A 35 years old pregnant female complaining of hearing loss, which aggravated during pregnancy, was sent for tympanometry. Which of the following graph will be seen?
Correct Answer: As
Description: Ans. a. As (Ref: Dhingra 4/e p25, 88) A 35 years old pregnant female complained of hearing loss, which was aggravated during pregnancy: This patient is most probably suffering from otosclerosis, which is more common in females and aggravated during pregnancy.Type As tympanogram is seen in otosclerosis'People of African-American descent rarely have otosclerosis - it is usually a condition found in persons of Caucasian or Oriental descent. Women are affected twice as often as men, and pregnancy often has an adverse effect. Otosclerosis is often discovered during or just after pregnancy. The effect of hormone supplements post-menopause is unknown.'- style="font-size: 1.04761904761905em; font-family: Times New Roman, Times, serif; margin: 0 0 0 8px; text-indent: 0">'A retrospective study has been made of a sample of 479 women with deafness from otosclerosis, classified according to the number of pregnancies they have had and whether there had been a subjective impression of deterioration of hearing during or immediately after at least 1 pregnancy. The study confirms previous reports that pregnancy does involve a risk of aggravating deafness in clinical otosclerosis.'- style="width: 49pt; font-family: Times New Roman, Times, serif">Types of TympanogramType ANormal tympanogramType ASCompliance is lower at or near ambient air pressureSeen in fixation of ossicles, e.g. OtosclerosisQ or Malleus fixationQType ADHigh compliance at or near ambient pressureSeen in ossicular discontinuityQ or thin and lax tympanic membraneQType BA flat or dome shaped graph. No change in compliance with pressure changes Seen in middle ear fluidQ or thick tympanic membraneQType CMaximum compliance occurs with negative pressure in excess of 100 mm of H2O.Seen in retracted tympanic membraneQ and may show some fluid in middle earQRemember: AS (S) for Sclerosis and AD (D) for discontinuityOtosclerosis (Otospongiosis)Disease of bony labyrinth where the normal dense enchondral bone is replaced by foci of irregularly laid spongy boneQ.50% patients have positive family history, inherited as autosomal dominantQ.White racesQ are affected more than negroesFemalesQ are more common than malesPregnancy aggravates otosclerosisAge of onset is around pubertyTypes of otosclerosis:1. Stapedial Otosclerosis:The part most commonly involved in otosclerosis is Oval windowStapedial otosclerosis causing stapes fixation and conductive deafness is the most common varietyQ.Lesion starts just in front of the oval window in an area called fissula ante fenestrum2. Cochlear Otosclerosis: Involves region of round windowQ3. Histologic Otosclerosis: Remains asymptomaticQClinical Presentation:Painless and progressive, bilateral (often) conductive hearing loss/deafness is presenting symptomQParacusis wilsiiQ: Patient hears better in noisy than quiet environmentTinnitus, vertigo and monotonous speechQ are other featuresTympanic membrane is usually normal and mobileQSchwartz SignQ: A reddish hue or Flamingo pink tinge maybe seen on the promontory through the tympanic membrane, indicating a focus of increased vascularity.Carhartz notchQ: A dip in bone conduction may be seen which is different at different frequencies but maximum at 2000 HzQ.Treatment:There is no medical treatment that cures otosclerosis, sodium fluorideQ has been used to attain maturity of active focus.Stapedectomy with prosthesis replacement is the treatment of choiceQHearing aidQ for patients who refuses or unfit for surgery
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