All are true statements regarding use of sodium fluoride in the treatment of otosclerosis except: [AIIMS May 2011]
|A||It inhibits osteoblastic activity|
|B||Used in active phase of otosclerosis when Schwartz sign is positive|
|C||Has proteolytiCactivity (bone enzymes)|
|D||Con'traindicated in chronic nephritis|
The most useful medication which prevents rapid progression of cochlear otosclerosis is sodium fluoride
Sodium Fluoride Therapy
Mechanism of Action
a. It reduces osteoclastic bone resorption and increases osteoblastic bone formation, which promote recalcification and reduce bone
b. remodelling in actively expanding osteolytic lesion.
c. It also inhibits proteolytic enzymes that are cytotoxic to cochlea and lead to SNHL (Hence specially useful in cochlear otosclerosis).
d. "Fluoride therapy has been found to significantly arrest the progression of SNHL in the low and high frequencies"
"Sodium fluoride therapy has a role in helping maturity of active focus to arrest cochlear loss"
Dose: Initially 50 mg daily followed by 25 mg daily for maintenance
Duration of treatment = 1 - 2 years
Indications for Sodium Fluoride Therapy:
a. Patients with progressive sensorineural deafness disproportionate with age (whose audiometric pattern indicates the possibility of cochlear otosclerosis)
b. Patients with radiological evidence of a demineralized focus in the cochlear capsule (demonstration of spongiotic changes in the cochlear caps-ule by popytomography).
c. Patients with positive Schwartz sign (indicates activity of otosclerotic focus).
d. Patients who have otosclerosis and are diagnosed to prevent with secondary hydrops.
Contraindications for Sodium Fluoride Therapy:
a. Patients with chronic nephritis with nitrogen retention
b. Patients with chronic rheumatoid arthritis
c. Pregnant or lactating women
d. In children before skeletal growth has been achieveD.
e. Patients with skeletal fluorosis
f. Patients allergic to fluoride.
Response is evidence by:
a. Reduced tinnitus
b. R duceddizziness
c. Fading of Schwartz sign
d. R diological signs of recalcification
- M/C Gastrointestinal side effects like nausea and vomiting
It can lead to skeletal fluorosis so.x-ray spine and long bones should be done routinely