A Treatise on Otosclerosis and its Treatment

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The field of otology is truly fortunate to have an otologist, who was willing to spend the time and effort to carefully research the literature and accurately document the circumlocution course of events that ultimately led to the current treatment of stapes fixation due to otosclerosis. In Professor Tange’s A Treatise on Otosclerosis And Its Treatment, the contributions of lesser known scientists such as Giovanni Ingrassia (1510-1580), who probably by accident discovered the stapes in the middle ear during a cadaver dissection; as well as the contributions of widely-known scientists and clinicians such as Valsalva, Toynbee, Politzer, Kessel, Rosen, Holmgren, Sourdille, Lempert, Shea, and others are carefully documented and referenced.

As described in this book, the path to the current treatment of otosclerosis with stapedotomy was a tortuous one. Many of the pioneers were ridiculed and some, such as Johannes Kessel, were forced to resign their positions. Others, such as Lempert, could not accept change and became obsolete. In the end, Dr. John Shea, with the assistance of Dr. Howard House, was able to present his experience with stapedectomy and return stapes surgery to its rightful place in the treatment of otosclerosis.

Using this historical perspective as a foundation, Dr. Tange thoroughly reviews the literature with respect to the etiologic theories and hypotheses on otosclerosis, the medical and surgical treatments, the role of imaging and the complications encountered during otosclerosis surgery.

The beautiful portraits and illustrations that accompany this book’s text and narrative not only give the reader a better understanding of what is being described, but also affords the reader an impression of the personas involved.

If one is looking for a definitive, detailed and accurate treatise on otosclerosis, one need look no further.

John T. McElveen, Jr., MD
President, Carolina Ear & Hearing Clinic
Secretary-Treasurer, Otosclerosis Study Group

For all ear doctors, otosclerosis is an intriguing condition. The disease appears to occur only in the human race and mainly in young adults. The pathology of the disorder has only been known for a little more than a century. Treatment of the fixed stapes has included many special therapies during that period. Because of the evolution of technology in medicine, the response to the development of otosclerosis has become increasingly clear in spite of the fact that the cause of this ear disease is still unknown.

Literature on otosclerosis includes thousands of publications, amongst which many textbooks. Recent books are often composed of chapters with a specific section on otosclerosis, written by a specialist in that area. Most of the time it concerns proceedings publications after an otological congress or symposium. A textbook containing all facets of the disorder is still missing.

To fill this gap, this Treatise on otosclerosis and its treatment has been compiled. As many publications as possible, from the discovery of the ear disease in the second half of the 19th century until now, have been used to compile a well-organized textbook. All the latest aspects of otosclerosis such as history, aetiology, genetic factors, histopathology, current stapedotomy procedure and complications in otosclerosis surgery are discussed extensively. In addition, attention was paid to cochlear otosclerosis, age and otosclerosis, imaging, hearing aids and future perspectives of otosclerosis treatment. This treatise on otosclerosis is a complete textbook that deals with all aspects of the ear disorder extensively.

Rinze Anthony Tange



1. Otosclerosis and early surgical treatment
1.1. Introduction
1.2. The anatomical discovery of the middle ear
1.3. The discovery of the otosclerosis
1.4. Early research on otosclerosis
1.5. Attempts to remobilize the ossiculair chain
1.6. Middle ear surgery in the 19th century
1.7. Tenotomy of the tensor tympani
1.8. Mechanical surgery of the middle ear ossicles by Lucae
1.9. Johannes Kessel, the ‘Father of stapes surgery’
1.10. Reactions to the first paper on stapes surgery
1.11. Frederick Lafayette Jack
1.12. Trephining the cochlea and stapedial footplate
1.13. Extraction of the auditory ossicles
1.14. The end of early stapes surgery
1.15. The condemnation of stapes and middle ear surgery

2. The father of otosclerosis
2.1. Introduction
2.2. Joseph Toynbee
2.3. Temporal bone studies
2.4. Toynbee’s death
2.5. Toynbee’s legacy

3. Etiological theories and hypotheses on otosclerosis
3.1. Introduction
3.2. Possible extrinsic etiological factors
3.3. Possible intrinsic etiological factors

4. Genetic factors in otosclerosis
4.1. Introduction
4.2. The HLA System and otosclerosis
4.3. COL1A1 gene and otosclerosis
4.4. A gene location for otosclerosis (OTSC, TGFB1, BMP2, and BMP4 )
4.5. Reviews on the etiology of otosclerosis since 2000

5. The pathology and histopathology of otosclerosis
5.1. Early otosclerosis histology
5.2. The localization of the otosclerosis foci
5.3. Histopathology studies on otosclerosis
5.4. Active and inactive otosclerotic lesions

6. Medical treatments of otosclerosis
6.1. Introduction
6.2. Phosphor treatment for otosclerosis
6.3. Slowing down the otosclerosis process by treating the endocrine system
6.4. Treatment of otosclerosis by Panitrin
6.5. Sex hormones and treatment of otosclerosis
6.6. Cortisone treatment of otosclerosis
6.7. Otosclerosis and fluoride therapy
6.8. Bisphosphonate treatment

7. Alternative treatments of otosclerosis
7.1. Advices to prevent otosclerosis
7.2. Ayurveda and otosclerosis
7.3. Cerebrospinal puncture and air replacement for otosclerosis
7.4. Diathermia treatment for otosclerosis
7.5. Bone implantation to solve the problem of otosclerosis biochemically
7.6. X-ray treatment of otosclerosis
7.7. Re-education machines

8. Hearing aids and otosclerosis
8.1. Introduction
8.2. Electric hearing aids
8.3. Bone-anchored hearing aids
8.4. Audiant Bone Conductor and BAHA attract implant
8.5. DACS (Direct Acoustical Cochlear Stimulation)

9. Pregnancy and otosclerosis
9.1 Otosclerosis in pregnancy
9.2. Eugenics and otosclerosis

10. Surgical treatment of otosclerosis
10.1. Wittmaack theory and treatment of otosclerosis
10.2. Raising of the dura mater as treatment for otosclerosis
10.3. Fenestration of the labyrinth
10.5. Fenestration operation
10.6. Osteogenetic closure of the newly-created fenestra in fenestration surgery
10.7. Results of the fenestration surgery
10.8. Mobilization of the stapes and stapediolysis
10.9. Stapedectomy and stapedotomy
10.10. Laser stapes surgery
10.11. Stapes prostheses

11. The current stapedotomy procedure
11.1. Diagnosis
11.2. Physical examination
11.3. Audiometry
11.4. Imaging before stapes surgery
11.5. Surgical treatment of otosclerosis
11.6. The incision
11.7. Exposition of the oval window
11.8. Middle inspection and removal stapes superstructure
11.9. Interposition of the stapes prosthesis
11.10. Postoperative care
11.11. Endoscopic ear surgery for otosclerosis

12. Complications in otosclerosis surgery
12.1. Introduction
12.2. Postoperative complications
12.3. Chorda tympani and otosclerosis surgery
12.4. Facial paralysis and stapes surgery
12.5. Conductive hearing loss remains
12.6. Incus necrosis
12.7. Perilymphatic fistula in stapes surgery
12.8. The persistent stapedial artery and stapes surgery
12.9. Ménière’s disease and vertigo in otosclerosis
12.10. Sensorineural hearing loss after stapes surgery
12.11. Revision stapes surgery in otosclerosis

13. Age and otosclerosis
13.1. Introduction
13.2. Juvenile otosclerosis
13.3. Otosclerosis in the elderly
13.4. Otosclerosis and quality of life

14. Imaging of otosclerosis
14.1. Radiography and roentgenogram
14.2. Polytomograph imaging technique in otology
14.3 Computer tomography and magnetic resonance imaging
14.4. Dehiscence of the superior semicircular canal mimicking otosclerosis

15. Cochlear otosclerosis
15.1. Introduction
15.2. Imaging of cochlear otosclerosis
15.3. Grading stapes and cochlear otosclerosis
15.4. Round window otosclerosis
15.5. Cochlear otosclerosis and cochlear implantation

16. Some well-known persons and otosclerosis
16.1. Ludwig von Beethoven
16.2. Harriet Martineau
16.3. Edward Sanford Martin
16.4. Louise of Hessen-Kasse, Queen of Denmark
16.5. Queen Alexandra
16.6. Prince Albert Victor
16.7. Georgina Battiscombe
16.8. Howard Hughes
16.9. Margaret Brooke Sullavan
16.10. Florence Henderson
16.11. Buzz Aldrin
16.12. Frankie Valli
16.13. Nanette Fabray
16.14. Sir John Warcup Cornforth, Jr
16.15. Richard Thomas
16.16. Graham Cole
16.17. Dina Carroll
16.18. Steve Downie

17. Future perspectives of otosclerosis
17.1. Introduction
17.2. Current results in otosclerosis surgery
17.3. Future ear surgeons
17.4. Decline of otosclerosis cases
17.5. Centers of expertise in otosclerosis
17.6. Hearing rehabilitation
17.7. New imaging procedures
17.8. Molecular research
17.9. Will otosclerosis become a rare disease?

About the author

Literature consulted

Publications by the author

This is a large format (A4) book which successfully combines a superb coverage of the history of our understanding of otosclerosis and its management, with recent advances and future prospects. It takes a clever author to mix so many images of some formidably severe and formal characters from the 19th Century or earlier, with the current triumphs of the radiologist or geneticist.

There is much humour to be found in this book, as we read of some bizarre theories and therapies associated with the condition of otosclerosis. Indeed the term itself is controversial with many of our Continental colleagues calling it Otospongiosis (not unreasonably), but certainly not in this text. For every topic there is much coverage of the earliest researchers, who were looking at the underlying pathology and evolving surgical management.

Countless memorable illustrations include that of Tullio blowing a whistle into the ear of an unfortunate rabbit, (in order to induce his eponymous phenomenon) or an ear trumpet wielded by what I think is an officer of Horse Artillery (who is wearing the Legion d’Honneur and may well have had noise induced deafness, I would bet).

There is a particularly novel and well updated coverage of the influence on Otosclerosis of ageing, pregnancy, genetics, hearing aids and medical treatment. Chapter 7 is disturbing, in covering “Alternative Treatments”, largely, thank goodness now obsolete. These include such measures to avoid the disease as “judicious clothing” and avoidance of living by the seashore. Indian traditional treatments, drainage of cerebrospinal fluid and replacement with air, diathermy or even ionizing radiation have all been employed and are covered in detail.

A chapter on “Well Known Persons and Otosclerosis” presented a few surprises. Beethoven we would expect, but I did not know his temporal bones had been harvested, only to disappear before proper analysis. Frankie Valli of Jersey Boys fame or Howard Hughes are among the sufferers. Buzz Aldrin at least only developed it after his moon landing, unlike Alan Shephard who was allowed to fly after a sac drainage procedure for Meniere’s Disease!

A brief final chapter is particularly thought provoking “Future Perspectives of Otosclerosis”. It is possible that the prevalence will decrease with fluoridation of drinking water, vaccination strategies, low dose contraception and the influence of Globalisation on our genetic make-up. The challenge then will be to develop the competence of earlier surgeons, even with the help of robots. Although there is no index, the opening table of contents is very detailed. The references run to over 50 pages and then a list of the author’s personal publications takes up another dozen.

Overall, this is a very entertaining read of a book where the emphasis is as much on the history of our concept of otosclerosis as it is on current management. It is recommended for the established otologist especially and certainly belongs in the departmental library, if the trainees are to understand “How we got to where we are”

Middlesbrough UK

Additional information

Weight 200 g
Dimensions 24 × 16 cm



Publication Year

2019 (3-9-2019)


Book. 2019. xiv and 363 pages. Publication date: 2019-09-03. Hardbound. Many figures and photos. A4