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Confirmed Otosclerosis Biomedical Research and Therapy, 6(3):3034-3039 Original Research Evaluation of balance function in patients with radiologically (CT scan) confirmed otosclerosis Rania Abdulfattah Sharaf1;∗, Rudrapathy Palaniappan2 ABSTRACT Objective: To assess balance function in patients with radiologically confirmed otosclerosis. Meth- ods: Sixteen patients (14 females and 2 males), who attended the Neuro-Otology clinic/ ENT clinics at the Royal National Throat Nose and Ear Hospital, participated in this study. After general medical, audiological and Neuro-Otological examination, patients underwent the caloric and rotational test- ing. Results: Thirteen of the 16 patients had radiologically confirmed otosclerosis (12 females and 1 male). A total of 3 patients (2 females and 1 male) did not have CT confirmation of otosclerosis, and therefore, were excluded from the study. The remaining 13 patients' data were analyzed. Nine patients had a mixed hearing impairment at least on one side, while eight patients had a bilateral mixed hearing loss and one patient had a sensorineural hearing loss on one side. Four patients had a bilateral sensorineural hearing loss. Only 1 patient had a canal paresis (CP) at 35 %. None of the patients had any significant directional preponderance (DP). The patient with significant CP (35%) did not show any rotational asymmetry on impulsive rotation. Eleven patients had a rotational chair test. Only one patient had a significant asymmetry to the right at 25.30% (normal range is <20%). Overall, 18% (n = 2) of the radiologically confirmed otosclerosis patients showed an abnormal bal- ance test, including both caloric and rotational tests. More than 80% (n = 9) of the patients with radiological otosclerosis showed balance symptoms. Conclusions: the current study indicates a high prevalence of balance symptoms (n = 9 or 82%) in patients with radiological otosclerosis, al- though only a small proportion (n = 2 or 18%) showed an abnormal vestibular function on caloric and impulse rotation testing. However, due to a small number of samples, further validation of this result is warranted. Key words: Balance, Otosclerosis, Canal paresis, Vestibular function, Hearing impairment 1National Guard health affairs, Ministry of Nation guard, Saudi Arabia 2Royal National Throat Nose and Ear INTRODUCTION sis. Unsteadiness and dizziness have been frequently Hospital, UCLH NHS Foundation Trust, observed in these patients. Abnormal electronystag- London, UK Balance function studies in otosclerosis were carried out mainly in the early and late 70s, when the diag- mographic (ENG) findings have been reported in oto- Correspondence 3 nosis of this condition was based essentially on au- sclerotics . In the last few years, the study of otoscle- Rania Abdulfattah Sharaf, National diometric findings without any radiological confir- rosis has principally been devoted to the histochem- Guard health affairs, Ministry of Nation istry of otosclerotic foci 4,5. guard, Saudi Arabia mation. It is, therefore, possible that the incidence of It is important to distinguish between clinical, non- Email: [email protected] balance disorder reported in otosclerosis may not be a true reflection of the problem. We conducted this clinical or histological otosclerosis; the latter is about History 6 • Received: Jan 02, 2019 study to assess balance function in patients with radi- 10 times more common than the former . A study has • Accepted: Mar 10, 2019 ologically (CT scan) confirmed otosclerosis, includ- revealed histological otosclerosis on temporal bones • 7 Published: Mar 29, 2019 ing both patients with fenestral and cochlear diseases. in 12% of patients . In 1944, Guild demonstrated histological otosclerosis in only 8.3% of 482 African DOI : 10.15419/bmrat.v6i3.526 In addition to typical conductive hearing loss, patients suffering from otosclerosis often have a perceptive races, which was much less in the wider population 8 hearing loss. Cochlear lesions are caused by the se- (around 1%) . cretions from the active otosclerotic foci, which then Otosclerosis is usually bilateral; however, the fre- enter the endolymph 1. Vestibular disturbances also quency of histological unilateral otosclerosis ranges Copyright appear in patients suffering from otosclerosis 2, which between 13% and 30% 8–10. The area of the © Biomedpress. This is an open- labyrinthine capsule immediately in front of the foot- access article distributed under the may be derived from otosclerotic vascular changes terms of the Creative Commons due to the disease or from biochemical changes in the plate of the stapes, which is called ‘fissula ante- Attribution 4.0 International license. inner ear fluids. Because hearing loss is the dominant fenestrum‘, is the site of predilection for otosclerosis. feature of otosclerosis, these patients may not be ex- Other frequent sites may include a border of the round amined for other disorders associated with otosclero- window and even the footplate of the stapes around Cite this article : Abdulfattah Sharaf R, Palaniappan R. Evaluation of balance function in patients with radiologically (CT scan) confirmed otosclerosis. Biomed. Res. Ther.; 6(3):3034-3039. 3034 Biomedical Research and Therapy, 6(3):3034-3039 the cochlea, the internal auditory canal, or less often, Physical examination 11 around the semicircular canal . Within the clinic, a brief interview was carried out to Previous studies reported vestibular symptoms in pa- conform to our inclusion and exclusion criteria. In 12,13 tients with otosclerosis . Clinical studies reported this initial interview, each patient was asked to fill the prevalence of vestibular symptoms in 3-35% of in the questionnaire and sign the consent form. The 14 patients with otosclerosis . Another study reported outer ear and the tympanic membrane (TM) were ex- increased caloric abnormalities in ears with cochlear amined using a halogen otoscope to exclude any per- pathology when compared to pure conductive hear- forations or abnormal looking ear drums prior to the 15 ing loss . The current study aimed to evaluate bal- test. ance function in patients with CT scan confirmed oto- sclerosis. Pure Tone Audiometry (PTA) METHODS PTA was carried out using a GSI6/clinical audiome- ter with a TDH-50P headphone, following the British Subjects Society of Audiology recommended procedure 16–18. The total of 16 patients, aged 13-82 (mean age = 56.5) The audiometer was maintained and calibrated by the and suffering from clinical otosclerosis, participated CAM services at the Royal National Throat, Nose & in this study. Patients with otosclerosis were recruited Ear Hospital (RNTNE) to ANSI 3.6, ISO 389. The from the Neuro-Otology and the ENT clinics at the audiometer was checked subjectively according to Royal National Throat N ose & e ar H ospital (RNT- the recommended procedure before the start of each NEH). Patients’ details of the above two clinics were clinic. Testing was carried out in a soundproof room collected from the respective consultants and they in the Neuro-Otology clinic. The test was performed were invited to take part in the study. Patients with by following the BSA recommended procedures. Pa- radiologically confirmed otosclerosis were included. tients were asked to press the switch button or raise Patients with a history of perforated eardrum or ear their fingers as soon as they heard the tone, and keep discharge, ear operations, head injuries, meningitis, pressing the button until they no longer heard the and ototoxic medication were excluded. As we al- tone. Tested frequencies were started at 1000 Hz, fol- ready had a normative data for the balance tests from lowed by 2000 Hz, 4000 Hz, 8000 Hz, 500 Hz, and the Neuro-Otology clinic at RNTNEH, the ethics 250 Hz, and retest was done at 1000 Hz, for the first committee did not give permission for caloric testing ear only. Then, the opposite ear was tested following of normal individuals. Consequently, this study could the same order. In a 3-second duration, tone was pre- not have a control group of normal individuals. How- sented at a level that was expected to be clearly au- ever, we were able to compare the data from the study dible to the patients, which was commonly about 30 with normative data available in the neuro-otology dB above the estimated threshold. Patient responses clinic. This study was approved by the Royal Free Hos- were checked if it was correct and indicated the en- pital and Medical School Local Research Ethics Com- tire duration. If there was no response, we raised the mittee. volume levels by 20 dB-intervals until a response was After necessary information, instruction and consent, obtained, and turned them down by 10 dB intervals patients had the following tests: until it dropped to 5dB or until the patient no longer 1-Pure tone Audiometry (PTA) responded. Tones were presented up to 4 times to de- 2-Impedance Audiometry (Tympanogram) cide whether at least 2 satisfactory responses were re- 3-Bithermal Water Caloric Test ceived. If this level was heard, it was the threshold for 4-Rotational chair Test (ENG) that tone, if not, we raised the levels by 5 dB and re- All patients had the impedance audiometry, pure peat the same steps until 2 out of 4 presentations were tone, air, and bone conduction thresholds as per satisfactory. British Society of Audiology (BSA) recommended procedures. All eligible patients had bithermal caloric Admittance Measures (Tympanometry) and rotational chair testing and the response was Impedance audiometry was carried out using GSI 33 recorded by electronystagmography. All patients Impedance Bridge, calibrated by CAM services at the filled in a q uestionnaire, which included 8 different Royal National Throat, Nose & Ear Hospital to ANSI types of questions regarding to their balance (See ap- 3.6 (1969), ISO 389 (1975) standards. Screening tym- pendix A). Each participant was requested to provide panometry was carried out in all patients, accord- a written informed consent form before participation. ing to the recommended procedures 19. Patients were 3035 Biomedical Research and Therapy, 6(3):3034-3039 given a brief description of the test procedure.
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