Meet The Expert: Dr. Saud Al-Ajmi

Meet The Expert: Dr. Saud Al-Ajmi

Patients who have been recommended to use hearing aids are counseled regarding the benefits and functions of hearing aids.

Can you briefly introduce yourself and the topic for the day?

I’m Sujatha Ravi, Audiologist and Speech therapist at Ahmadi hospital. I have been working here for the past 5 years. Today I would like to discuss Otosclerosis from an audiologist’s perspective.

Can you explain what precisely is otosclerosis?

With pleasure, otosclerosis is a condition in which there is an abnormal growth of the bones of the ear, usually of the stapes, which is the smallest middle-ear bone that leads to the inner ear.

What are the most common symptoms of otosclerosis?

Hearing loss is the most frequently reported symptom of otosclerosis. It usually starts in one ear and then moves to the other. It may have a gradual onset. And the other symptoms that are associated with this condition include tinnitus and unsteadiness in few cases.

What really causes otosclerosis?

Well, while the cause of otosclerosis remains unknown at present, most often otosclerosis seems inherited and is reportedly more common in females. Hearing loss associated with otosclerosis has been noted to accelerate during pregnancy in some women. Some studies have observed measles virus to be associated with otosclerosis.

How does Otosclerosis cause hearing impairment and to what extent?

In normal hearing, sound (vibration of air particles) causes the eardrum to vibrate, and those vibrations are carried to the inner ear through three small middle ear bones(malleus, incus, and stapes) called the ossicles . The stapes is the last bone in the chain of ossicles which vibrates like a piston and transforms the air vibrations of sound into fluid vibrations in the inner ear or cochlea. Otosclerosis can cause different types of hearing loss, depending on which structure within the ear is affected. In early stages, the abnormal bone growths in otosclerosis usually affects the stapes, a middle-ear bone that leads to the inner ear. This bone growth fixates the stapes in the oval window and prevents it from moving properly, as a consequence makes it difficult for sound to be conducted to the inner ear. This results in a conductive hearing loss. Less frequently, otosclerosis may cause a mixed hearing loss as the disease progresses to the inner ear and damages the inner ear hair cells. Once this develops hearing loss is permanent. If untreated, it may gradually worsen and in few it can even cause profound hearing loss.

Can you talk briefly about your experience with patients having otosclerosis and your role in identifying this condition ?

In my experience, I have seen that not everyone with otosclerosis has obvious symptoms, and some people experience only mild symptoms throughout their lives. Since the hearing loss that can come along with otosclerosis happens gradually, most people with otosclerosis may not notice this loss until they reach their late teens, early twenties, or even enter middle age, although it may have started earlier. A person with otosclerosis usually speaks softly , while people with cochlear (or nerve) loss usually speak loudly. The presence of extra background noise usually adds to the hearing difficulty of people with cochlear deafness, but in otosclerosis this confusion does not occur. In fact, the person may even hear better in noisy surroundings, possibly because other people's voices are raised.

Audiologists play a major role in quantifying the hearing loss to arrive at diagnosis, does hearing evaluation as part of post- operative follow-up and also in management of otosclerosis by helping the patient choose and be fitted with the most appropriate hearing aid. Careful selection and fitting of hearing aids by an audiologist is usually more beneficial for otosclerosis that leads to conductive deafness than with nerve deafness. Besides conventional amplification devices, implants like Bone anchored hearing aids (BAHA) , sound bridge and tinnitus masker to manage tinnitus may also be recommended for these patients.

What is your advice to patients with otosclerosis?

I would suggest that they take notice of the onset of the hearing loss especially for those with a positive family history, it’s progression whether it is gradual or rapid, inform your doctor about the family history; if you have tinnitus (ringing, buzzing, or clicking in the ears) as a symptom of otosclerosis, take measures to make sure your hearing is not damaged further. For example, protect your ears when you are exposed to loud sounds, such as on an MP3 player. Make sure to keep medical appointments. This is because otosclerosis is a progressive disease, and different degrees of hearing loss may require different treatments.

For example, someone with more hearing loss from their otosclerosis may need surgery, while someone with less hearing loss may benefit from a hearing aid,or not need treatment at all for a while. Someone with tinnitus may need a hearing aid, white noise maker, or masker to help them with the noise produced by their tinnitus. Women who are pregnant and who notice a rapid change in their hearing ability should see their doctor as soon as possible, as pregnancy can make otosclerosis progress quickly. Lastly, I would recommend that they educate themselves about what to expect when they go to a specialist dealing with these kind of problems.