Otosclerosis

Fluoride therapy

Support for Flouride in early stage otosclerosis

The effect of sodium fluoride treatment in patients with otospongiosis has been evaluated in a prospective clinical double-blind, placebo-controlled study of 95 patients. The results showed a statistically significant greater deterioration of hearing loss in the placebo group than in the group actively treated with 40 mg of sodium fluoride daily

One group of subjects was treated with NaF in doses ranging from 6 to 16 mg according to age. The treatment lasted 2 years. A second group served as a control.
Changes in stapedius reflex morphology were evaluated at 1, 2, and 5 years from the onset of treatment.
The investigation demonstrated that NaF has a stabilizing effect on early otosclerosis. This drug, in fact, arrests the disease process in more than 60 percent of ears at the 2-year follow-up and in more than 50 percent at 5 years

Sodium fluoride is an enzyme inhibitor and reduces osteoclastic bone resorption and, if the dosage is more than 60 mg a day, may rebuild pseudohaversian bone.

Sodium fluoride administered to patients with mixed otosclerosis and an active focus of disease does not increase the difficulty of working with the footplate during stapedectomy, and it increases the hearing gain after the procedure.

The dosage can be adjusted starting with 60 mg and continuing with the maintenance dosage of 20–25 mg if clinical proof of effectiveness of the treatment is seen.

There is low quality evidence suggesting that sodium fluoride may be of benefit to preserve hearing and reduce vestibular symptoms in patients with otosclerosis.

Use of sodium fluoride to arrest development of otosclerosis was championed by Shambaugh and was fairly widespread in the 1960s and 1970s.
Fluoride ions replace the usual hydroxyl group in hydroxyapatite. The result is a fluorapatite complex resistant to osteoclastic degradation. Sodium fluoride therapy is now less commonly used, but it still has supporters.
The recommended dosage is 20-120 mg/day.
Effectiveness is monitored by noting the disappearance of the Schwartze sign, repeating audiometric testing, and performing follow-up CT.

The usual dose of sodium fluoride is 20 – 40 mg per day
Side effects of sodium fluoride include rash, arthritis, and gastrointestinal distress. Dosage for children and pregnant women is reduced
After two years of treatment, if the disease has stabilized, patients may take a life-long maintenance dose of about 25 mg per day.
Stopping the sodium fluoride can cause reactivation of the disease
Sodium fluoride may also be used for 6 – 12 months prior to stapedectomy to induce maturation of the diseased area and reduce chances that the disease will progress after surgery.