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Physical examination

* The results of your audiometry must be confirmed by a tuning fork test. In most cases, only

a 512-! tuning fork is necessary. The "eber test is more sensiti#e than the $inne test. %e

sure to mask the better-hearing ear &ith narro&-band noise &hen there is a substantial

difference bet&een the t&o ears. %e a&are thatcartilaginouscolla'se, caused by theear'hone, may yield a false-'ositi#e result for aconducti#e hearing loss.

* (ou should be able to #ery closely 'redict theaudiometricresults by using your o&n #oice.

If the 'atient hears the softest &his'er )&hen your li's are mo#ing, the hearing loss is less

than 15 d%. +ther benchmarks a soft &his'er, less than 2 d% a soft to medium &his'er, /

to 0 d% a moderate &his'er, 5 d% a loud &his'er, d% a soft #oice, d% a medium

#oice, 3 d% and a shout, 4 d%. Patients &ith high-freuency hearing losses &ill still hear a

soft &his'er. 6ask &ith &hite noise &hen there is a substantial difference in hearing bet&een

the t&o ears.

* Test the mo#ement of themalleus&ith your 'neumatic otosco'eor &ith direct'al'ationunder the microsco'e after anestheti!ing the umbo&ith 'henol.

* If the hearing is nearly eual in the t&o ears and the decision is to either )1 'erform

re#ision surgery on the 're#iously o'erated ear or )2 o'erate on the 're#iously uno'erated

ear, choose the second o'tion. 7uccess rates in 're#iously uno'erated ears are &ell abo#e

48, &hile those for re#ision surgery are a''roximately 58.

* In 'lanning to o'erate on both ears in &hich the hearing is nearly eual, do the left ear first

if you are right-handed con#ersely, do the right ear first if you are left-handed. This is

es'ecially im'ortant for obese 'atients, for 'atients &ith a large chest or short neck, and for

'atients &ho cannot freely turn their necks.

* In 'atients &ith both otosclerosisand serous otitis media, treat the serous otitis media first.

* Post'one surgery in 'atients &ith external otitis until the otitis is adeuately treated.

* Post'one surgery if the 'atient has any infection any&here.

* 9o not 'erform surgery if the air-bone ga' is less than 2 d%.

* :l&ays test each 'atient at least t&ice before surgery.

* 9o not de'end on the 7ch&art! sign. It is rarely seen.

* 6ake sure that the hearing aid is ke't out of the ear to be o'erated on for at least a &eek

before surgery.

* If the eardrumis atro'hic, be 're'ared to re'air it at the time of surgery by reinforcing the

drum &ith fascia,'erichondrium,or a #ein graft.

* If there is attic retraction, be 're'ared to re'air it &ith cartilage or 'erichondrium.

* If a 'erforation is 'resent and it is anything but #ery small, 'erform a tym'ano'lasty.

http://medical-dictionary.thefreedictionary.com/cartilaginoushttp://medical-dictionary.thefreedictionary.com/cartilaginoushttp://medical-dictionary.thefreedictionary.com/conductive+hearing+losshttp://medical-dictionary.thefreedictionary.com/conductive+hearing+losshttp://www.thefreedictionary.com/audiometrichttp://www.thefreedictionary.com/audiometrichttp://medical-dictionary.thefreedictionary.com/Malleushttp://medical-dictionary.thefreedictionary.com/Malleushttp://medical-dictionary.thefreedictionary.com/otoscopehttp://medical-dictionary.thefreedictionary.com/Palpationhttp://medical-dictionary.thefreedictionary.com/umbohttp://medical-dictionary.thefreedictionary.com/umbohttp://encyclopedia2.thefreedictionary.com/Otosclerosishttp://medical-dictionary.thefreedictionary.com/eardrumhttp://medical-dictionary.thefreedictionary.com/perichondriumhttp://medical-dictionary.thefreedictionary.com/perichondriumhttp://medical-dictionary.thefreedictionary.com/tympanoplastyhttp://medical-dictionary.thefreedictionary.com/conductive+hearing+losshttp://www.thefreedictionary.com/audiometrichttp://medical-dictionary.thefreedictionary.com/Malleushttp://medical-dictionary.thefreedictionary.com/otoscopehttp://medical-dictionary.thefreedictionary.com/Palpationhttp://medical-dictionary.thefreedictionary.com/umbohttp://encyclopedia2.thefreedictionary.com/Otosclerosishttp://medical-dictionary.thefreedictionary.com/eardrumhttp://medical-dictionary.thefreedictionary.com/perichondriumhttp://medical-dictionary.thefreedictionary.com/tympanoplastyhttp://medical-dictionary.thefreedictionary.com/cartilaginous

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hearing loss &ith good s'eech discrimination and absent reflexes. "e often 'ut 'atients like

this on sodium fluoride, e#en if the reflexes are 'resent.

* If a 'atient has a conducti#e hearing loss and reflexes are 'resent, obtain com'uted

tomogra'hy of the tem'oral bones to rule outsu'erior semicircular canaldehiscence.

* 9o not 'erform a sta'edectomy on a 'atient &hose reflexes are 'resent.

* :s soon as a diagnosis of otosclerosis is made, all adults should be treated &ith >lorical )a

sodium fluoride and calcium su''lement, 2 to 0 tablets 'er day de'ending on the amount of

ner#e loss and the si!e of the 'atient, 'lus 0 @ of #itamin 9. Treatment can continue

indefinitely after surgery the greater the ner#e in#ol#ement is, the longer the treatment

should be. :dults &ho are taking a tetracycline or &ho ha#e kidney stones can take >lorical.

Those &ho ex'erience gastric sym'toms on >lorical may s&itch to 6onocal, a form of

sodium fluoride and calcium that is absorbed in the intestine rather than the stomach.

:dolescents can be treated &ith 2.2 mg=day of sodium fluoride.

* If the sensorineuralcom'onent of the hearing loss continues to &orsen in 'osto'erati#e

'atients on >lorical and #itamin 9, add mg of 6. 7hort- and long-term results of

sta'edectomy in children. Baryngosco'e 144313)0 Pt 154-2.

)2. Bi''y ", %urkey C6, >ucci 6C, et al. 7ta'edectomy in the elderly. :m C +tol

1441)3/1-0.

)/. Bi''y ", %attista $:, 7churing :D, $i!er >6. >ar-ad#anced otosclerosis. :m C +tol

144015)2225-3.

)0. Eat!a# C, Bi''y ", 7hamiss :, 9a#idson %F. 7ta'edectomy in combat 'ilots. :m C

+tol 1441)30-4.

http://encyclopedia.thefreedictionary.com/Superior+semicircular+canalhttp://encyclopedia.thefreedictionary.com/Superior+semicircular+canalhttp://medical-dictionary.thefreedictionary.com/dehiscencehttp://medical-dictionary.thefreedictionary.com/dehiscencehttp://medical-dictionary.thefreedictionary.com/dehiscencehttp://medical-dictionary.thefreedictionary.com/sensorineuralhttp://www.thefreedictionary.com/Dehiscenthttp://www.thefreedictionary.com/Dehiscenthttp://medical-dictionary.thefreedictionary.com/footplatehttp://medical-dictionary.thefreedictionary.com/footplatehttp://encyclopedia.thefreedictionary.com/Superior+semicircular+canalhttp://medical-dictionary.thefreedictionary.com/dehiscencehttp://medical-dictionary.thefreedictionary.com/sensorineuralhttp://www.thefreedictionary.com/Dehiscenthttp://medical-dictionary.thefreedictionary.com/footplate

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)5. 9aniels $B, Erieger B", Bi''y ". The other ear >indings and results in 1,3

bilateral sta'edectomies. +tol ;eurotol 2122)5/-.

>rom The Bi''y Drou' for Aar, ;ose and Throat, "arren, +hio.