Third-generation bisphosphonates for treatment of sensorineural hearing loss in otosclerosis

Abstract

Objective: To evaluate hearing outcomes in patients treated with third generation bisphosphonates for otosclerosis-related sensorineural hearing loss (SNHL).

Hypothesis: Otosclerosis is a disease of abnormal bone remodeling in the otic capsule. In recent years, third generation bisphosphonates, with more powerful anti-resorptive properties and increased bone affinity, have demonstrated effectiveness in the treatment of osteoporosis and other metabolic bone diseases. We hypothesized that newer generation bisphosphonates, such as risedronate and zoledronate, would be effective in slowing the progression of SNHL in patients with otosclerosis.

Study design: Retrospective review.

Setting: Tertiary referral center, ambulatory care.

Interventions: Risedronate or zoledronate administration.

Main outcome measures: Bone conduction pure tone threshold averages (PTAs) and word recognition (WR) scores were examined for each ear before and after bisphosphonate treatment. Criteria for significant change were defined as greater than 10 decibels in PTA or between 4% and 18% in WR based on binomial variance.

Results: All 10 patients had audiometric progression of SNHL in the pretreatment monitoring interval and 12 ears met criteria for significant progression. All 10 patients (19 ears) showed at least no significant progression of SNHL (i.e., stabilization) at an average follow-up of 13 months. Two patients (3 ears) showed improvement by defined audiometric criteria. There were no major complications.

Conclusion: Treatment with zoledronate or risedronate stabilized progressive SNHL related to otosclerosis in this small group of patients. Further evaluation of third-generation bisphosphonate treatments is warranted.

Figures

Figure 1

A and B show bone conduction pure tone average (BC-PTA) and word recognition score (WR) in the pre-treatment interval. C and D show BC-PTA and WR in the post-treatment interval. Each point on the graph represents one ear. The black line is a reference line that marks no change between the first available and the immediate pre-treatment audiograms in A and B, and between the immediate pre-treatment and post-treatment audiograms in C and D. Change is not considered significant within the shaded area, with significance defined by more than 10 dB change in PTA (A and C) or by the binomial model of variance for WR (B and D). The majority of the ears are below the line in A and B. In contrast, most ears after treatment, as shown in C and D, are close to the line or above the line.