Otosclerosis – Progressive hearing loss


Otosclerosis is hereditary disease that causes  progressive hearing loss. It affects about 10% of the population but a much smaller proportion has symptoms. It usually appears in both ears and is more common to women (70%) compared to men (30%).
In most cases it starts between the ages of 20 and 30 and rarely in childhood or adolescence. Symptoms can be exacerbated in female patients during pregnancy. In addition to hearing loss that worsens over time (progressive), the most common and often annoying symptom is tinnitus, and some patients report that their hearing ability is better in noisy environments.

Progressive hearing loss

Hearing loss due to otosclerosis is one of the few cases of hearing loss that can be treated surgically.


If the hearing loss is not severe, the patient is simply  monitored by a specialist at regular intervals while on the other hand, if the situation is severe, a surgery must be performed to replace the affected part of the ear (usually the stirrup bone).

In cases where surgery is not possible, hearing aids can be fitted.


It is an inflammation of the larynx and may be acute or chronic laryngitis.

Acute laryngitis

Acute laryngitis is mainly caused by viruses and may be exclusively related to the larynx or may be part of a more general respiratory infection. Voice hoarseness is the most common symptom in acute laryngitis and in some cases complete loss of voice (aphonia). The patient may also complain of pain during speech and swallowing. If the disease affects the entire upper respiratory system, the symptoms are accompanied by fever and general malaise.
Treatment of acute laryngitis includes aphonia, painkillers, inhalation of water vapor and antibiotic treatment if necessary. The importance of aphonia should be emphasized to the patient, since forced phonation in a larynx that is already inflamed can cause permanent vocal disturbances. The patient should avoid speaking when possible and if he or she has to communicate verbally to do so for a brief period of time with a calm voice – whisper should also be avoided.
There are special forms of acute laryngitis that affect mostly children and are caused by viruses or germs. They can lead to life-threatening situations for a child, so parents and pediatricians should pay more attention.

Chronic laryngitis

Chronic laryngitis can be established from the outset as a standalone condition or it can be the result of acute laryngitis.
Factors favoring the establishment of chronic laryngitis include smoking, the inhalation of dust or air containing chemicals (eg in the workplace), oral respiration, persistent irritation of the larynx from the nose and pharynx, voice abuse, gastroesophageal reflux disease.

It manifests with hoarseness, which may be accompanied by pain or cough.


The treatment of chronic laryngitis consists of avoiding the etiologic factors that cause it, voice economy and proper medication. If these measures do not relieve the disease and laryngoscopy reveals alterations in the vocal cords, a biopsy is needed to rule out malignancy.

Quinsy- tonsil infection

It is usually a complication of tonsillitis and is the collection of pus in the tissues around the tonsils. It usually occurs on one side and is more common in males while rare in children. The quinsy is often formed during the attenuation of acute tonsillitis. That is, after a brief amelioration of the symptoms of tonsillitis, the patient sharply gets high fever, complains for severe pain in one side of the neck that reflects the ear and worsens even when swallowing saliva. Also, the patient has a distorted voice as if he has a hot potato in his mouth, which makes it difficult or impossible to open.
Quinsy is a serious condition that can even threaten patient’s life. For the treatment, it is necessary to open and drain the abscess, which immediately relieves the patient. At the same time, antibiotics are being administrated , and in many cases hospitalization is necessary.
Due to the high recurrence rate of the abscess, the tonsils should be removed after a reasonable period of time and after the general improvement of patients’ health. This period usually ranges from 4-6 weeks.

Acute tonsillitis

Acute tonsillitis is the inflammation of parietal tonsils caused by germs or viruses. It is a common children disease (between 5 and 10 years) and rarely occurs in older people (especially after 50). Tonsillitis is spread with saliva droplets, which is why children are often infected at school, where the disease can also become epidemic.

Acute tonsillitis is characterized by sudden onset of symptoms, high fever and poor general condition. Also, the patient reports neck pain, especially when swallowing, which can “hit” the ears. There may be a  mouth stench, possibly accompanied with voice change and bubo (swollen  lymph node).

The disease usually lasts for 4-5 days. Treatment basically requires staying in bed, topical antisepsis with gargles and painkillers. If the cause is microbial, the appropriate antibiotic should be administered. Dosage, route of administration (orally or through vein) and time of antibiotic treatment are evaluated on a case-by-case basis to ensure that complications are avoided and the full recovery of patient’s health.

The duration of administration of the medication should not be less than 10 days to avoid the emergence of resistant germs.
Frequent attacks or relapses in acute tonsillitis cause persistent inflammation of the parietal tonsils, which is characterized as chronic tonsillitis and is more common in adults.

Tonsils are either hypertrophic or atrophic.

Chronic tonsillitis

Chronic tonsillitis is caused by the same pathogens that cause acute tonsillitis. Usually there is a bad smell due to the presence of plugs in the tonsils.
Symptoms are persistent slight pain in swallowing, feeling of choking or knot in the throat, tensile fever, joint pain, swollen lymph nodes.
The treatment is surgical. Tonsillectomy is always recommended when tonsillitis is due to streptococci to avoid complications, as chronically inflamed tonsils are considered to be a source of infection for the body.
Complications of tonsillitis are local, such as abscesses in the adjacent tonsils and systemic such as rheumatic fever (which affects the joints and the heart) and glomerulonephritis that affect the kidneys.
The indications for tonsillectomy can be distinguished in absolute cases when surgery is necessary and in relevant cases where surgery may be avoided. The strict indications are severe hypertrophy which causes difficulty in breathing and sleep apnea syndrome,  peritonsilar abscess  and all the complications of tonsillitis, chronic tonsillitis and mainly streptococcal and suspicion of tonsilar tumors.

There is no contradiction concerning the age of the patients. The operation  can be done at any age as long as the indications suggest it.
However, children younger than 4 years old should only be operated if this is absolutely necessary.
The procedure usually takes less than an hour and often does not require an overnight stay in the clinic. Nowadays, a new method of tonsil removal imply ultrasound surgical head (Ultracision), which minimizes pain and bleeding.

Nasal bone fracture (nose fracture)

Deviation of the nasal septum