A 32-year-old woman with bilateral progressive conductive hearing loss is noted to have bilateral absent acoustic reflexes and Carhart's notch (mechanical BC notch at 2 kHz) on audiometry. Tympanogram shows shallow Type As (stiffness) pattern. Which medical treatment may slow progression of otosclerosis?

• A Oral prednisolone
• B Intranasal calcitonin spray
• C Sodium fluoride tablets (NaF) — inhibits osteoclast activity in active otospongiosis ✓
• D Bisphosphonates (alendronate)

Explanation

Sodium fluoride (NaF 40–60 mg/day with calcium supplementation) is the only established medical treatment for active otosclerosis. It inhibits osteoclast activity by converting hydroxyapatite to fluorapatite in the active otospongiotic focus, slowing the spongiotic (active) phase of otosclerosis and potentially reducing the risk of sensorineural hearing loss progression. It does not reverse conductive hearing loss, for which stapedectomy/stapedotomy remains the treatment. Bisphosphonates are used for Paget's disease; steroids and calcitonin are not established for otosclerosis.

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.