The efficacy of etidronate, a Bisphosphonate, was assessed as a treatment for the inner ear symptoms of otosclerosis in a retrospective case review of 896 patients diagnosed with otosclerosis, with primary complaints of dizziness, hearing loss, tinnitus or Meniere's syndrome. The diagnosis of otosclerosis was based on small-pixel computed tomography of the temporal bones. Of the 896 patients placed on an etidronate protocol, 545 were followed for more than six months and were analyzed. The symptomatic response to etidronate, as well as audiologic and computerized rotary chair results were used in the assessment. Patients who were previously on sodium fluoride were separately analyzed. In this preliminary study etidronate appeared to be an effective treatment for the neurotologic symptoms of otosclerosis. Prospective blinded efficacy studies of the bisphosphonates in the treatment of otosclerosis should be undertaken.
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References
1.
BrooklerKH. Meniere's disease: Role of otospongiosis and metabolic disorders. Acta Otolaryngol1984; (Suppl 406):31–6.
2.
CausseJR, ChevanceLG. Sensorineural hearing loss due to cochlear otospongiosis: Etiology. Otolaryngol Clin North Am1978; 11:125–34.
3.
CausseJR, CausseJB, BretlauP, Etiology of otospongiosis sensorineural losses. Am J Otol1989; 10:99–107.
4.
CodyDTR, BakerHLJ. Otosclerosis: Vestibular symptoms and sensorineural hearing loss. Ann Otol Rhinol Laryngol1978; 87:778–96.
FreemanJ.Otosclerosis and vestibular dysfunction. Laryngoscope1980; 90:1481–7.
7.
FreemanJ.Progressive sensorineural hearing loss and cochlear otosclerosis: A prospective study. Laryngoscope1979; 89:1487–1521.
8.
GrossCW. Sensorineural hearing loss in clinical and histological otosclerosis. Larygoscope1969; 79:104–12.
9.
GundersenT.Sensorineural hearing loss in otosclerosis. Scand Audiol1973; 2:43–51.
10.
GungovichVA, RosenfeldLG. The diagnosis of cochlear otosclerosis. Arch Otolaryngol1974; 99:281.
11.
GussenR.Labyrinthine otosclerosis and sensorineural deafness. Pathologic findings of the spiral ligament. Arch Otolaryngol1975; 101:438–40.
12.
HansenMC. Otosclerosis and sensorineural hearing loss. Arch Otolaryngol1983; 109:598–600.
13.
HavriliakD, ParisierS.Cochlear otosclerosis presenting in children: A case report. Am J Otol1991; 12(1):61–3.
14.
HulkJ, JongkeesLBW. Vestibular examination in cases of otosclerosis. J Laryngol1950; 64:126–30.
15.
IgarashiM, JergerS, ToshiakiO, Fluctuating hearing loss and recurrent vertigo in otosclerosis: An audiologic and temporal bone study. Arch Otorhinolaryngol1982; 236:161–71.
16.
KhrappoNS. Vestibular disorders in otosclerosis and their anatomical physiological bases. Vestn Oto-Rhino-Laryng1964; 26:22–8.
17.
LindsayJR, BealDD. Sensorineural deafness in otosclerosis. Observations on histopathology. Ann Otol Rhinol Laryngol1966; 75:436–57.
18.
LinthicumFHJ. Correlation of sensorineural hearing impairment and otosclerosis. Tr Am Otol Soc1966; 54:155–68.
19.
LinthicumFH, FilipoR, BrodyS.Sensorineural hearing loss due to cochlear otospongiosis: Theoretical considerations of etiology. Ann Otol Rhinol Laryngol1975; 84:544–51.
20.
LinthicumFHJ, LalaniAS. Sensorineural impairment in unilateral otosclerosis. Ann Otol Rhinol Laryngol1975; 84:11–5.
21.
LinthicumFHJ, NeelyJG. Unrelated sensorineural hearing loss in patients with otosclerosis. A report of three cases. Laryngoscope1977; 87:1746–52.
22.
ListonSL, PaparellaMM, ManciniF, Otosclerosis and endolymphatic hydrops. Laryngoscope1984; 94:1003–7.
23.
McCabeBF. Otosclerosis and vertigo. Trans Pac Coast Otoophthalmol Soc1966; 47:37–42.
24.
MeurmanO, AantaaE, VirolainenE.Vestibular disorders in clinical otosclerosis. Arch Otolaryngol1969; 90:756–8.
25.
Morales-GarciaC.Cochleovestibular involvement in otosclerosis. Acta Otolaryngol1972; 73:484–92.
26.
NauntonR, ValvassoriG.Sensorineural hearing loss in otosclerosis. Arch Otolaryngol1969; 99:281.
27.
PaparellaMM, ManciniF, ListonSL. Otosclerosis and Meniere's syndrome: Diagnosis and treatment. Laryngoscope1984; 94:1414–17.
28.
ParahyC, LinthicumFHJ. Otosclerosis: Relationship of spiral ligament hyalinization to sensorineural hearing loss. Laryngoscope1983; 93:717–20.
29.
ParahyC, LinthicumFHJ. Otosclerosis and otospongiosis: Clinical and histological comparisons. Laryngoscope1984; 94:508–12.
30.
RasmussenH.Vestibular function prior to and following operation for otosclerosis. Arch Otolaryngol1949; 49:402–13.
31.
RichardsSS. Meniere's syndrome in otosclerosis. Brit Med J1964; 2:1227.
32.
RuediL.Histopathology of sensorineural degeneration and other inner ear changes in otosclerosis, in SchuknechtHF (ed): Otosclerosis. London, Churchill Livingstone, 1962.
33.
SataloffJ, FarbS, MendukeH, Sensorineural hearing loss in otosclerosis. Trans Am Acad Ophthalmol Otolaryngol1964; 68:243–8.
34.
SchowRL. Tomography and sensorineural hearing loss in otospongiosis: New data on unresolved issues, in ShambaughGE, JasJJ (eds): Proceedings of the Shambaugh Fifth International Workshop on Middle Ear Microsurgery and Fluctuant Hearing Loss. Huntsville, AL, Strode Publishers Inc, 1977; 492–9.
35.
ShambaughG.Sensorineural hearing loss due to cochlear otospongiosis: Pathogenesis, clinical diagnosis, and therapy. Otolaryngol Clin North Am1978; 11:135–54.
36.
SismanisA, HughesGB, AbediE.Coexisting otosclerosis and Meniere's disease: A diagnostic and therapeutic dilemma. Laryngoscope1986; 96:9–13.
37.
ValleV, LinthicumFJ. Proven cochlear otosclerosis: Sensorineural with conductive hearing loss. Ann Otol Rhinol Otolaryngol1984; 93:105–11.
38.
ThomasJE, CodyDTR. Neurologic perspectives of otosclerosis. Mayo Clin Proc1981; 56:17–21.
39.
VirolainenE.Vestibular disturbances in clinical otosclerosis. Acta Otolaryngol1972; (Suppl 306): 1–34.
40.
LinthicumF.Histopathology of otosclerosis. Otolaryngol Clin North Am1993; 26:335–52.
41.
JohnssonLG, HawkinsJE, LinthicumFH. Cochlear and vestibular lesions in capsular otosclerosis as seen in microdissection. Ann Otol Rhinol Laryngol1978; 87 (suppl 48): 1–40.
42.
JohnssonLG, HawkinsJE, RouseRC, Cochlear and otoconial abnormalities in capsular otosclerosis with hydrops. Ann Otol Rhinol Laryngol1982; (Suppl 91):3.
43.
SandoI, HemenwayWG, MillerDR, Vestibular pathology in otosclerosis temporal bone histopathological report. Laryngoscope1974; 84:593–605.
44.
WolffD, BellucciR.The histopathology observed in fifty biopsied stapedes. Trans Amer Acad Ophth Otolaryngol1960; (July-August):540–53.
45.
CausseJR, ChevanceLG, BretlauP, Enzymatic concept of otospongiosis and cochlear otospongiosis. Clin Otol1977; 2:23–32.
46.
CausseJR, ShambaughGEJ, CausseJB, Enzymology of otospongiosis and NaF therapy. Amer J Otol1980; 1:206.
47.
PetrovicAG, StutzmannJJ, ShambaughGEJ. Experimental studies on pathology and therapy of otospongiosis. Am J Otol1985; 6:43–50.
CausseJR, UrielJ, BergesJ, Objective changes in trypsin, å1-antitrypsin, and å2-macroglobulin values as a result of sodium fluoride treatment in patients with otosclerosis. Am J Otol1985; 6:38–42.
50.
CausseJR, CausseJB. Clinical studies on fluoride in otospongiosis. Am J Otol1985; 6:51–5.
51.
ShambaughGE, CausseJR, PetrovicA, New concepts in management of otospongiosis. Arch Otolaryngol1974; 100:419–26.
52.
BretlauP, HansenHJ, CausseJB, Otospongiosis: Morphologic and microchemical investigation after NaF-treatment. Otolaryngol Head Neck Surg1981; 89:646–50.
53.
CausseJR, ChevanceLG. Sensorineural hearing loss due to cochlear otospongiosis: Etiolgy. Otolaryngol Clin North Am1978; 11:125–34.
ChevanceLG, CausseJR, BretlauP, Hydrolitic activity of the perilymph in otosclerosis. A preliminary report. Acta Otolaryngol (Stockh)1972; 74:23–8.
56.
ChevanceLG, CausseJR, BergesJ.Study of alpha 1 antitrypsin activity of the perilymph during the progression of otospongiosis. Arch Otol1976; 102:363–4.
57.
CausseJ, ChevanceLG, ShambaughGE. Clinical experience and experimental findings with sodium fluoride in otosclerosis (otospongiosis). Ann Otol1974; 83:643–7.
58.
BretlauP, CausseJR, CausseJB, Otospongiosis and sodium fluoride. A blind experimental and clinical evaluation of the effects of sodium fluoride treatment in patients with otospongiosis. Ann Otol Rhinol Laryngol1985; 94:103–7.
59.
CausseJR, CausseJB, UrielJ, Sodium fluoride therapy. Am J Otol1993; 14:482–90.
60.
CausseJ, UrielJ, BergesJ, The enzymatic mechanism of the otospongiotic disease and NaF action on the enzymatic balance. Am J Otol1982; 3:297–314.
61.
CausseJR, ShambaughGE, CausseJB, Enzymology of otospongiosis and (NaF) sodium fluoride therapy. Am J Otol1980; 1(4):206–14.
62.
ForquerBD, LinthicumFHJ, BennetC.Sodium fluoride: Effectiveness of treatment for cochlear otosclerosis. Am J Otol1986; 7:121–5.
63.
KerrG, HoffmanG.Fluoride therapy for otosclerosis. Ear Nose Throat J1989; 68:426–9.
64.
ShambaughGEJ, ScottA.Sodium fluoride for the arrest of otosclerosis. Arch Otolaryngol1964; 80:263.
65.
ShambaughGEJ, PetrovicAG. Effects of sodium fluoride on bone: Application to otosclerosis and other decalcifying bone diseases. J Am Med Assoc1968; 204:969–73.
66.
ShambaughGE. Fluorides for otospongiosis and other osteoporotic states. Ann ORL1973; 90:129–38.
67.
ShambaughGEJ. Further experiences with moderate dosage sodium fluoride for sensorineural hearing loss, tinnitus and vertigo due to otospongiosis. Adv Oto-Rhino-Laryngol1977; 22:35–42.
68.
ShambaughJEJ. Adult fluoride therapy for otosclerosis (otospongiosis). Arch Otolaryngol1983; 109:353.
69.
KennedyD, HofferM, HollidayM.The effects of etidronate disodium on progressive hearing loss from otosclerosis. Otolaryngol Head Neck Surg1992; 109:461–467.
70.
PetrovicAG, StutzmanJJ. Diphosphonates: A potential medication for evolutive otospongiosis, in DonathA, CourvoisierB (eds): Symposium CEMO, Centre d'Etude des Maladies Osteoarticulares de Geneve IV. Nyon, Switzerland, Editions Medicine et Hygiene, Geneve, 1982; 417–22.
71.
ElbrondO, JensenJJ. Otosclerosis and pregnancy: A study on the influence of pregnancy on the hearing threshold before and after stapedectomy. Clin Otolaryngol1979; 4:259.
72.
GristwoodRE, VenablesWN. Pregnancy and otosclerosis. Clin Otolaryngol1983; 8:205–10.
73.
SmithHW. Effect of pregnancy on otosclerosis. AMA Arch Otolaryngol1948; 48:159.
74.
WalshTE. The effect of pregnancy on deafness of otosclerosis. Trans Amer Acad Ophthalmol Otolaryngol1954; 58:420.
75.
CausseJR, CausseJB. Otospongiosis as a genetic disease: Early detection, medical management and prevention. Am J Otol1984; 5:211–23.
76.
DavenportCB, MillesBL, FrinkLB. The genetic factor in otosclerosis. AMA Arch Otolaryngol1933; 17:135–70, 340–83, 503–48.
77.
Gapany-GapanaviciusB.Otosclerosis: Genetics and Surgical Rehabilitation. Jerusalem, Keter, 1975.
78.
GordonMA. The genetics of otosclerosis: A review. Am J Otol1989; 10:426–37.
79.
HallJG. Otosclerosis in Norway, a geographical and genetical study. Acta Otolaryngol1974; 324:1–20.
80.
HenryKR, ChoieRA. Genetic and functional analysis of the otosclerosis-like condition of the LP/J mouse. Audiology1987; 26:44–55.
81.
LarssonA.Otosclerosis. A genetic and clinical study. Acta Otolaryngol1960; (Suppl 154): 1–86.
82.
Hernandez-OrozcoF, CourtneyGT. Genetic aspects of clinical otosclerosis. Ann Otol Rhinol Laryngol1964; 73:632–44.
83.
MorrisonAW. Genetic factors in otosclerosis. Ann R Coll Surg Engl1967; 41:2.
84.
SchaapT, Gapany-GapanaviciusB.The genetics of otosclerosis. I. Distorted sex ratio. Am J Hum Genet1978; 30:59–64.
85.
GrahamAB. An audiological and otological investigation of normal hearing individuals with a family history of otosclerosis. Chicago, Northwestern University PhD Thesis, 1953
86.
SaundersJE, DereberryMJ, LoWWM. Magnetic resonance imaging of cochlear otosclerosis. Ann Otol Rhinol Laryngol1995; 104:826–9.
87.
BelJ, CausseJR, MichauxP, Mechanical explanation of the on/off effect (diphasic impedance change) in otospongiosis. Audiol1976; 15:128–40.
88.
CausseJR, CausseJB. Otospongiosis as a genetic disease. Early detection, medical management and prevention. Am J Otol1984; 5:211–23.
ForquerBD, SheehyJL. The negative on/off effect in cochlear and early stapedial otosclerosis. Ear Hear1981; 2:256–9.
91.
ForquerB, SheehyJ.Cochlear otosclerosis: A review of audiometric findings in 150 cases. Am J Otol1987; 8:1–4.
92.
LinthicumF, ForquerB.Sodium fluoride as a treatment for otosclerotic hearing loss. Am J Otol1985; 6:35–37.
93.
VartiainenE, VirtaniemiJ, KemppainenM, Hearing levels of patients with otosclerosis 10 years after stapedectomy. Otolaryngol Head Neck Surg1993; 108:251–5.
AltmannF.Histopathology and etiology of otosclerosis: A critical review, in SchuknechtHF (ed): Otosclerosis. Boston, Little, Brown and Company, 1962; 16–42.
96.
SandoI, HemenwayWG, MillerDR, Vestibular pathology in otosclerosis temporal bone histopathological report. Laryngoscope1974; 84:593–605.
97.
RuediL.Histopathologic confirmation of labyrinthine otosclerosis. Laryngoscope1965; 75:1582–1609.
98.
NagerG.Histopathology of otosclerosis. Arch Otolaryngol1969; 89:341–62.
99.
NadolJBJ, McKennaMS. Histopathology of Meniere's diisease and otosclerosis: Relevance of possible immune mediated pathogenesis, in VeldmanJE (ed): Immunobiology, histopathology, and tumor immunology in otolaryngology. Proceedings Second International Academic Conference, Utrecht, The Netherlands, August 26–29, 1986. Amsterdam, Kugler Publications, 1987; 165–84.
100.
LindsayJR. Otosclerosis: Histopathology, in PaparellaMM, ShumrickDA (eds): Textbook of Ear, Nose and Throat, Vol. 2. Philadelphia, WB Saunders, 1973; 205–30.
101.
LindsayJR. Histopathology of otosclerosis. Arch Otolaryngol1973; 97:24–9.
102.
LindsayJ.Histopathology in autopsy specimens after stapes surgery, in Shucknecht (ed): Otosclerosis HFH-iso. Boston, Little Brown & Co, 1962; 359–70.
103.
LiW, SchachernP, PaparellaM.Extensive otosclerosis and endolymphatic hydrops: Histopathologic study of temporal bones. Am J Otolaryngol1994; 15:158–61.
104.
Antoli-CandelaF, McGillT, PeronD.Histopathological observations on the cochlear changes in otosclerosis. Ann Otol Rhinol Laryngol1977; 86:813–20.
105.
AltmannF, KornfeldM, SheaJJ. Inner ear changes in otosclerosis. Histopathological studies. Ann Otol Rhinol Laryngol1966; 75:1–29.
106.
VignaudJ, Marsot-DupuchK, PharabozC, Imaging of the vestibule. Otolaryngol Head Neck Surg1995; 112:36–49.
107.
D'AchambeauO, ParizelP, KoekelkorenE, CT diagnosis and differential diagnosis of otodystrophic lesions of the temporal bone. Eur J Radiol1990; 11:22–30.
108.
DamsmaH.CT of cochlear otosclerosis. Radiol Clin North Am1984; 22(1):37–43.
109.
DeGrootJAM, HuizingFW, DamsmaH, Labyrinthine otosclerosis studied with a new computed tomography technique. Ann Otol Rhinol Laryngol1985; 94:223–5.
110.
MafeeMF, HenriksonGC, DeitchRL, Use of CT in stapedial otosclerosis. 1985; 156(3):709–14.
111.
MafeeM, ValvassoriG, DeitchR, Use of CT in the evaluation of cochlear otosclerosis. Radiol1985; 156:703–708.
SwartzJ, MandellD, WolfsonR, Fenestral and cochlear otosclerosis: Computed tomography evaluation. Am J Otol1985; 6:476–81.
115.
ValvassoriG, DobbenG.CT densitometry of the cochlear capsule in otosclerosis. AJNR1985; 6:661–7.
116.
ValvassoriGE. CT densitometry in otosclerosis. Adv Oto-Rhino-Laryngol (Basel)1987; 37:47–9.
117.
ValvassoriG.Imaging of otosclerosis. Otolaryngol Clin N Am1993; 26(3):359–71.
118.
HarrisS, WattsM, JacksonR, Four year study of intermittent cyclical etidronate treatment of postmenopausal osteoporosis: Three years of blinded therapy followed by one year of open therapy. Am J Med1993; 95:557–67.
119.
StormT, ThamsborgG, SteinicheT, Effect of intermittent cyclical etidronate therapy on bone mass and fracture rate in women with postmenopausal osteoporosis. N Engl J Med1990; 322:1265–71.
120.
WattsN, HarrisS, GenantM, Intermittent cyclical etidronate treatment of postmenopausal osteoporosis. N Engl J Med1990; 323:73–9.
121.
FleischH.Bisphosphonates—History and experimental basis. Bone1987; 8(suppl 1): S23–S28.
122.
FleischH.Bisphosphonates: Pharmacology. Sem Arth Rheum1994; 23:261–2.
123.
OttS.Clinical effects of bisphosphonates in involutional osteoporosis. J Bone Min Res1993; 8(suppl 2):S597–S606.
124.
WattsN.Treatment of osteoporosis with bisphosphonates. Rheum Dis Clin N Am1994; 20(3):717–34.
125.
RodanG, BalenaR.Bisphosphonates in the treatment of metabolic bone disease. Ann Med1993; 373–8.
126.
GennariC, NutiR, AgnusdeiD, Management of osteoporosis and Paget's disease. Drug Safety1994; 11:179–95.
127.
KhokerM, DandonaP.Diphosphonales inhibit human osteoblast secretion and proliferation. Metabolism1989; 38:184–7.
128.
SahniM, GuentherH, FleischH, Bisphosphonates act on rat resorption through the mediation of osteoblasts. J Clin Invest1993; 91:2004–11.
129.
PaparellaMM, ChasinWD. Otosclerosis and vertigo. J Laryngol Otol1966; 80:511–19.
130.
BalleV, LinthicumFHJ. Histologically proven cochlear otosclerosis with pure sensorineural hearing loss. Ann Otol Rhinol Laryngol1984; 93:105–11.
131.
BrowningG, GatehouseS.Sensorineural hearing loss in stapedial otosclerosis. Ann Otol Rhinol Laryngol1984; 93:13–6.
132.
LinthicumFH, ReunesR, BelalA.Histologic and polytomographic correlations in cochlear otosclerosis, in ShambaughGE, SheaJJ (eds): Proceedings of the Sixth Shambaugh and Third Shea International Workshop on Otomicrosurgery and Shea Fluctuant Hearing Loss Symposium, 1980. Huntsville, AL, Strode Publishers, 1981; 468–71.
133.
RuediL, SpoendlinH.Pathogenesis of sensorineural hearing loss in otosclerosis. Ann ORL1966; 75:525–52.
134.
DeGrootJ, HuizingE.Computed tomography of the petrous bone in otosclerosis and Meniere's disease. Acta Otolaryngol (Stockh)1987;(Suppl 434):1–135.
135.
IshibeT, YooTJ, SheaJJ, Immunohistochemical studies in Meniere's disease, otosclerosis, and tympanosclerosis. Assoc Res Otolaryngol1985; 92.
136.
IssaTK, BahgatMA, LinthicumFHJ, The effect of stapedectomy on hearing of patients with otosclerosis and Meniere's disease. Am J Otol1983; 4:323–6.
137.
YooTJ, StuartJM, KangAH, Type II collagen autoimmunity in otosclerosis and Meniere's disease. Science1982; 217:1153–5.
138.
YoonTH, PaparellaMM, SchachernPA. Otosclerosis involving the vestibular aqueduct and Meniere's disease. Otolaryngol Head Neck Surg1990; 103:107–12.
139.
RubinW.Harmonic acceleration tests as a measure of vestibular compensation. Laryngoscope1982; 91:489–92.
140.
BrooklerK, GlennM.Meniere's Syndrome: An approach to therapy. Ear Nose Throat J1995; 74:534–42.
141.
MalletteL, LeBlancA, PoolJ, Cyclic therapy of osteoporosis with neutral phosphate and brief, high-dose pulses of etidronate. J Bone Min Res1989; 4:143–8.
142.
HeaneyR, SavilleP.Etidronate disodium in postmenopausal osteoporosis. Clin Pharm Therapeut1976; 20:593–604.
143.
LafageM, BalenaR, BattleM, Comparison of alendrolate and sodium fluoride effects on cancellous and cortical bone in minipigs. J Clin Invest1995; 95:2127–33.
144.
ReginsterJ.Treatment of bone in elderly subjects: Calcium, vitamin D, fluor, bisphosphonates, calcitonin. Horm Res1995; 43:83–8.
