A 32-year-old woman with bilateral conductive hearing loss worsening during pregnancy is found to have a flamingo-pink blush of the promontory on otoscopy (Schwartze sign). On tympanometry, type A trace is obtained. Which treatment has the best long-term outcomes for this condition?
- A Sodium fluoride therapy alone (lifelong)
- B Hearing aid fitting without surgery
- C Stapedectomy/stapedotomy (surgical replacement of the fixed stapes with a prosthesis over the oval window) ✓
- D Bisphosphonate therapy to arrest otospongiosis
Correct answer: C. Stapedectomy/stapedotomy (surgical replacement of the fixed stapes with a prosthesis over the oval window)
Explanation
The Schwartze sign (flamingo-pink hue of the promontory through the tympanic membrane) represents hypervascularity of active otosclerotic foci. Stapedectomy/stapedotomy is the treatment of choice, achieving hearing improvement in over 90% of cases. Sodium fluoride arrests otospongiosis progression but does not restore hearing. Pregnancy worsens otosclerosis due to estrogen-stimulated otospongiotic activity, supporting surgical planning before or after pregnancy. Hearing aids are an alternative for those who decline surgery.
Reference: Dhingra Diseases of Ear, Nose and Throat, 7th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.