Causes and Treatment of Otosclerosis Discussion

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What is the cause of otosclerosis. List and briefly describe 3 treatment options for otosclerosis

What is otosclerosis?
Otosclerosis is a common cause of hearing loss. It is caused by a problem with the tiny bones (ossicles) which transmit vibrations through the middle ear so we can hear sound. Usually both ears are affected in otosclerosis but sometimes only one ear is affected.

Spirituality is the way to find meaning, hope, comfort, and inner peace in life. Many people find spirituality through religion. Some people find it through music, art, or a connection with nature. Others find it in their values and principles. Spirituality involves the recognition of a feeling or sense or belief that there is something greater than myself, something more to being human than sensory experience, and that the greater whole of which we are part is cosmic or divine in nature.

Healthy spirituality gives a sense of peace, wholeness, and balance among the physical, emotional, social, and spiritual aspects of our lives. However, for most people, the path to such spirituality passes through struggles and suffering and often includes experiences that are frightening and painful. Positive beliefs, comfort, and strength gained from religion, meditation, and prayer can contribute to well-being. It may even promote healing. Improving your spiritual health may not cure an illness, but it may help you feel better.

Patients who are spiritual may utilize their beliefs in coping with illness, pain, and life stresses. Some studies indicate that those who are spiritual tend to have a more positive outlook and a better quality of life (Bogue, 2020).

Similar to other caring activities and procedures, spiritual care improves people’s spiritual well-being and performance as well as the quality of their spiritual life. Spiritual care has positive effects on individuals’ stress responses, and spiritual well-being such as the balance between physical, psychosocial, and spiritual aspects of self, a sense of integrity and excellence, and interpersonal relationships. Spiritual well-being is important for an individual’s health potential and the experience of illness/hospitalization can threaten the optimum achievement of this potential. Professional nursing embraces spiritual care as a dimension of practice. Causes and Treatment of Otosclerosis Discussion

Nurses’ practice patterns in the area of spiritual care can be grouped into two categories including religious and nonreligious interventions. Religious interventions include treating patients’ religious beliefs without prejudice, providing them with opportunities for connecting with God and expressing their values and beliefs, helping them practice their religion, and referring them to clerical and religious leaders (O’Brien, et al., 2019). Nonreligious interventions include nurses’ presence for patients and their families, making direct eye contact when communicating with patients, sympathizing with patients and their families, listening to patients and their families attentively, and having love and enthusiasm for patients.

Although spiritual care is meant to help people, I frequently gain as a nurse. Interpersonal trust and a connection with the patient require high emotional intelligence. It’s important to realize that spirituality isn’t always theological care (Ross et al., 2018). Whereas the healthcare industry easily incorporates spirituality into therapy, spiritual care is essential in all sectors of operation. For the sake of our clients, we as caregivers must respect spiritual support, learn the required skills, and schedule time to satisfy these needs.

References

Bogue, D. W., & Hogan, M. (2020). Practicing dignity: An introduction to Christian values and decision making in Health Care. Retrieved from https://lc.gcumedia.com/phi413v/practicing-dignity-an-introduction-to-christian-values-and-decision-making-in-health-care/v1.1/#/chapter/1

O’Brien, M., Kinloch, K., Groves, K., & Jack, B. (2019, August 9). Meeting patients’ spiritual needs during end of life care: A qualitative study of nurses’ and healthcare professionals’ perceptions of spiritual care training. Edge Hill University. Retrieved from https://research.edgehill.ac.uk/en/publications/meeting-patients-spiritual-needs-during-end-of-life-care-a-qualit-2

Ross , L., McSherry, W., Giske, T., Van Leeuwen, R., Schep-Akkerman, A., Koslander, T., Hall, J., Ostergaard Steenfeldt , V., & Jarvis, P. (2018, August). Nursing and midwifery students’ perceptions of spirituality, spiritual care, and spiritual care competency: A prospective, Longitudinal, correlational European study. Nurse education today. Retrieved from https://pubmed.ncbi.nlm.nih.gov/29763841/

Otosclerosis affects about 1 or 2 in 100 people in the UK.

It usually first develops between the ages of 15-35 years but sometimes develops in younger children.
Women are affected twice as often as men.
Pregnancy is not a cause but may make the condition worse, so symptoms are commonly first noticed during pregnancy.
Nobody actually knows why otosclerosis happens. However, what is known is that otosclerosis is not caused or worsened by listening to loud music or working in a loud environment.

Otosclerosis happens because there is abnormal bone formation in one of the tiny bones in the middle ear. It is not clear why this happens but it is likely to be caused by a combination of various factors:

Hereditary (genetic) factors.
Complications from having had a virus.
Possible effect of low fluoride levels.
Otosclerosis symptoms
Hearing loss
Speaking softly
Hearing better in noisy surroundings
Hearing sounds from within your body
Dizziness and balance problems
Hearing loss
Hearing loss is the main symptom of otosclerosis. The hearing loss may remain mild but commonly it gradually becomes worse. It usually affects both ears, but not always. In some people the hearing loss stays mild for a number of years before getting worse. In others the hearing loss quickly becomes worse. Without treatment, in time, the affected ears often become totally deaf.

The hearing loss is usually of lower sounds, whereas age-related hearing loss has more effect on higher-pitched sounds.

Speaking softly
If you have otosclerosis, you may speak unusually quietly. The effect of otosclerosis on your ears is to make your own voice sound loud to you.

Hearing better in noisy surroundings
Paracusis is also common. If you have this, you can hear better when there is a lot of background noise. For example, you seem to hear better when talking to someone in a pub or a café that is full of other people. This may be because other people raise their voices in noisy places.

Hearing sounds from within your body
Tinnitus is an abnormal noise which you hear but which seems not to come from outside your ear. It occurs in about 4 in 5 people with otosclerosis. Noises heard include ringing, whistles, roaring, machine-type noises, etc. Tinnitus tends to worsen as hearing loss worsens.

Dizziness and balance problems
Vertigo is a condition where problems with dizziness and balance are experienced. This condition develops in some people with otosclerosis, although it is less common. It occurs when the balance mechanism in the inner ear (the semicircular canals) is affected.

What are the likely causes of otosclerosis?
Faulty bone formation
Bone is a living tissue and contains cells that make, mould and take back up (resorb) bone. Normally bone is continually being broken down and re-modelled. In otosclerosis, it seems that the re-modelling process of the stirrup (stapes) – one of the tiny bony ossicles in the middle ear – becomes faulty. New bone is not made properly and abnormal bone forms. However, the reason why this occurs mainly in the stapes (and sometimes the cochlea) is not entirely clear.

Have you inherited it?
Hereditary (genetic) factors seem to be important because a tendency for otosclerosis can be inherited. About 2 out of every 3 people with otosclerosis have other family members who also have this condition. However, some people with otosclerosis have no family history.

Could it be a virus?
It is also thought that a virus may play a part and the measles virus has been suggested. Indeed, the number of people diagnosed with otosclerosis seems to have decreased since the measles virus vaccination has been given. It may be that a genetic tendency to develop otosclerosis is inherited by some people. Then a trigger, such as a viral infection, actually causes the condition to develop.

Low levels of fluoride
It is also possible that low levels of fluoride may have something to do with the development of otosclerosis. The number of cases of otosclerosis in the UK went down after fluoride was routinely added to drinking water. However, this possible link with low levels of fluoride is controversial.

What is affected in otosclerosis?
Otosclerosis mainly affects the tiny bone (ossicle) called the stirrup (stapes). To have normal hearing, the ossicles need to be able to move freely in response to sound waves. In otosclerosis, abnormal bone material grows around the stapes. The foot of the stapes, where it attaches to the cochlea, is usually where the condition starts. The abnormal bone reduces the movement of the stapes, which reduces the amount of sound that is transferred to the cochlea. The growth of the abnormal bone is very gradual. However, eventually the stapes can become fixed, or fused, with the bone of the cochlea. This can cause severe hearing loss. The hearing loss is known as conductive hearing loss because sound vibrations cannot be conducted (transmitted) from the stapes to the cochlea.

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In most cases, it is just the stapes which is affected. However, sometimes, over time, otosclerosis can also affect the bony shell of the cochlea and the nerve cells within it. If this is the case, the damage to the nerve cells means that the transmission of nerve impulses to the brain can be affected. A different type of hearing loss, called sensorineural hearing loss, can then occur.

What is the ear like and how do we hear?
The ear is divided into three parts – the outer (external) ear, the middle ear, and the inner ear. The middle ear behind the eardrum is filled with air. Air comes from the back of the nose up a thin channel called the Eustachian tube. In the middle ear there are three tiny bones (ossicles) – the hammer (malleus), anvil (incus) and stirrup (stapes). The inner ear includes the cochlea and semicircular canals.

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Sound waves come into the outer ear and hit the eardrum.
The sound waves cause the eardrum to vibrate.
The sound vibrations pass from the eardrum to the middle ear bones.
The bones then transmit the vibrations to the cochlea in the inner ear.
The cochlea converts the vibrations to sound signals which are sent along a nerve from the ear to the brain, allowing us to hear.
The semicircular canals in the inner ear contain a fluid that moves around as we move. The movement of the fluid is sensed by tiny hairs in the semicircular canals. These send messages to the brain along the ear (auditory) nerve to the brain to help maintain balance and posture.

How is otosclerosis diagnosed?
If you are worried about hearing loss, make an appointment to see your doctor. They will ask about the symptoms you have been getting and then they will generally look into your ears using an auriscope. This is the common instrument used to look inside your ears if you have earache. In otosclerosis, your eardrum usually looks normal and healthy when your doctor looks inside your ear.

Your doctor may refer you on to an ear, nose and throat specialist who will be able to make the diagnosis of otosclerosis. They will do hearing tests which will show a specific pattern of hearing loss in otosclerosis. The specialist may also use a small device that is placed in your ear, called a tympanometer. This can help them look at the movement of the bones within your ear. In otosclerosis, the stirrup (stapes) will move less. This test is very quick and does not cause any pain.

Sometimes the specialist may decide that you need to have a CT scan which will give them more information about how severe the otosclerosis is.

What are the treatment options for otosclerosis?
Hearing aids
At first, when the hearing loss is mild, you may not need any treatment. As the disease progresses and hearing loss becomes worse, hearing aids can make a big difference. However, when the hearing loss becomes severe, hearing aids may not be of much help.

Surgery
The most common operation that is done is to replace the stapes with an artificial bone made of plastic or metal. The operation is called a stapedectomy (or sometimes a stapedotomy). In most cases, this operation is successful and restores hearing. It may also reduce the chance of otosclerosis progressing to affect your inner ear.

However, it is a very delicate operation. There is a small risk that the operation will fail and cause total deafness in the operated ear. Also, there is a small risk of damaging other nerves during the operation and of causing disturbance to balance or taste. The operation may not cure tinnitus and will not improve hearing in the small number of cases which affect the cochlea. You should ask your surgeon about their success rates for this type of surgery.

So, although the operation is usually successful, it may be a difficult decision about if, or when, to opt for an operation. Because of the small chance of serious complications, some people decide to stick with hearing aids. They do so until their hearing becomes so bad that hearing aids are not helping very much. Other people opt for surgery earlier so as not to need hearing aids. When surgery is decided upon, the ear that is most badly affected is operated on first. This is the ear with most to gain if the operation is successful. It means that the best ear is still preserved in the small number of cases where the operation does not work.

There is debate about whether the second ear should be operated on in the future. Some surgeons feel not, because if anything were to go wrong with the ear already operated on, you would still have the possibility of wearing a hearing aid and hearing something with your second ear. You should discuss this with your surgeon.

Fluoride tablets
There is some limited evidence that fluoride tablets may possibly slow the progression of the otosclerosis in some cases. They may help to preserve hearing and also help to reduce the symptoms of dizziness and balance problems. However, such treatment is not widely used in the UK.

Hormone tablets and the contraceptive pill
Some doctors feel that taking the contraceptive pill or hormone replacement therapy may make otosclerosis worse. If you have otosclerosis and are considering taking hormone treatment such as this, you should discuss the pros and cons fully with your doctor.

What happens long-term?
Generally the hearing loss progresses over time, although this may be very slow. If it becomes bad enough for you to need an operation, that is usually very successful at resolving the hearing problems and other symptoms.