Medical treatment of otosclerosis: rationale for use of bisphosphonates.
Otosclerosis is a bony dyscrasia characterized by histopathological findings of osteoclast production. Osteoclastogenesis explains the pathogenesis of otosclerosis. Basic science research in the experimental animal otic capsule has given insight into the process of evolution of otosclerosis. The normal otic capsule is preserved with very little bone turnover as a result of the production of osteoprotegerin (OPG) by the membranous inner ear that prevents the activation of osteoclasts. Animals genetically unable to produce OPG demonstrated the production of hearing loss and histopathology of the temporal bones consistent with that seen in otosclerosis. Applying the understanding of osteoclastogenesis to the treatment of otosclerosis has led to the clinical use of the class of drugs called bisphosphonates. The bisphosphonate group of drugs specifically targets osteoclasts by reducing production of osteoclasts and accelerating their early cell death. The rationale for use of bisphosphonates to treat the sensorineural hearing loss of otosclerosis is explained, with cases that illustrate the bisphosphonates treatment algorithms and the response to treatment.
Brookler
Kenneth
K
Neurotologic Associates, PC, New York, New York 10075, USA. khbrooklermd@mac.com
D000368:Aged; D019386:Alendronate / Q000627:therapeutic use*; D000818:Animals; D050071:Bone Density Conservation Agents / Q000627:therapeutic use*; D001862:Bone Resorption / Q000188:drug therapy; D016923:Cell Death / Q000187:drug effects / Q000502:physiology; D003131:Combined Modality Therapy; D004164:Diphosphonates / Q000627:therapeutic use*; D004195:Disease Models, Animal; D004305:Dose-Response Relationship, Drug; D004334:Drug Administration Schedule; D004359:Drug Therapy, Combination; D007758:Ear, Inner / Q000187:drug effects / Q000503:physiopathology; D004432:Ear, Middle / Q000187:drug effects / Q000503:physiopathology; D012968:Etidronic Acid / Q000031:analogs & derivatives* / Q000627:therapeutic use*; D005500:Follow-Up Studies; D006310:Hearing Aids; D006319:Hearing Loss, Sensorineural / Q000188:drug therapy / Q000503:physiopathology; D006801:Humans; D008297:Male; D008875:Middle Aged; D010010:Osteoclasts / Q000187:drug effects / Q000502:physiology; D053244:Osteoprotegerin / Q000502:physiology; D010040:Otosclerosis / Q000188:drug therapy* / Q000503:physiopathology; D000068296:Risedronic Acid; D013063:Speech Discrimination Tests; D013069:Speech Reception Threshold Test; D013201:Stapes Surgery; D014012:Tinnitus / Q000188:drug therapy / Q000503:physiopathology
D050071:Bone Density Conservation Agents; D004164:Diphosphonates; D053244:Osteoprotegerin; D000068296:Risedronic Acid; D012968:Etidronic Acid; D019386:Alendronate