Scanning Electron Microscopy Images and Energy-Dispersive X-Ray Microanalysis of the Stapes in Otosclerosis and Van der Hoeve Syndrome

Objective/Hypothesis The objective of this study was to evaluate the morphological and microchemical changes that affect sclerotic stapes in otospongiosis and van der Hoeve syndrome. Methods A scanning electron microscope equipped with an energy‐dispersive x‐ray analyzer was used in the experiments. Results In otosclerosis, focal lesions are poorly mineralized, with low calcium salt and reduced calcium‐to‐phosphorus (Ca/P) ratio (1.9:1). This finding correlates with a spongiotic type of lesion and indicates unstable mineralization with possible change from hydroxyapatite to calcium triphosphate. In van der Hoeve syndrome the presence of magnesium in stapes suggests osteoclastic function stimulation. The osteoclasts secrete many protons, causing an acidified microenvironment. Brushite is formed, and Ca/P ratio decreases in comparison with that of control patients (2.0:1 vs. 2.6:1).