4): 482–5. doi:10.1177/019459988509300403. PMID 3931022.
  16. ^ Riley DN, Herberger S, McBride G, Law K (March 1997). "Myringotomy and ventilation tube insertion: a ten-year follow-up". The Journal of Laryngology and Otology. 111 (3): 257–61. doi:10.1017/s0022215100137016. PMID 9156062.
  17. ^ De Beer BA, Schilder AG, Zielhuis GA, Graamans K (September 2005). "Natural course of tympanic membrane pathology related to otitis media and ventilation tubes between ages 8 and 18 years". Otology & Neurotology. 26 (5): 1016–21. doi:10.1097/01.mao.0000185058.89586.ed. PMID 16151352.
  18. ^ Pereira MB, Pereira DR, Costa SS (2005). "Tympanostomy tube sequelae in children with otitis media with effusion: a three-year follow-up study". Brazilian Journal of Otorhinolaryngology. 71 (4): 415–20. doi:10.1590/S0034-72992005000400003. hdl:10183/48960. PMID 16446953.
    - Schilder AG, Zielhuis GA, Haggard MP, van den Broek P (May 1995). "Long-term effects of otitis media with effusion: otomicroscopic findings". The American Journal of Otology. 16 (3): 365–72. PMID 8588632.
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