15
Gavin Morrison Guy’s & St Thomas’ Hospitals, London, UK 28 th Politzer Society, Athens, 28 Sept – 1 October 2011
Gavin Morrison
Guyrsquos amp St Thomasrsquo Hospitals London UK
28th Politzer Society Athens 28 Sept ndash 1 October 2011
Otosclerosis amp Dizziness
Clinical Features
Aetiologies of Hydrops with otosclerosis
Temporal bone studies
Investigations
Managements When to Operate
Post operative
Hydrops
Simulated Hydrops
frac14 patients have some dizziness
Most do not have endolymphatic Hydrops
Types of Dizziness
Vague or brief dizziness - resolves after stapedectomy
BPPV ndash improves after Epley manoeuvre and after stapedectomy
True Endolymphatic Hydrops
Post Operative Endolymphatic Hydrops With fistula
Delayed
Simulated Post-op Hydrops
Fluctuant hearing levels
Menierersquos disease like Vertigo attacks
Aural Fullness tinnitus
Possible Hennebertrsquos sign
Audiogram
2007 Anita Pollak Zurich ndash 2 bones with hydrops due to otosclerotic foci obstructing endolymphatic duct (ref 1)
1982 Johnsson et al ndash 4 temporal bones with cochleo-saccular hydrops at otospongiotic foci fluid dynamics disturbed (ref 2)
1984 Liston Paparella et al (ref 3)
1990 Yoon Paparella Schachem 4128 (3) temporal bones with otosclerosis involved VA and had hydrops 10128 (78) had hydrops (ref 4)
1990 H Fisch ndash hydrops due to capsular otosclerosis causing duct obstruction 18 other cases without hydrops (5) ref 5
Last 200 referrals with Otosclerosis
Presentation with clinical picture of associated Hydrops in 11 cases
Incidence at presentation = 55
No suggestive history ndash no need
Suggestive History
Electrocochleography (70-85 sensitivity 2002 Shea Ear Clinic) ( ref6 )
MRI Scan
Cutting edge inner ear MRI (ref 7) Japan
3 Tesla novel phase sequences after Gd
Otology amp Neurotology 2008 29(4)571-572 Active Otospongiosis amp Hydrops (ref8)
Dilated Saccule or Reissnerrsquos membrane in contact with footplate
Intraoperative or post operative rupture
Confirm with ECOG Treat Medically
Fluoride Low salt Possible Diuretics vasodilators or Dexametasone
Avoid Stapedotomy Hearing aid BAHA Consider Stapes surgery after 2 years if no symptoms and
ECOG returned to normal Only consider stapes surgery if audiogram favourablehellip
If surgery undertaken ndash Mobilisation or posterior 13 small fenestra
Poor cochlear function amp Good hearing in other ear
Bone conduction worse than 45dB at 500 Hz and high frequency loss (House group 1984) (ref 9)
Early ndash with Perilymph Fistula Leak rate too fast for replacement through cochlear
aqueduct Low CSF pressure syndrome E Hydrops Management ndash SURGERY to close fistula
Delayed Hydrops
Otospongiotic obstruction of VAELS Inner ear scar tissue ndash obstruction (eg Saccule collapse) Non-suppurative labyrinthitis causes altered fluid
production drainage (ref 10)
Simulated Hydrops
Piston abutting or adherent to saccule ndash vertigo but not hydrops (-ve ECOG)
Endolymphatic Hydrops occurs secondary to Otosclerosis in about 8 cases presenting for treatment
If the history is suggestive ndash Undertake ECOG
Avoid Stapes Surgery with genuine active hydrops
Post-operative Hydrops can develop due to fistulization ndash if so seal it
Delayed Post-op hydrops is also described and requires conservative management
1 Otosclerosis associated with Meacuteniegraveres disease a histological study Advances in oto-rhino-laryngology Adv-Otorhinolaryngol 2007 vol 65 p 50-2 ISSN 0065-3071 Pollak-Anita
2 Cochlear and otoconial abnormalities in capsular otosclerosis with hydrops Johnsson LG Hawkins JE Jr Rouse RC Linthicum FH Jr Ovid MEDLINE(R) Annals of Otology Rhinology amp Laryngology - Supplement 973-15 1982 Sep-Oct
3 Extensive otosclerosis and endolymphatic hydrops histopathologic study of temporal bones Li W Schachern PA Paparella MM
4 Ovid MEDLINE(R) American Journal of Otolaryngology 15(2)158-61 1994 Mar-Apr Otosclerosis involving the vestibular aqueduct and Menieres disease Yoon TH Paparella MM Schachern PA Ovid MEDLINE(R) Otolaryngology - Head amp Neck Surgery 103(1)107-12 1990 Jul
5 Menieres symptoms resulting from bilateral otosclerotic occlusion of the endolymphatic duct an analysis of a causal relationship between otosclerosis and Menieres disease Franklin DJ Pollak A Fisch U Ovid MEDLINE(R) American Journal of Otology 11(2)135-40 1990 Mar
6 Transtympanic electrocochleography a 10-year experience Otology amp neurotology official publication of the American Otological Society American Neurotology Society (and) European Academy of Otology and Neurotology Otol-Neurotol Sep 2002 vol 23 no 5 p 799-805
7 Cutting edge of inner ear MRI Acta oto-laryngologica Supplementum Acta-Otolaryngol-Suppl Feb 2009 no 560 p 15-21 22 refs ISSN 0365-5237 Naganawa-Shinji Nakashima-Tsutomu
8 Cochlear otosclerosis amp endolymphatic hydrops Otology amp Neurotology 2008 29(4)571-572 A Makarem FH Linthicum
9 The effect of stepedectomy on hearing of patients with otosclerosis and menierersquos disease American J of Otology 19834323-326
10 Endolymphatic hydrops associated with otosclerosis The American journal of otology Am-J-Otol May 1994 vol 15 no 3 p 348-57 ISSN 0192-9763 Shea-J-J-Jr Ge-X Orchik-D-J
Otosclerosis amp Dizziness
Clinical Features
Aetiologies of Hydrops with otosclerosis
Temporal bone studies
Investigations
Managements When to Operate
Post operative
Hydrops
Simulated Hydrops
frac14 patients have some dizziness
Most do not have endolymphatic Hydrops
Types of Dizziness
Vague or brief dizziness - resolves after stapedectomy
BPPV ndash improves after Epley manoeuvre and after stapedectomy
True Endolymphatic Hydrops
Post Operative Endolymphatic Hydrops With fistula
Delayed
Simulated Post-op Hydrops
Fluctuant hearing levels
Menierersquos disease like Vertigo attacks
Aural Fullness tinnitus
Possible Hennebertrsquos sign
Audiogram
2007 Anita Pollak Zurich ndash 2 bones with hydrops due to otosclerotic foci obstructing endolymphatic duct (ref 1)
1982 Johnsson et al ndash 4 temporal bones with cochleo-saccular hydrops at otospongiotic foci fluid dynamics disturbed (ref 2)
1984 Liston Paparella et al (ref 3)
1990 Yoon Paparella Schachem 4128 (3) temporal bones with otosclerosis involved VA and had hydrops 10128 (78) had hydrops (ref 4)
1990 H Fisch ndash hydrops due to capsular otosclerosis causing duct obstruction 18 other cases without hydrops (5) ref 5
Last 200 referrals with Otosclerosis
Presentation with clinical picture of associated Hydrops in 11 cases
Incidence at presentation = 55
No suggestive history ndash no need
Suggestive History
Electrocochleography (70-85 sensitivity 2002 Shea Ear Clinic) ( ref6 )
MRI Scan
Cutting edge inner ear MRI (ref 7) Japan
3 Tesla novel phase sequences after Gd
Otology amp Neurotology 2008 29(4)571-572 Active Otospongiosis amp Hydrops (ref8)
Dilated Saccule or Reissnerrsquos membrane in contact with footplate
Intraoperative or post operative rupture
Confirm with ECOG Treat Medically
Fluoride Low salt Possible Diuretics vasodilators or Dexametasone
Avoid Stapedotomy Hearing aid BAHA Consider Stapes surgery after 2 years if no symptoms and
ECOG returned to normal Only consider stapes surgery if audiogram favourablehellip
If surgery undertaken ndash Mobilisation or posterior 13 small fenestra
Poor cochlear function amp Good hearing in other ear
Bone conduction worse than 45dB at 500 Hz and high frequency loss (House group 1984) (ref 9)
Early ndash with Perilymph Fistula Leak rate too fast for replacement through cochlear
aqueduct Low CSF pressure syndrome E Hydrops Management ndash SURGERY to close fistula
Delayed Hydrops
Otospongiotic obstruction of VAELS Inner ear scar tissue ndash obstruction (eg Saccule collapse) Non-suppurative labyrinthitis causes altered fluid
production drainage (ref 10)
Simulated Hydrops
Piston abutting or adherent to saccule ndash vertigo but not hydrops (-ve ECOG)
Endolymphatic Hydrops occurs secondary to Otosclerosis in about 8 cases presenting for treatment
If the history is suggestive ndash Undertake ECOG
Avoid Stapes Surgery with genuine active hydrops
Post-operative Hydrops can develop due to fistulization ndash if so seal it
Delayed Post-op hydrops is also described and requires conservative management
1 Otosclerosis associated with Meacuteniegraveres disease a histological study Advances in oto-rhino-laryngology Adv-Otorhinolaryngol 2007 vol 65 p 50-2 ISSN 0065-3071 Pollak-Anita
2 Cochlear and otoconial abnormalities in capsular otosclerosis with hydrops Johnsson LG Hawkins JE Jr Rouse RC Linthicum FH Jr Ovid MEDLINE(R) Annals of Otology Rhinology amp Laryngology - Supplement 973-15 1982 Sep-Oct
3 Extensive otosclerosis and endolymphatic hydrops histopathologic study of temporal bones Li W Schachern PA Paparella MM
4 Ovid MEDLINE(R) American Journal of Otolaryngology 15(2)158-61 1994 Mar-Apr Otosclerosis involving the vestibular aqueduct and Menieres disease Yoon TH Paparella MM Schachern PA Ovid MEDLINE(R) Otolaryngology - Head amp Neck Surgery 103(1)107-12 1990 Jul
5 Menieres symptoms resulting from bilateral otosclerotic occlusion of the endolymphatic duct an analysis of a causal relationship between otosclerosis and Menieres disease Franklin DJ Pollak A Fisch U Ovid MEDLINE(R) American Journal of Otology 11(2)135-40 1990 Mar
6 Transtympanic electrocochleography a 10-year experience Otology amp neurotology official publication of the American Otological Society American Neurotology Society (and) European Academy of Otology and Neurotology Otol-Neurotol Sep 2002 vol 23 no 5 p 799-805
7 Cutting edge of inner ear MRI Acta oto-laryngologica Supplementum Acta-Otolaryngol-Suppl Feb 2009 no 560 p 15-21 22 refs ISSN 0365-5237 Naganawa-Shinji Nakashima-Tsutomu
8 Cochlear otosclerosis amp endolymphatic hydrops Otology amp Neurotology 2008 29(4)571-572 A Makarem FH Linthicum
9 The effect of stepedectomy on hearing of patients with otosclerosis and menierersquos disease American J of Otology 19834323-326
10 Endolymphatic hydrops associated with otosclerosis The American journal of otology Am-J-Otol May 1994 vol 15 no 3 p 348-57 ISSN 0192-9763 Shea-J-J-Jr Ge-X Orchik-D-J
frac14 patients have some dizziness
Most do not have endolymphatic Hydrops
Types of Dizziness
Vague or brief dizziness - resolves after stapedectomy
BPPV ndash improves after Epley manoeuvre and after stapedectomy
True Endolymphatic Hydrops
Post Operative Endolymphatic Hydrops With fistula
Delayed
Simulated Post-op Hydrops
Fluctuant hearing levels
Menierersquos disease like Vertigo attacks
Aural Fullness tinnitus
Possible Hennebertrsquos sign
Audiogram
2007 Anita Pollak Zurich ndash 2 bones with hydrops due to otosclerotic foci obstructing endolymphatic duct (ref 1)
1982 Johnsson et al ndash 4 temporal bones with cochleo-saccular hydrops at otospongiotic foci fluid dynamics disturbed (ref 2)
1984 Liston Paparella et al (ref 3)
1990 Yoon Paparella Schachem 4128 (3) temporal bones with otosclerosis involved VA and had hydrops 10128 (78) had hydrops (ref 4)
1990 H Fisch ndash hydrops due to capsular otosclerosis causing duct obstruction 18 other cases without hydrops (5) ref 5
Last 200 referrals with Otosclerosis
Presentation with clinical picture of associated Hydrops in 11 cases
Incidence at presentation = 55
No suggestive history ndash no need
Suggestive History
Electrocochleography (70-85 sensitivity 2002 Shea Ear Clinic) ( ref6 )
MRI Scan
Cutting edge inner ear MRI (ref 7) Japan
3 Tesla novel phase sequences after Gd
Otology amp Neurotology 2008 29(4)571-572 Active Otospongiosis amp Hydrops (ref8)
Dilated Saccule or Reissnerrsquos membrane in contact with footplate
Intraoperative or post operative rupture
Confirm with ECOG Treat Medically
Fluoride Low salt Possible Diuretics vasodilators or Dexametasone
Avoid Stapedotomy Hearing aid BAHA Consider Stapes surgery after 2 years if no symptoms and
ECOG returned to normal Only consider stapes surgery if audiogram favourablehellip
If surgery undertaken ndash Mobilisation or posterior 13 small fenestra
Poor cochlear function amp Good hearing in other ear
Bone conduction worse than 45dB at 500 Hz and high frequency loss (House group 1984) (ref 9)
Early ndash with Perilymph Fistula Leak rate too fast for replacement through cochlear
aqueduct Low CSF pressure syndrome E Hydrops Management ndash SURGERY to close fistula
Delayed Hydrops
Otospongiotic obstruction of VAELS Inner ear scar tissue ndash obstruction (eg Saccule collapse) Non-suppurative labyrinthitis causes altered fluid
production drainage (ref 10)
Simulated Hydrops
Piston abutting or adherent to saccule ndash vertigo but not hydrops (-ve ECOG)
Endolymphatic Hydrops occurs secondary to Otosclerosis in about 8 cases presenting for treatment
If the history is suggestive ndash Undertake ECOG
Avoid Stapes Surgery with genuine active hydrops
Post-operative Hydrops can develop due to fistulization ndash if so seal it
Delayed Post-op hydrops is also described and requires conservative management
1 Otosclerosis associated with Meacuteniegraveres disease a histological study Advances in oto-rhino-laryngology Adv-Otorhinolaryngol 2007 vol 65 p 50-2 ISSN 0065-3071 Pollak-Anita
2 Cochlear and otoconial abnormalities in capsular otosclerosis with hydrops Johnsson LG Hawkins JE Jr Rouse RC Linthicum FH Jr Ovid MEDLINE(R) Annals of Otology Rhinology amp Laryngology - Supplement 973-15 1982 Sep-Oct
3 Extensive otosclerosis and endolymphatic hydrops histopathologic study of temporal bones Li W Schachern PA Paparella MM
4 Ovid MEDLINE(R) American Journal of Otolaryngology 15(2)158-61 1994 Mar-Apr Otosclerosis involving the vestibular aqueduct and Menieres disease Yoon TH Paparella MM Schachern PA Ovid MEDLINE(R) Otolaryngology - Head amp Neck Surgery 103(1)107-12 1990 Jul
5 Menieres symptoms resulting from bilateral otosclerotic occlusion of the endolymphatic duct an analysis of a causal relationship between otosclerosis and Menieres disease Franklin DJ Pollak A Fisch U Ovid MEDLINE(R) American Journal of Otology 11(2)135-40 1990 Mar
6 Transtympanic electrocochleography a 10-year experience Otology amp neurotology official publication of the American Otological Society American Neurotology Society (and) European Academy of Otology and Neurotology Otol-Neurotol Sep 2002 vol 23 no 5 p 799-805
7 Cutting edge of inner ear MRI Acta oto-laryngologica Supplementum Acta-Otolaryngol-Suppl Feb 2009 no 560 p 15-21 22 refs ISSN 0365-5237 Naganawa-Shinji Nakashima-Tsutomu
8 Cochlear otosclerosis amp endolymphatic hydrops Otology amp Neurotology 2008 29(4)571-572 A Makarem FH Linthicum
9 The effect of stepedectomy on hearing of patients with otosclerosis and menierersquos disease American J of Otology 19834323-326
10 Endolymphatic hydrops associated with otosclerosis The American journal of otology Am-J-Otol May 1994 vol 15 no 3 p 348-57 ISSN 0192-9763 Shea-J-J-Jr Ge-X Orchik-D-J
Fluctuant hearing levels
Menierersquos disease like Vertigo attacks
Aural Fullness tinnitus
Possible Hennebertrsquos sign
Audiogram
2007 Anita Pollak Zurich ndash 2 bones with hydrops due to otosclerotic foci obstructing endolymphatic duct (ref 1)
1982 Johnsson et al ndash 4 temporal bones with cochleo-saccular hydrops at otospongiotic foci fluid dynamics disturbed (ref 2)
1984 Liston Paparella et al (ref 3)
1990 Yoon Paparella Schachem 4128 (3) temporal bones with otosclerosis involved VA and had hydrops 10128 (78) had hydrops (ref 4)
1990 H Fisch ndash hydrops due to capsular otosclerosis causing duct obstruction 18 other cases without hydrops (5) ref 5
Last 200 referrals with Otosclerosis
Presentation with clinical picture of associated Hydrops in 11 cases
Incidence at presentation = 55
No suggestive history ndash no need
Suggestive History
Electrocochleography (70-85 sensitivity 2002 Shea Ear Clinic) ( ref6 )
MRI Scan
Cutting edge inner ear MRI (ref 7) Japan
3 Tesla novel phase sequences after Gd
Otology amp Neurotology 2008 29(4)571-572 Active Otospongiosis amp Hydrops (ref8)
Dilated Saccule or Reissnerrsquos membrane in contact with footplate
Intraoperative or post operative rupture
Confirm with ECOG Treat Medically
Fluoride Low salt Possible Diuretics vasodilators or Dexametasone
Avoid Stapedotomy Hearing aid BAHA Consider Stapes surgery after 2 years if no symptoms and
ECOG returned to normal Only consider stapes surgery if audiogram favourablehellip
If surgery undertaken ndash Mobilisation or posterior 13 small fenestra
Poor cochlear function amp Good hearing in other ear
Bone conduction worse than 45dB at 500 Hz and high frequency loss (House group 1984) (ref 9)
Early ndash with Perilymph Fistula Leak rate too fast for replacement through cochlear
aqueduct Low CSF pressure syndrome E Hydrops Management ndash SURGERY to close fistula
Delayed Hydrops
Otospongiotic obstruction of VAELS Inner ear scar tissue ndash obstruction (eg Saccule collapse) Non-suppurative labyrinthitis causes altered fluid
production drainage (ref 10)
Simulated Hydrops
Piston abutting or adherent to saccule ndash vertigo but not hydrops (-ve ECOG)
Endolymphatic Hydrops occurs secondary to Otosclerosis in about 8 cases presenting for treatment
If the history is suggestive ndash Undertake ECOG
Avoid Stapes Surgery with genuine active hydrops
Post-operative Hydrops can develop due to fistulization ndash if so seal it
Delayed Post-op hydrops is also described and requires conservative management
1 Otosclerosis associated with Meacuteniegraveres disease a histological study Advances in oto-rhino-laryngology Adv-Otorhinolaryngol 2007 vol 65 p 50-2 ISSN 0065-3071 Pollak-Anita
2 Cochlear and otoconial abnormalities in capsular otosclerosis with hydrops Johnsson LG Hawkins JE Jr Rouse RC Linthicum FH Jr Ovid MEDLINE(R) Annals of Otology Rhinology amp Laryngology - Supplement 973-15 1982 Sep-Oct
3 Extensive otosclerosis and endolymphatic hydrops histopathologic study of temporal bones Li W Schachern PA Paparella MM
4 Ovid MEDLINE(R) American Journal of Otolaryngology 15(2)158-61 1994 Mar-Apr Otosclerosis involving the vestibular aqueduct and Menieres disease Yoon TH Paparella MM Schachern PA Ovid MEDLINE(R) Otolaryngology - Head amp Neck Surgery 103(1)107-12 1990 Jul
5 Menieres symptoms resulting from bilateral otosclerotic occlusion of the endolymphatic duct an analysis of a causal relationship between otosclerosis and Menieres disease Franklin DJ Pollak A Fisch U Ovid MEDLINE(R) American Journal of Otology 11(2)135-40 1990 Mar
6 Transtympanic electrocochleography a 10-year experience Otology amp neurotology official publication of the American Otological Society American Neurotology Society (and) European Academy of Otology and Neurotology Otol-Neurotol Sep 2002 vol 23 no 5 p 799-805
7 Cutting edge of inner ear MRI Acta oto-laryngologica Supplementum Acta-Otolaryngol-Suppl Feb 2009 no 560 p 15-21 22 refs ISSN 0365-5237 Naganawa-Shinji Nakashima-Tsutomu
8 Cochlear otosclerosis amp endolymphatic hydrops Otology amp Neurotology 2008 29(4)571-572 A Makarem FH Linthicum
9 The effect of stepedectomy on hearing of patients with otosclerosis and menierersquos disease American J of Otology 19834323-326
10 Endolymphatic hydrops associated with otosclerosis The American journal of otology Am-J-Otol May 1994 vol 15 no 3 p 348-57 ISSN 0192-9763 Shea-J-J-Jr Ge-X Orchik-D-J
2007 Anita Pollak Zurich ndash 2 bones with hydrops due to otosclerotic foci obstructing endolymphatic duct (ref 1)
1982 Johnsson et al ndash 4 temporal bones with cochleo-saccular hydrops at otospongiotic foci fluid dynamics disturbed (ref 2)
1984 Liston Paparella et al (ref 3)
1990 Yoon Paparella Schachem 4128 (3) temporal bones with otosclerosis involved VA and had hydrops 10128 (78) had hydrops (ref 4)
1990 H Fisch ndash hydrops due to capsular otosclerosis causing duct obstruction 18 other cases without hydrops (5) ref 5
Last 200 referrals with Otosclerosis
Presentation with clinical picture of associated Hydrops in 11 cases
Incidence at presentation = 55
No suggestive history ndash no need
Suggestive History
Electrocochleography (70-85 sensitivity 2002 Shea Ear Clinic) ( ref6 )
MRI Scan
Cutting edge inner ear MRI (ref 7) Japan
3 Tesla novel phase sequences after Gd
Otology amp Neurotology 2008 29(4)571-572 Active Otospongiosis amp Hydrops (ref8)
Dilated Saccule or Reissnerrsquos membrane in contact with footplate
Intraoperative or post operative rupture
Confirm with ECOG Treat Medically
Fluoride Low salt Possible Diuretics vasodilators or Dexametasone
Avoid Stapedotomy Hearing aid BAHA Consider Stapes surgery after 2 years if no symptoms and
ECOG returned to normal Only consider stapes surgery if audiogram favourablehellip
If surgery undertaken ndash Mobilisation or posterior 13 small fenestra
Poor cochlear function amp Good hearing in other ear
Bone conduction worse than 45dB at 500 Hz and high frequency loss (House group 1984) (ref 9)
Early ndash with Perilymph Fistula Leak rate too fast for replacement through cochlear
aqueduct Low CSF pressure syndrome E Hydrops Management ndash SURGERY to close fistula
Delayed Hydrops
Otospongiotic obstruction of VAELS Inner ear scar tissue ndash obstruction (eg Saccule collapse) Non-suppurative labyrinthitis causes altered fluid
production drainage (ref 10)
Simulated Hydrops
Piston abutting or adherent to saccule ndash vertigo but not hydrops (-ve ECOG)
Endolymphatic Hydrops occurs secondary to Otosclerosis in about 8 cases presenting for treatment
If the history is suggestive ndash Undertake ECOG
Avoid Stapes Surgery with genuine active hydrops
Post-operative Hydrops can develop due to fistulization ndash if so seal it
Delayed Post-op hydrops is also described and requires conservative management
1 Otosclerosis associated with Meacuteniegraveres disease a histological study Advances in oto-rhino-laryngology Adv-Otorhinolaryngol 2007 vol 65 p 50-2 ISSN 0065-3071 Pollak-Anita
2 Cochlear and otoconial abnormalities in capsular otosclerosis with hydrops Johnsson LG Hawkins JE Jr Rouse RC Linthicum FH Jr Ovid MEDLINE(R) Annals of Otology Rhinology amp Laryngology - Supplement 973-15 1982 Sep-Oct
3 Extensive otosclerosis and endolymphatic hydrops histopathologic study of temporal bones Li W Schachern PA Paparella MM
4 Ovid MEDLINE(R) American Journal of Otolaryngology 15(2)158-61 1994 Mar-Apr Otosclerosis involving the vestibular aqueduct and Menieres disease Yoon TH Paparella MM Schachern PA Ovid MEDLINE(R) Otolaryngology - Head amp Neck Surgery 103(1)107-12 1990 Jul
5 Menieres symptoms resulting from bilateral otosclerotic occlusion of the endolymphatic duct an analysis of a causal relationship between otosclerosis and Menieres disease Franklin DJ Pollak A Fisch U Ovid MEDLINE(R) American Journal of Otology 11(2)135-40 1990 Mar
6 Transtympanic electrocochleography a 10-year experience Otology amp neurotology official publication of the American Otological Society American Neurotology Society (and) European Academy of Otology and Neurotology Otol-Neurotol Sep 2002 vol 23 no 5 p 799-805
7 Cutting edge of inner ear MRI Acta oto-laryngologica Supplementum Acta-Otolaryngol-Suppl Feb 2009 no 560 p 15-21 22 refs ISSN 0365-5237 Naganawa-Shinji Nakashima-Tsutomu
8 Cochlear otosclerosis amp endolymphatic hydrops Otology amp Neurotology 2008 29(4)571-572 A Makarem FH Linthicum
9 The effect of stepedectomy on hearing of patients with otosclerosis and menierersquos disease American J of Otology 19834323-326
10 Endolymphatic hydrops associated with otosclerosis The American journal of otology Am-J-Otol May 1994 vol 15 no 3 p 348-57 ISSN 0192-9763 Shea-J-J-Jr Ge-X Orchik-D-J
Last 200 referrals with Otosclerosis
Presentation with clinical picture of associated Hydrops in 11 cases
Incidence at presentation = 55
No suggestive history ndash no need
Suggestive History
Electrocochleography (70-85 sensitivity 2002 Shea Ear Clinic) ( ref6 )
MRI Scan
Cutting edge inner ear MRI (ref 7) Japan
3 Tesla novel phase sequences after Gd
Otology amp Neurotology 2008 29(4)571-572 Active Otospongiosis amp Hydrops (ref8)
Dilated Saccule or Reissnerrsquos membrane in contact with footplate
Intraoperative or post operative rupture
Confirm with ECOG Treat Medically
Fluoride Low salt Possible Diuretics vasodilators or Dexametasone
Avoid Stapedotomy Hearing aid BAHA Consider Stapes surgery after 2 years if no symptoms and
ECOG returned to normal Only consider stapes surgery if audiogram favourablehellip
If surgery undertaken ndash Mobilisation or posterior 13 small fenestra
Poor cochlear function amp Good hearing in other ear
Bone conduction worse than 45dB at 500 Hz and high frequency loss (House group 1984) (ref 9)
Early ndash with Perilymph Fistula Leak rate too fast for replacement through cochlear
aqueduct Low CSF pressure syndrome E Hydrops Management ndash SURGERY to close fistula
Delayed Hydrops
Otospongiotic obstruction of VAELS Inner ear scar tissue ndash obstruction (eg Saccule collapse) Non-suppurative labyrinthitis causes altered fluid
production drainage (ref 10)
Simulated Hydrops
Piston abutting or adherent to saccule ndash vertigo but not hydrops (-ve ECOG)
Endolymphatic Hydrops occurs secondary to Otosclerosis in about 8 cases presenting for treatment
If the history is suggestive ndash Undertake ECOG
Avoid Stapes Surgery with genuine active hydrops
Post-operative Hydrops can develop due to fistulization ndash if so seal it
Delayed Post-op hydrops is also described and requires conservative management
1 Otosclerosis associated with Meacuteniegraveres disease a histological study Advances in oto-rhino-laryngology Adv-Otorhinolaryngol 2007 vol 65 p 50-2 ISSN 0065-3071 Pollak-Anita
2 Cochlear and otoconial abnormalities in capsular otosclerosis with hydrops Johnsson LG Hawkins JE Jr Rouse RC Linthicum FH Jr Ovid MEDLINE(R) Annals of Otology Rhinology amp Laryngology - Supplement 973-15 1982 Sep-Oct
3 Extensive otosclerosis and endolymphatic hydrops histopathologic study of temporal bones Li W Schachern PA Paparella MM
4 Ovid MEDLINE(R) American Journal of Otolaryngology 15(2)158-61 1994 Mar-Apr Otosclerosis involving the vestibular aqueduct and Menieres disease Yoon TH Paparella MM Schachern PA Ovid MEDLINE(R) Otolaryngology - Head amp Neck Surgery 103(1)107-12 1990 Jul
5 Menieres symptoms resulting from bilateral otosclerotic occlusion of the endolymphatic duct an analysis of a causal relationship between otosclerosis and Menieres disease Franklin DJ Pollak A Fisch U Ovid MEDLINE(R) American Journal of Otology 11(2)135-40 1990 Mar
6 Transtympanic electrocochleography a 10-year experience Otology amp neurotology official publication of the American Otological Society American Neurotology Society (and) European Academy of Otology and Neurotology Otol-Neurotol Sep 2002 vol 23 no 5 p 799-805
7 Cutting edge of inner ear MRI Acta oto-laryngologica Supplementum Acta-Otolaryngol-Suppl Feb 2009 no 560 p 15-21 22 refs ISSN 0365-5237 Naganawa-Shinji Nakashima-Tsutomu
8 Cochlear otosclerosis amp endolymphatic hydrops Otology amp Neurotology 2008 29(4)571-572 A Makarem FH Linthicum
9 The effect of stepedectomy on hearing of patients with otosclerosis and menierersquos disease American J of Otology 19834323-326
10 Endolymphatic hydrops associated with otosclerosis The American journal of otology Am-J-Otol May 1994 vol 15 no 3 p 348-57 ISSN 0192-9763 Shea-J-J-Jr Ge-X Orchik-D-J
No suggestive history ndash no need
Suggestive History
Electrocochleography (70-85 sensitivity 2002 Shea Ear Clinic) ( ref6 )
MRI Scan
Cutting edge inner ear MRI (ref 7) Japan
3 Tesla novel phase sequences after Gd
Otology amp Neurotology 2008 29(4)571-572 Active Otospongiosis amp Hydrops (ref8)
Dilated Saccule or Reissnerrsquos membrane in contact with footplate
Intraoperative or post operative rupture
Confirm with ECOG Treat Medically
Fluoride Low salt Possible Diuretics vasodilators or Dexametasone
Avoid Stapedotomy Hearing aid BAHA Consider Stapes surgery after 2 years if no symptoms and
ECOG returned to normal Only consider stapes surgery if audiogram favourablehellip
If surgery undertaken ndash Mobilisation or posterior 13 small fenestra
Poor cochlear function amp Good hearing in other ear
Bone conduction worse than 45dB at 500 Hz and high frequency loss (House group 1984) (ref 9)
Early ndash with Perilymph Fistula Leak rate too fast for replacement through cochlear
aqueduct Low CSF pressure syndrome E Hydrops Management ndash SURGERY to close fistula
Delayed Hydrops
Otospongiotic obstruction of VAELS Inner ear scar tissue ndash obstruction (eg Saccule collapse) Non-suppurative labyrinthitis causes altered fluid
production drainage (ref 10)
Simulated Hydrops
Piston abutting or adherent to saccule ndash vertigo but not hydrops (-ve ECOG)
Endolymphatic Hydrops occurs secondary to Otosclerosis in about 8 cases presenting for treatment
If the history is suggestive ndash Undertake ECOG
Avoid Stapes Surgery with genuine active hydrops
Post-operative Hydrops can develop due to fistulization ndash if so seal it
Delayed Post-op hydrops is also described and requires conservative management
1 Otosclerosis associated with Meacuteniegraveres disease a histological study Advances in oto-rhino-laryngology Adv-Otorhinolaryngol 2007 vol 65 p 50-2 ISSN 0065-3071 Pollak-Anita
2 Cochlear and otoconial abnormalities in capsular otosclerosis with hydrops Johnsson LG Hawkins JE Jr Rouse RC Linthicum FH Jr Ovid MEDLINE(R) Annals of Otology Rhinology amp Laryngology - Supplement 973-15 1982 Sep-Oct
3 Extensive otosclerosis and endolymphatic hydrops histopathologic study of temporal bones Li W Schachern PA Paparella MM
4 Ovid MEDLINE(R) American Journal of Otolaryngology 15(2)158-61 1994 Mar-Apr Otosclerosis involving the vestibular aqueduct and Menieres disease Yoon TH Paparella MM Schachern PA Ovid MEDLINE(R) Otolaryngology - Head amp Neck Surgery 103(1)107-12 1990 Jul
5 Menieres symptoms resulting from bilateral otosclerotic occlusion of the endolymphatic duct an analysis of a causal relationship between otosclerosis and Menieres disease Franklin DJ Pollak A Fisch U Ovid MEDLINE(R) American Journal of Otology 11(2)135-40 1990 Mar
6 Transtympanic electrocochleography a 10-year experience Otology amp neurotology official publication of the American Otological Society American Neurotology Society (and) European Academy of Otology and Neurotology Otol-Neurotol Sep 2002 vol 23 no 5 p 799-805
7 Cutting edge of inner ear MRI Acta oto-laryngologica Supplementum Acta-Otolaryngol-Suppl Feb 2009 no 560 p 15-21 22 refs ISSN 0365-5237 Naganawa-Shinji Nakashima-Tsutomu
8 Cochlear otosclerosis amp endolymphatic hydrops Otology amp Neurotology 2008 29(4)571-572 A Makarem FH Linthicum
9 The effect of stepedectomy on hearing of patients with otosclerosis and menierersquos disease American J of Otology 19834323-326
10 Endolymphatic hydrops associated with otosclerosis The American journal of otology Am-J-Otol May 1994 vol 15 no 3 p 348-57 ISSN 0192-9763 Shea-J-J-Jr Ge-X Orchik-D-J
Otology amp Neurotology 2008 29(4)571-572 Active Otospongiosis amp Hydrops (ref8)
Dilated Saccule or Reissnerrsquos membrane in contact with footplate
Intraoperative or post operative rupture
Confirm with ECOG Treat Medically
Fluoride Low salt Possible Diuretics vasodilators or Dexametasone
Avoid Stapedotomy Hearing aid BAHA Consider Stapes surgery after 2 years if no symptoms and
ECOG returned to normal Only consider stapes surgery if audiogram favourablehellip
If surgery undertaken ndash Mobilisation or posterior 13 small fenestra
Poor cochlear function amp Good hearing in other ear
Bone conduction worse than 45dB at 500 Hz and high frequency loss (House group 1984) (ref 9)
Early ndash with Perilymph Fistula Leak rate too fast for replacement through cochlear
aqueduct Low CSF pressure syndrome E Hydrops Management ndash SURGERY to close fistula
Delayed Hydrops
Otospongiotic obstruction of VAELS Inner ear scar tissue ndash obstruction (eg Saccule collapse) Non-suppurative labyrinthitis causes altered fluid
production drainage (ref 10)
Simulated Hydrops
Piston abutting or adherent to saccule ndash vertigo but not hydrops (-ve ECOG)
Endolymphatic Hydrops occurs secondary to Otosclerosis in about 8 cases presenting for treatment
If the history is suggestive ndash Undertake ECOG
Avoid Stapes Surgery with genuine active hydrops
Post-operative Hydrops can develop due to fistulization ndash if so seal it
Delayed Post-op hydrops is also described and requires conservative management
1 Otosclerosis associated with Meacuteniegraveres disease a histological study Advances in oto-rhino-laryngology Adv-Otorhinolaryngol 2007 vol 65 p 50-2 ISSN 0065-3071 Pollak-Anita
2 Cochlear and otoconial abnormalities in capsular otosclerosis with hydrops Johnsson LG Hawkins JE Jr Rouse RC Linthicum FH Jr Ovid MEDLINE(R) Annals of Otology Rhinology amp Laryngology - Supplement 973-15 1982 Sep-Oct
3 Extensive otosclerosis and endolymphatic hydrops histopathologic study of temporal bones Li W Schachern PA Paparella MM
4 Ovid MEDLINE(R) American Journal of Otolaryngology 15(2)158-61 1994 Mar-Apr Otosclerosis involving the vestibular aqueduct and Menieres disease Yoon TH Paparella MM Schachern PA Ovid MEDLINE(R) Otolaryngology - Head amp Neck Surgery 103(1)107-12 1990 Jul
5 Menieres symptoms resulting from bilateral otosclerotic occlusion of the endolymphatic duct an analysis of a causal relationship between otosclerosis and Menieres disease Franklin DJ Pollak A Fisch U Ovid MEDLINE(R) American Journal of Otology 11(2)135-40 1990 Mar
6 Transtympanic electrocochleography a 10-year experience Otology amp neurotology official publication of the American Otological Society American Neurotology Society (and) European Academy of Otology and Neurotology Otol-Neurotol Sep 2002 vol 23 no 5 p 799-805
7 Cutting edge of inner ear MRI Acta oto-laryngologica Supplementum Acta-Otolaryngol-Suppl Feb 2009 no 560 p 15-21 22 refs ISSN 0365-5237 Naganawa-Shinji Nakashima-Tsutomu
8 Cochlear otosclerosis amp endolymphatic hydrops Otology amp Neurotology 2008 29(4)571-572 A Makarem FH Linthicum
9 The effect of stepedectomy on hearing of patients with otosclerosis and menierersquos disease American J of Otology 19834323-326
10 Endolymphatic hydrops associated with otosclerosis The American journal of otology Am-J-Otol May 1994 vol 15 no 3 p 348-57 ISSN 0192-9763 Shea-J-J-Jr Ge-X Orchik-D-J
Dilated Saccule or Reissnerrsquos membrane in contact with footplate
Intraoperative or post operative rupture
Confirm with ECOG Treat Medically
Fluoride Low salt Possible Diuretics vasodilators or Dexametasone
Avoid Stapedotomy Hearing aid BAHA Consider Stapes surgery after 2 years if no symptoms and
ECOG returned to normal Only consider stapes surgery if audiogram favourablehellip
If surgery undertaken ndash Mobilisation or posterior 13 small fenestra
Poor cochlear function amp Good hearing in other ear
Bone conduction worse than 45dB at 500 Hz and high frequency loss (House group 1984) (ref 9)
Early ndash with Perilymph Fistula Leak rate too fast for replacement through cochlear
aqueduct Low CSF pressure syndrome E Hydrops Management ndash SURGERY to close fistula
Delayed Hydrops
Otospongiotic obstruction of VAELS Inner ear scar tissue ndash obstruction (eg Saccule collapse) Non-suppurative labyrinthitis causes altered fluid
production drainage (ref 10)
Simulated Hydrops
Piston abutting or adherent to saccule ndash vertigo but not hydrops (-ve ECOG)
Endolymphatic Hydrops occurs secondary to Otosclerosis in about 8 cases presenting for treatment
If the history is suggestive ndash Undertake ECOG
Avoid Stapes Surgery with genuine active hydrops
Post-operative Hydrops can develop due to fistulization ndash if so seal it
Delayed Post-op hydrops is also described and requires conservative management
1 Otosclerosis associated with Meacuteniegraveres disease a histological study Advances in oto-rhino-laryngology Adv-Otorhinolaryngol 2007 vol 65 p 50-2 ISSN 0065-3071 Pollak-Anita
2 Cochlear and otoconial abnormalities in capsular otosclerosis with hydrops Johnsson LG Hawkins JE Jr Rouse RC Linthicum FH Jr Ovid MEDLINE(R) Annals of Otology Rhinology amp Laryngology - Supplement 973-15 1982 Sep-Oct
3 Extensive otosclerosis and endolymphatic hydrops histopathologic study of temporal bones Li W Schachern PA Paparella MM
4 Ovid MEDLINE(R) American Journal of Otolaryngology 15(2)158-61 1994 Mar-Apr Otosclerosis involving the vestibular aqueduct and Menieres disease Yoon TH Paparella MM Schachern PA Ovid MEDLINE(R) Otolaryngology - Head amp Neck Surgery 103(1)107-12 1990 Jul
5 Menieres symptoms resulting from bilateral otosclerotic occlusion of the endolymphatic duct an analysis of a causal relationship between otosclerosis and Menieres disease Franklin DJ Pollak A Fisch U Ovid MEDLINE(R) American Journal of Otology 11(2)135-40 1990 Mar
6 Transtympanic electrocochleography a 10-year experience Otology amp neurotology official publication of the American Otological Society American Neurotology Society (and) European Academy of Otology and Neurotology Otol-Neurotol Sep 2002 vol 23 no 5 p 799-805
7 Cutting edge of inner ear MRI Acta oto-laryngologica Supplementum Acta-Otolaryngol-Suppl Feb 2009 no 560 p 15-21 22 refs ISSN 0365-5237 Naganawa-Shinji Nakashima-Tsutomu
8 Cochlear otosclerosis amp endolymphatic hydrops Otology amp Neurotology 2008 29(4)571-572 A Makarem FH Linthicum
9 The effect of stepedectomy on hearing of patients with otosclerosis and menierersquos disease American J of Otology 19834323-326
10 Endolymphatic hydrops associated with otosclerosis The American journal of otology Am-J-Otol May 1994 vol 15 no 3 p 348-57 ISSN 0192-9763 Shea-J-J-Jr Ge-X Orchik-D-J
Confirm with ECOG Treat Medically
Fluoride Low salt Possible Diuretics vasodilators or Dexametasone
Avoid Stapedotomy Hearing aid BAHA Consider Stapes surgery after 2 years if no symptoms and
ECOG returned to normal Only consider stapes surgery if audiogram favourablehellip
If surgery undertaken ndash Mobilisation or posterior 13 small fenestra
Poor cochlear function amp Good hearing in other ear
Bone conduction worse than 45dB at 500 Hz and high frequency loss (House group 1984) (ref 9)
Early ndash with Perilymph Fistula Leak rate too fast for replacement through cochlear
aqueduct Low CSF pressure syndrome E Hydrops Management ndash SURGERY to close fistula
Delayed Hydrops
Otospongiotic obstruction of VAELS Inner ear scar tissue ndash obstruction (eg Saccule collapse) Non-suppurative labyrinthitis causes altered fluid
production drainage (ref 10)
Simulated Hydrops
Piston abutting or adherent to saccule ndash vertigo but not hydrops (-ve ECOG)
Endolymphatic Hydrops occurs secondary to Otosclerosis in about 8 cases presenting for treatment
If the history is suggestive ndash Undertake ECOG
Avoid Stapes Surgery with genuine active hydrops
Post-operative Hydrops can develop due to fistulization ndash if so seal it
Delayed Post-op hydrops is also described and requires conservative management
1 Otosclerosis associated with Meacuteniegraveres disease a histological study Advances in oto-rhino-laryngology Adv-Otorhinolaryngol 2007 vol 65 p 50-2 ISSN 0065-3071 Pollak-Anita
2 Cochlear and otoconial abnormalities in capsular otosclerosis with hydrops Johnsson LG Hawkins JE Jr Rouse RC Linthicum FH Jr Ovid MEDLINE(R) Annals of Otology Rhinology amp Laryngology - Supplement 973-15 1982 Sep-Oct
3 Extensive otosclerosis and endolymphatic hydrops histopathologic study of temporal bones Li W Schachern PA Paparella MM
4 Ovid MEDLINE(R) American Journal of Otolaryngology 15(2)158-61 1994 Mar-Apr Otosclerosis involving the vestibular aqueduct and Menieres disease Yoon TH Paparella MM Schachern PA Ovid MEDLINE(R) Otolaryngology - Head amp Neck Surgery 103(1)107-12 1990 Jul
5 Menieres symptoms resulting from bilateral otosclerotic occlusion of the endolymphatic duct an analysis of a causal relationship between otosclerosis and Menieres disease Franklin DJ Pollak A Fisch U Ovid MEDLINE(R) American Journal of Otology 11(2)135-40 1990 Mar
6 Transtympanic electrocochleography a 10-year experience Otology amp neurotology official publication of the American Otological Society American Neurotology Society (and) European Academy of Otology and Neurotology Otol-Neurotol Sep 2002 vol 23 no 5 p 799-805
7 Cutting edge of inner ear MRI Acta oto-laryngologica Supplementum Acta-Otolaryngol-Suppl Feb 2009 no 560 p 15-21 22 refs ISSN 0365-5237 Naganawa-Shinji Nakashima-Tsutomu
8 Cochlear otosclerosis amp endolymphatic hydrops Otology amp Neurotology 2008 29(4)571-572 A Makarem FH Linthicum
9 The effect of stepedectomy on hearing of patients with otosclerosis and menierersquos disease American J of Otology 19834323-326
10 Endolymphatic hydrops associated with otosclerosis The American journal of otology Am-J-Otol May 1994 vol 15 no 3 p 348-57 ISSN 0192-9763 Shea-J-J-Jr Ge-X Orchik-D-J
Poor cochlear function amp Good hearing in other ear
Bone conduction worse than 45dB at 500 Hz and high frequency loss (House group 1984) (ref 9)
Early ndash with Perilymph Fistula Leak rate too fast for replacement through cochlear
aqueduct Low CSF pressure syndrome E Hydrops Management ndash SURGERY to close fistula
Delayed Hydrops
Otospongiotic obstruction of VAELS Inner ear scar tissue ndash obstruction (eg Saccule collapse) Non-suppurative labyrinthitis causes altered fluid
production drainage (ref 10)
Simulated Hydrops
Piston abutting or adherent to saccule ndash vertigo but not hydrops (-ve ECOG)
Endolymphatic Hydrops occurs secondary to Otosclerosis in about 8 cases presenting for treatment
If the history is suggestive ndash Undertake ECOG
Avoid Stapes Surgery with genuine active hydrops
Post-operative Hydrops can develop due to fistulization ndash if so seal it
Delayed Post-op hydrops is also described and requires conservative management
1 Otosclerosis associated with Meacuteniegraveres disease a histological study Advances in oto-rhino-laryngology Adv-Otorhinolaryngol 2007 vol 65 p 50-2 ISSN 0065-3071 Pollak-Anita
2 Cochlear and otoconial abnormalities in capsular otosclerosis with hydrops Johnsson LG Hawkins JE Jr Rouse RC Linthicum FH Jr Ovid MEDLINE(R) Annals of Otology Rhinology amp Laryngology - Supplement 973-15 1982 Sep-Oct
3 Extensive otosclerosis and endolymphatic hydrops histopathologic study of temporal bones Li W Schachern PA Paparella MM
4 Ovid MEDLINE(R) American Journal of Otolaryngology 15(2)158-61 1994 Mar-Apr Otosclerosis involving the vestibular aqueduct and Menieres disease Yoon TH Paparella MM Schachern PA Ovid MEDLINE(R) Otolaryngology - Head amp Neck Surgery 103(1)107-12 1990 Jul
5 Menieres symptoms resulting from bilateral otosclerotic occlusion of the endolymphatic duct an analysis of a causal relationship between otosclerosis and Menieres disease Franklin DJ Pollak A Fisch U Ovid MEDLINE(R) American Journal of Otology 11(2)135-40 1990 Mar
6 Transtympanic electrocochleography a 10-year experience Otology amp neurotology official publication of the American Otological Society American Neurotology Society (and) European Academy of Otology and Neurotology Otol-Neurotol Sep 2002 vol 23 no 5 p 799-805
7 Cutting edge of inner ear MRI Acta oto-laryngologica Supplementum Acta-Otolaryngol-Suppl Feb 2009 no 560 p 15-21 22 refs ISSN 0365-5237 Naganawa-Shinji Nakashima-Tsutomu
8 Cochlear otosclerosis amp endolymphatic hydrops Otology amp Neurotology 2008 29(4)571-572 A Makarem FH Linthicum
9 The effect of stepedectomy on hearing of patients with otosclerosis and menierersquos disease American J of Otology 19834323-326
10 Endolymphatic hydrops associated with otosclerosis The American journal of otology Am-J-Otol May 1994 vol 15 no 3 p 348-57 ISSN 0192-9763 Shea-J-J-Jr Ge-X Orchik-D-J
Early ndash with Perilymph Fistula Leak rate too fast for replacement through cochlear
aqueduct Low CSF pressure syndrome E Hydrops Management ndash SURGERY to close fistula
Delayed Hydrops
Otospongiotic obstruction of VAELS Inner ear scar tissue ndash obstruction (eg Saccule collapse) Non-suppurative labyrinthitis causes altered fluid
production drainage (ref 10)
Simulated Hydrops
Piston abutting or adherent to saccule ndash vertigo but not hydrops (-ve ECOG)
Endolymphatic Hydrops occurs secondary to Otosclerosis in about 8 cases presenting for treatment
If the history is suggestive ndash Undertake ECOG
Avoid Stapes Surgery with genuine active hydrops
Post-operative Hydrops can develop due to fistulization ndash if so seal it
Delayed Post-op hydrops is also described and requires conservative management
1 Otosclerosis associated with Meacuteniegraveres disease a histological study Advances in oto-rhino-laryngology Adv-Otorhinolaryngol 2007 vol 65 p 50-2 ISSN 0065-3071 Pollak-Anita
2 Cochlear and otoconial abnormalities in capsular otosclerosis with hydrops Johnsson LG Hawkins JE Jr Rouse RC Linthicum FH Jr Ovid MEDLINE(R) Annals of Otology Rhinology amp Laryngology - Supplement 973-15 1982 Sep-Oct
3 Extensive otosclerosis and endolymphatic hydrops histopathologic study of temporal bones Li W Schachern PA Paparella MM
4 Ovid MEDLINE(R) American Journal of Otolaryngology 15(2)158-61 1994 Mar-Apr Otosclerosis involving the vestibular aqueduct and Menieres disease Yoon TH Paparella MM Schachern PA Ovid MEDLINE(R) Otolaryngology - Head amp Neck Surgery 103(1)107-12 1990 Jul
5 Menieres symptoms resulting from bilateral otosclerotic occlusion of the endolymphatic duct an analysis of a causal relationship between otosclerosis and Menieres disease Franklin DJ Pollak A Fisch U Ovid MEDLINE(R) American Journal of Otology 11(2)135-40 1990 Mar
6 Transtympanic electrocochleography a 10-year experience Otology amp neurotology official publication of the American Otological Society American Neurotology Society (and) European Academy of Otology and Neurotology Otol-Neurotol Sep 2002 vol 23 no 5 p 799-805
7 Cutting edge of inner ear MRI Acta oto-laryngologica Supplementum Acta-Otolaryngol-Suppl Feb 2009 no 560 p 15-21 22 refs ISSN 0365-5237 Naganawa-Shinji Nakashima-Tsutomu
8 Cochlear otosclerosis amp endolymphatic hydrops Otology amp Neurotology 2008 29(4)571-572 A Makarem FH Linthicum
9 The effect of stepedectomy on hearing of patients with otosclerosis and menierersquos disease American J of Otology 19834323-326
10 Endolymphatic hydrops associated with otosclerosis The American journal of otology Am-J-Otol May 1994 vol 15 no 3 p 348-57 ISSN 0192-9763 Shea-J-J-Jr Ge-X Orchik-D-J
Endolymphatic Hydrops occurs secondary to Otosclerosis in about 8 cases presenting for treatment
If the history is suggestive ndash Undertake ECOG
Avoid Stapes Surgery with genuine active hydrops
Post-operative Hydrops can develop due to fistulization ndash if so seal it
Delayed Post-op hydrops is also described and requires conservative management
1 Otosclerosis associated with Meacuteniegraveres disease a histological study Advances in oto-rhino-laryngology Adv-Otorhinolaryngol 2007 vol 65 p 50-2 ISSN 0065-3071 Pollak-Anita
2 Cochlear and otoconial abnormalities in capsular otosclerosis with hydrops Johnsson LG Hawkins JE Jr Rouse RC Linthicum FH Jr Ovid MEDLINE(R) Annals of Otology Rhinology amp Laryngology - Supplement 973-15 1982 Sep-Oct
3 Extensive otosclerosis and endolymphatic hydrops histopathologic study of temporal bones Li W Schachern PA Paparella MM
4 Ovid MEDLINE(R) American Journal of Otolaryngology 15(2)158-61 1994 Mar-Apr Otosclerosis involving the vestibular aqueduct and Menieres disease Yoon TH Paparella MM Schachern PA Ovid MEDLINE(R) Otolaryngology - Head amp Neck Surgery 103(1)107-12 1990 Jul
5 Menieres symptoms resulting from bilateral otosclerotic occlusion of the endolymphatic duct an analysis of a causal relationship between otosclerosis and Menieres disease Franklin DJ Pollak A Fisch U Ovid MEDLINE(R) American Journal of Otology 11(2)135-40 1990 Mar
6 Transtympanic electrocochleography a 10-year experience Otology amp neurotology official publication of the American Otological Society American Neurotology Society (and) European Academy of Otology and Neurotology Otol-Neurotol Sep 2002 vol 23 no 5 p 799-805
7 Cutting edge of inner ear MRI Acta oto-laryngologica Supplementum Acta-Otolaryngol-Suppl Feb 2009 no 560 p 15-21 22 refs ISSN 0365-5237 Naganawa-Shinji Nakashima-Tsutomu
8 Cochlear otosclerosis amp endolymphatic hydrops Otology amp Neurotology 2008 29(4)571-572 A Makarem FH Linthicum
9 The effect of stepedectomy on hearing of patients with otosclerosis and menierersquos disease American J of Otology 19834323-326
10 Endolymphatic hydrops associated with otosclerosis The American journal of otology Am-J-Otol May 1994 vol 15 no 3 p 348-57 ISSN 0192-9763 Shea-J-J-Jr Ge-X Orchik-D-J
1 Otosclerosis associated with Meacuteniegraveres disease a histological study Advances in oto-rhino-laryngology Adv-Otorhinolaryngol 2007 vol 65 p 50-2 ISSN 0065-3071 Pollak-Anita
2 Cochlear and otoconial abnormalities in capsular otosclerosis with hydrops Johnsson LG Hawkins JE Jr Rouse RC Linthicum FH Jr Ovid MEDLINE(R) Annals of Otology Rhinology amp Laryngology - Supplement 973-15 1982 Sep-Oct
3 Extensive otosclerosis and endolymphatic hydrops histopathologic study of temporal bones Li W Schachern PA Paparella MM
4 Ovid MEDLINE(R) American Journal of Otolaryngology 15(2)158-61 1994 Mar-Apr Otosclerosis involving the vestibular aqueduct and Menieres disease Yoon TH Paparella MM Schachern PA Ovid MEDLINE(R) Otolaryngology - Head amp Neck Surgery 103(1)107-12 1990 Jul
5 Menieres symptoms resulting from bilateral otosclerotic occlusion of the endolymphatic duct an analysis of a causal relationship between otosclerosis and Menieres disease Franklin DJ Pollak A Fisch U Ovid MEDLINE(R) American Journal of Otology 11(2)135-40 1990 Mar
6 Transtympanic electrocochleography a 10-year experience Otology amp neurotology official publication of the American Otological Society American Neurotology Society (and) European Academy of Otology and Neurotology Otol-Neurotol Sep 2002 vol 23 no 5 p 799-805
7 Cutting edge of inner ear MRI Acta oto-laryngologica Supplementum Acta-Otolaryngol-Suppl Feb 2009 no 560 p 15-21 22 refs ISSN 0365-5237 Naganawa-Shinji Nakashima-Tsutomu
8 Cochlear otosclerosis amp endolymphatic hydrops Otology amp Neurotology 2008 29(4)571-572 A Makarem FH Linthicum
9 The effect of stepedectomy on hearing of patients with otosclerosis and menierersquos disease American J of Otology 19834323-326
10 Endolymphatic hydrops associated with otosclerosis The American journal of otology Am-J-Otol May 1994 vol 15 no 3 p 348-57 ISSN 0192-9763 Shea-J-J-Jr Ge-X Orchik-D-J
