title: Perspectives of pharmacological treatment in otosclerosis.
abstract: To review our current knowledge of the pathologic bone metabolism in otosclerosis and to discuss the possibilities of non-surgical, pharmacological intervention. Otosclerosis has been suspected to be associated with defective measles virus infection, local inflammation and consecutive bone deterioration in the human otic capsule. In the early stages of otosclerosis, different pharmacological agents may delay the progression or prevent further deterioration of the disease and consecutive hearing loss. Although effective anti-osteoporotic drugs have become available, the use of sodium fluoride and bisphosphonates in otosclerosis has not yet been successful. Bioflavonoids may relieve tinnitus due to otosclerosis, but there is no data available on long-term application and effects on sensorineural hearing loss. In the initial inflammatory phase, corticosteroids or non-steroidal anti-inflammatory drugs may be effective; however, extended systemic application may lead to serious side effects. Vitamin D administration may have effects on the pathological bone loss, as well as on inflammation. No information has been reported on the use of immunosuppressive drugs. Anti-cytokine targeted biological therapy, however, may be feasible. Indeed, one study on the local administration of infliximab has been reported. Potential targets of future therapy may include osteoprotegerin, RANK ligand, cathepsins and also the Wnt-β-catenin pathway. Finally, anti-measles vaccination may delay the progression of the disease and potentially decrease the number of new cases. In conclusion, stapes surgery remains to be widely accepted treatment of conductive hearing loss due to otosclerosis. Due to lack of solid evidence, the place of pharmacological treatment targeting inflammation and bone metabolism needs to be determined by future studies.
authors: Department of Otolaryngology, Bajcsy-Zsilinszky Hospital, Budapest, Hungary.
authors: Balázs
authors: B
authors: Liktor
authors: Zoltán
authors: Z
authors: Szekanecz
authors: Tamás József
authors: TJ
authors: Batta
authors: István
authors: I
authors: Sziklai
authors: Tamás
authors: T
authors: Karosi
mesh_terms: D000893:Anti-Inflammatory Agents / Q000627:therapeutic use; D050071:Bone Density Conservation Agents / Q000627:therapeutic use; D016207:Cytokines / Q000037:antagonists & inhibitors; D018450:Disease Progression; D061345:Early Medical Intervention; D005419:Flavonoids / Q000627:therapeutic use; D006319:Hearing Loss, Sensorineural / Q000209:etiology / Q000517:prevention & control*; D006801:Humans; D008458:Measles Vaccine / Q000627:therapeutic use; D010040:Otosclerosis / Q000150:complications / Q000188:drug therapy* / Q000821:virology; D014807:Vitamin D / Q000627:therapeutic use
chemical_list: D000893:Anti-Inflammatory Agents; D050071:Bone Density Conservation Agents; D016207:Cytokines; D005419:Flavonoids; D008458:Measles Vaccine; D014807:Vitamin D