A note on progression of the otosclerotic focus.

One thousand and thirteen consecutive patients in South Australia with stapedial fixation from otosclerosis were classified by duration of deafness, age at onset and degree of footplate pathology to determine whether there is an orderly progression in severity of the oval window lesion with duration of symptoms. The conclusions drawn were as follows. (1) An early age of onset of clinical otosclerosis, during the period of skeletal growth, dramatically increases the chance of contracting a fulminating lesion with severe and diffuse involvement of the stapedial footplate or obliteration of the oval window niche. (2) A late age of onset of clinical otosclerosis tends to be associated with lesions of the stapes footplate that are limited to the anterior pole, and there is good evidence that the lesion tends to remain stable or to progress only very slowly. (3) The case for a regular and orderly pathological progression of the otosclerotic lesion through various patterns of severity from minor to major degrees of footplate pathology is not established by the data; nor is it convincingly refuted. It is clear that if a pathological progression of the lesion does take place it must be at vastly different rates for different individuals.