Treatment of Otosclerosis with Impaired Renal Function
In patients with otosclerosis and impaired renal function, the selection of pharmacological therapy requires specific adjustment. Reduced excretion changes which agents can be safely used, directly shaping the treatment approach for this population.
Clinical Scenario
Impaired renal function is a critical modifier in otosclerosis management. Sodium fluoride — used in other otosclerosis contexts — is contraindicated in this setting, as reduced renal excretion may lead to toxic accumulation.
Treatment Approach
In this scenario, management shifts to an alternative class of bone-metabolism inhibitors. Options exist in both oral and intravenous forms. The full protocol specifies which agents are appropriate and how they are administered.
Clinical Goals
The primary objectives are preservation and stabilisation of hearing thresholds (sensorineural component), along with improvement of tinnitus and vertigo.
References
DOI: 10.1016/j.otc.2017.11.006
- The use of this therapy is contraindicated in patients with impaired renal function because excretion of sodium fluoride may be reduced with resulting toxic levels.
- Alendronate, a bisphosphonate similar in action to etidronate, is recommended in a daily dose of a 10-mg tablet; risedronate is recommended at a dose of 5 mg/d.
- Formulations with a higher concentration of alendronate and risedronate have been developed with a more convenient, once-a-week dosing of 70 and 35 mg, respectively.
- The bisphosphonates that present formulations for intravenous use are Clodronate, Pamidronate, and zoledronate at doses of 1500 mg (monthly), 90 mg (monthly), and 4 mg (annual), respectively, for infusion over 4 hours for both clodronate and pamidronate and over 15 minutes for zoledronate.
- The use of inhibitors of bone metabolism aims to preserve hearing thresholds (sensorineural component) and improve symptoms such as tinnitus and vertigo.
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