Perspectives of pharmacological treatment in otosclerosis

Abstract

To review our current knowledge of the pathologic bone metabolism in otosclerosis and to discuss the possibilities of non-surgical, pharmacological intervention. Otosclerosis has been suspected to be associated with defective measles virus infection, local inflammation and consecutive bone deterioration in the human otic capsule. In the early stages of otosclerosis, different pharmacological agents may delay the progression or prevent further deterioration of the disease and consecutive hearing loss. Although effective anti-osteoporotic drugs have become available, the use of sodium fluoride and bisphosphonates in otosclerosis has not yet been successful. Bioflavonoids may relieve tinnitus due to otosclerosis, but there is no data available on long-term application and effects on sensorineural hearing loss. In the initial inflammatory phase, corticosteroids or non-steroidal anti-inflammatory drugs may be effective; however, extended systemic application may lead to serious side effects. Vitamin D administration may have effects on the pathological bone loss, as well as on inflammation. No information has been reported on the use of immunosuppressive drugs. Anti-cytokine targeted biological therapy, however, may be feasible. Indeed, one study on the local administration of infliximab has been reported. Potential targets of future therapy may include osteoprotegerin, RANK ligand, cathepsins and also the Wnt-β-catenin pathway. Finally, anti-measles vaccination may delay the progression of the disease and potentially decrease the number of new cases. In conclusion, stapes surgery remains to be widely accepted treatment of conductive hearing loss due to otosclerosis. Due to lack of solid evidence, the place of pharmacological treatment targeting inflammation and bone metabolism needs to be determined by future studies.

Vestibular Disorders after Stapedial Surgery in Patients with Otosclerosis

“…Treatment tends to be medical or surgical, with surgery being the preferred option, namely, a stapedotomy or stapedectomy. Although uncommon, in certain circumstances, some health professionals treat the condition medically with bisphosphonates or fluorine compounds, normally during the initial stages of the illness [ 8 ], either separate from or in combination with calcium and vitamin D [ 9 ]. The use of glucocorticoids has also been proposed when there is an associated sensorineural component [ 9 , 10 ], and even the use of calcitonin has been suggested [ 11 ].…”

Otosclerosis. 1. rész: patogenezis

“…Az aktív stádium igen sejtdús (osteoclastok), bazofil karakterű, melyet kifejezett osteolysis jellemez. Ezzel szöges ellentétben áll az inaktív fázis, amely igen sejtszegény, kiégett eozinofil végállapotnak tekinthető [6,7].…”

Identification of a dynamic middle ear microbiome in healthy adults

“…As a result, the otic samples were enriched (85%) in Proteobacteria and Actinobacteria [19], which are also the most abundant phyla in the outer ear canal [23,24]. Transcanal sample collection in these prior studies [17][18][19][20] also considered as healthy controls, individuals undergoing surgery to 6 treat otic conditions (e.g., otosclerosis, middle ear malformation, Bell's palsy and deafness) that are associated with local inflammation and viral and bacterial infections [25][26][27][28]. Hence, the assumption that these individuals are healthy is questionable.…”