Ear calcification causes symptoms surgical treatment and essential tips

Ear calcification is a health issue that affects hearing and quality of life, whether in adults or children. This condition occurs when calcified bone forms in the middle ear, reducing the movement of the tiny bones responsible for transmitting sound to the inner ear. As a result, it leads to gradual hearing loss, ringing in the ears (tinnitus), or dizziness.In this article on Daili Medical, we will discuss the causes of ear calcification, its symptoms, diagnostic methods, and the latest treatment options, including medication, surgery, and laser therapy. Additionally, we'll provide essential post-surgery tips to improve hearing and maintain ear health.

What is Inner Ear Calcification (Otosclerosis)?

Inner ear calcification, also known as otosclerosis, is a condition that occurs when the stapes bone in the ear loses its ability to move due to abnormal bone growth. As a result, the ear's ability to transmit sound to the auditory nerve is reduced, leading to gradual hearing loss.

Otosclerosis typically affects both ears, but it may start in one ear first. It is more common among women and usually begins at a young age, potentially worsening over time if left untreated.

Does Ear Calcification Affect Both Ears?

In most cases, ear calcification affects both ears. Sometimes, it begins in one ear, and symptoms may appear in the other ear later.

Is Ear Calcification Dangerous?

Ear calcification can lead to gradual hearing loss if untreated. It occurs due to the accumulation of calcium in the middle ear, affecting the function of the stapes bone and the ear's ability to transmit sound normally.

How Many Ossicles are in the Middle Ear?

The middle ear contains three tiny ossicles:

The Malleus (Hammer)
The Incus (Anvil)
The Stapes (Stirrup)

These ossicles work together to transmit sound from the eardrum to the inner ear, playing a crucial role in the hearing process.

Is Tympanic Membrane Stiffening a Serious Disease?

Tympanic membrane stiffening can lead to hearing loss or impairment if left untreated. With early diagnosis and proper treatment, it is possible to maintain healthy hearing and normal ear function.

Who is at Risk for Ear Calcification?

Children and older adults are more likely to develop ear calcification. People with a history of chronic ear infections, allergies, or other health conditions are also at higher risk.

Can Ear Calcification Recur After Treatment?

Yes, in some cases, particularly if the person has recurrent ear infections. Regular follow-up visits with the doctor are essential to prevent recurrence and monitor hearing.

Is Ear Calcification Common in Children?

Ear calcification is very rare in children and typically appears in adults aged 30-40 years. In some genetic cases, early hearing loss may occur due to stapes calcification.

Does Ear Calcification Lead to Complete Deafness?

It usually does not lead to complete deafness. However, it causes gradual hearing loss if untreated, and the patient may need surgery to restore hearing.

Can Ear Calcification Be Prevented?

There is no guaranteed way to prevent ear calcification, but you can reduce the risk by:

Maintaining bone health
Preventing recurrent ear infections

Can Ear Calcification Be Treated with Laser Alone, Without Surgery?

Laser is used as an adjunct tool in Stapedotomy surgery. It alone cannot treat complete bony calcification of the stapes, and surgery is essential to restore hearing.

How Long Does Recovery Take After Ear Calcification Surgery?

Recovery typically takes 2-4 weeks for normal daily activities. Full hearing improvement may take several weeks to stabilize. Adhering to the doctor's instructions helps minimize potential complications.

Is the Procedure Painful?

No, the procedure is usually performed under either local or general anesthesia. After the surgery, the patient may experience mild pressure or temporary dizziness, which can be controlled with pain relievers.

Are the Results of the Procedure Permanent?

Most cases show a significant improvement in hearing (>90%). In rare cases, the patient may require an adjustment to the implant or a second procedure after several years.

Can Hearing Aids Be Used After the Procedure?

If the other ear is also at risk of calcification or hearing loss, hearing aids may be used to amplify sound. Some medications may also be prescribed to stabilize the condition, as per the doctor’s instructions.

Causes of Ear Calcification (Otosclerosis)

Otosclerosis occurs when the bones of the middle ear, particularly the stapes bone, grow abnormally, hindering sound transmission and leading to hearing loss. The main causes include:

Genetic Factors
Genetics plays a key role. If one parent has the condition, the likelihood of offspring developing otosclerosis increases.
Hormonal Changes
Pregnancy or hormonal therapy may accelerate the development of calcification.
Chronic Middle Ear Infections
Repeated ear infections affect the bones and increase calcification.
Age-related Factors
Symptoms typically begin between ages 20 and 40. Hearing loss tends to gradually worsen with age.
Bone Disorders
Conditions like osteoporosis or metabolic bone disorders may contribute to otosclerosis.

Symptoms of Ear Calcification

Symptoms develop gradually and include:

Gradual Hearing Loss
Usually begins in one ear and may spread to the other over time. Sounds may seem muffled or distant, especially low-pitched sounds.
Difficulty Hearing Conversations
Especially in noisy environments or when there is background noise.
Tinnitus (Ringing in the Ears)
Continuous ringing, buzzing, or hissing sound in the affected ear.
Balance Issues (Rare)
Some patients may experience dizziness or a sensation of imbalance.
Increased Sensitivity to Sound
The patient may become more sensitive to loud or sudden noises.
Gradual Progression of Symptoms
The symptoms usually develop over several years, not suddenly.

Steps in Otosclerosis Surgery

The surgery aims to remove or bypass the calcified bone (stapes) to restore sound transmission:

Anesthesia
Local anesthesia with sedation or general anesthesia, depending on the patient's condition.
Opening the Ear Canal
Accessing the eardrum and gently lifting it, if necessary.
Identifying the Calcified Bone (Stapes)
The affected bone is identified, which has turned abnormally hard.
Removing or Modifying the Stapes
- Stapedectomy: Removal of the stapes and replacement with a small implant.
- Stapedotomy: Creating a small hole in the stapes and placing a tiny implant to transmit sound.
Implant Placement
The implant is carefully placed to ensure sound vibrations reach the inner ear.
Closing the Eardrum and Canal
The eardrum is repositioned, and the ear canal is covered with gauze or a bandage for protection.

Post-Operative Follow-up

Monitoring hearing after a few weeks.
Checking for any bleeding, dizziness, or persistent tinnitus.
Avoiding ear pressure or water entry during the first few weeks.

Types of Ear Calcification

Otosclerosis is classified based on its location and its impact on hearing:

Classic Otosclerosis (Ossicular Otosclerosis)
Occurs in the middle ear bones, particularly the stapes. It prevents the normal movement of the stapes, leading to conductive hearing loss. It usually starts in one ear and may spread to the other over time.
Cochlear Otosclerosis (Internal Otosclerosis)
Affects the cochlea in the inner ear, causing sensorineural hearing loss along with tinnitus. Less common but may lead to permanent hearing loss if untreated.
Mixed Otosclerosis
Involves both conductive hearing loss and sensorineural hearing loss. This occurs when calcification spreads from the middle ear bones to the inner ear. Symptoms are typically more severe and affect quality of life more significantly.

Diagnosis of Ear Calcification

Diagnosis is based on medical history, clinical examination, and specialized tests:

Medical History and Clinical Examination
The doctor asks about gradual hearing loss, tinnitus, potential dizziness, and family history. An otoscopic exam is performed to assess the eardrum and stapes mobility.
Audiometry Tests
Determines the type of hearing loss:
- Conductive loss: Caused by stapes calcification.
- Sensorineural loss: When calcification reaches the inner ear.
- Mixed loss: Both types of hearing loss present.
Tympanometry
Measures eardrum movement and middle ear pressure, revealing stapes rigidity or middle ear blockage.
Imaging and Radiological Tests
A CT scan reveals abnormal bone growth in the stapes or inner ear, helping to assess the extent of calcification before surgery.
Additional Tests if Needed
- Auditory Brainstem Response (ABR) for children or those who cannot undergo conventional hearing tests, evaluating the function of the inner ear and auditory nerves.

Success Rate of Otosclerosis Surgery

The surgery, known as Stapedectomy or Stapedotomy, aims to remove or bypass the calcified stapes to restore middle ear function and improve hearing.

Overall Success Rate
Most studies indicate a success rate of 90–95% in improving conductive hearing loss. Success is measured by improved hearing and a reduced gap between the affected and healthy ear.
Factors Affecting Success
- Surgeon’s experience and specialization in delicate ear surgeries.
- The extent of calcification and its spread to the inner ear.
- Presence of other ear problems, such as chronic infections or associated sensorineural hearing loss.
- Patient adherence to post-operative instructions (rest, avoiding ear pressure, medical follow-up).
Rare Risks or Complications
- Partial or complete hearing loss in very rare cases (<1%).
- Persistent or worsening tinnitus.

Temporary Dizziness After Surgery

Some patients may experience temporary dizziness after surgery.
Mild inflammation or slight bleeding, which usually resolves within a few days.

Post-Operative Expectations

Most patients notice significant improvement in their hearing within a few weeks.
Some patients may require periodic follow-up visits to ensure the results remain stable.

Treatment Duration for Ear Calcification

The duration of treatment depends on the type of treatment and the severity of the condition:

Pharmacological Treatment
- Medications like Bisphosphonates or supplements to slow the progression of calcification.
- Treatment duration: Several months to years to notice any effect on stabilizing hearing.
- Goal: To stabilize the condition and prevent further hearing loss, but not to fully restore hearing.
Hearing Aids
- Used for moderate hearing loss or when surgery is not suitable.
- Usage: Continuous, as needed, with regular follow-up to adjust the volume settings.
Surgical Treatment (Stapedectomy/Stapedotomy)
- Surgery duration: Around 1 to 2 hours, depending on the case.
- Recovery time:
  - Rest at home for 1 to 2 days.
  - Avoid intense physical activity or air travel for 2-3 weeks.
  - Full recovery and improved stapes movement usually occur within 4-6 weeks.
- Hearing follow-up: Hearing tests are conducted several times over the following months to ensure stable results.
Factors Affecting Treatment Duration
- Patient’s age and general health.
- The extent of calcification and its effect on the inner ear.
- Adherence to the doctor’s post-operative instructions.

Important Post-Surgery Tips for Ear Calcification

Rest and Avoid Stress
- Get complete rest in the first few days after the surgery.
- Avoid carrying heavy objects or engaging in strenuous physical activity for 2-3 weeks.
Protecting the Ear
- Avoid getting water in the ear while showering or swimming during the first few weeks.
- Do not clean the ear with cotton swabs or any tools inside the ear canal.
Avoiding Pressure on the Ear
- Refrain from sneezing or coughing forcefully. Use your mouth to alleviate pressure when necessary.
- Avoid air travel or diving in the first few weeks unless approved by the doctor.
Monitoring Symptoms
- Mild bleeding or dizziness is normal in the first few days.
- Contact your doctor immediately if you experience:
  - Sudden hearing loss or increased tinnitus.
  - Heavy bleeding from the ear.
  - High fever or signs of infection.
Hearing Follow-up
- Conduct hearing tests after a few weeks to ensure improved auditory performance.
- Regular follow-ups are important to assess the stability of results and monitor for complications.
Adherence to Medications
- Take any prescribed antibiotics, pain relievers, or ear drops as directed by the doctor.
- Do not stop any medication without consulting your doctor.
Nutrition and Sleep
- Eat light and balanced meals.
- Ensure adequate sleep and keep your head elevated slightly to reduce swelling and dizziness.

Complications of Ear Calcification Surgery

Although ear calcification surgery is generally considered safe, especially when performed by a specialized surgeon, there are some potential complications that may arise post-surgery. Here are the most common possible complications:

Partial or Total Hearing Loss
In very rare cases (less than 1%), permanent hearing loss may occur after the surgery. This is usually linked to issues within the inner ear or improper placement of the implant.
Tinnitus (Ringing in the Ear)
Some patients may experience an increase in tinnitus or continued ringing in the ear. In most cases, tinnitus improves gradually over the weeks or months following surgery.
Dizziness or Balance Loss
Some patients may feel dizziness or a sense of imbalance for a short period after the surgery. This sensation usually resolves within days or weeks with rest and medical follow-up.
Bleeding or Fluid Accumulation
Mild bleeding or fluid accumulation is normal in the first few days following surgery. If there is heavy bleeding, it’s essential to consult the doctor immediately for proper treatment.
Infection or Inflammation
Local infection or inflammation in the ear canal may occur post-surgery. Typically, this is treated with antibiotics prescribed by the doctor.
Taste or Facial Problems (Very Rare)
Due to the proximity of the facial nerve to the middle ear, some patients may experience temporary numbness, a change in taste, or facial movement issues. These complications are rare and usually temporary.
Implant Movement or Ineffectiveness
In some cases, the implant may shift or fail to set correctly, leading to continued hearing loss. In such cases, a second surgery may be needed to adjust or replace the implant.

Medical Treatment for Ear Calcification

Ear calcification is not typically treated permanently with medication, but there are some treatments that can help slow the progression of the condition or stabilize hearing, especially for patients who are not suitable for surgery or are in the pre-surgical phase. Here are the details:

Bone Calcification Inhibitors (Bisphosphonates)
Medications like Alendronate or Risedronate are used to slow the abnormal bone growth in the middle ear.
- Usage: Typically taken in pill form on a weekly or monthly basis as prescribed by the doctor.
- Duration: Treatment can last several months to years, depending on the doctor’s evaluation.
- Note: These medications do not restore hearing but help prevent further worsening and slow the progression of calcification.
Calcium and Vitamin D Supplements
These help improve overall bone health, potentially reducing the speed of calcification.
- Usage: Often used alongside bisphosphonates.
Anti-inflammatory or Steroid Medications (Rare)
These are used only if there is significant swelling in the middle ear or accompanying infections.
- Usage: Generally prescribed for short periods and under strict medical supervision.
Symptom Management
- Antivertigo Medications: If the patient experiences frequent dizziness due to ear calcification.
- Hearing Aids: Used for moderate hearing loss or if surgery is not an option. These devices help improve hearing temporarily or permanently, depending on the case.
The Relationship Between Medications and Surgery
- Before Surgery: Medications may be used to stabilize the condition or improve the situation prior to surgery.
- After Surgery: Some medications help maintain bone health and prevent deterioration in the other ear if it is at risk of calcification.

Surgical Treatment for Ear Calcification

Surgery is the most effective solution for restoring hearing in cases of ear calcification, especially when hearing loss is moderate to severe. Here are the available surgical options:

Stapedectomy (Complete Removal of the Stapes)
- Procedure: Removal of the calcified bone (stapes) in the middle ear and replacing it with a small implant made of specialized materials.
- Goal: To restore normal sound transmission from the eardrum to the inner ear.
- Surgical Methods:
  - Traditional Surgery via the Ear Canal (Transcanal): The middle ear is accessed using delicate instruments.
  - Endoscopic Surgery: A more precise method that reduces bleeding and speeds up recovery.
- Success Rate: Significant improvement in hearing, with a success rate of 90–95%.
Stapedotomy (Making a Hole in the Stapes)
- Procedure: Instead of removing the stapes entirely, a small hole is made in the calcified bone, and a small implant is inserted.
- Goal: Useful in cases of limited calcification, reducing the risk of hearing loss.
Removal of Congenital Cysts or Masses
- Procedure: In some cases, bone masses or congenital cysts may exist in the middle ear.
- Treatment: These are surgically removed to avoid blockage of sound and hearing loss complications.

Laser Treatment for Ear Calcification Surgery

Laser can be used as an adjunct tool in ear calcification surgery, especially in Stapedotomy surgery, which involves making a small hole in the calcified bone (stapes) or removing thin membranes. Here are the details:

Usage:
- Goal: The laser is used to create a precise hole in the calcified stapes or remove thin tissue membranes that may hinder the movement of the ossicles.
- Suitable Cases: Effective in cases of tissue calcification or small holes, and is useful for removing delicate tissue.
Benefits of Laser Use:
- High Precision: The laser allows for a small, precise hole to be made in the bone, minimizing accidental damage to surrounding tissue.
- Reduced Bleeding and Swelling: The laser promotes faster tissue healing, reducing bleeding and swelling.
- Faster Recovery: Laser surgery typically leads to a quicker recovery compared to traditional surgery.
Limitations:
- Effective Only for Tissue Blockages: Laser is effective only in cases where there is soft tissue blockage or small holes.
- Not Suitable for Complete Bone Calcification: When calcification has fully affected the stapes or middle ear, more extensive surgery, such as Stapedectomy, is required to remove the calcified bone and replace it with an implant.

Risks of Ear Calcification Surgery

Although ear calcification surgery is relatively safe, there are still some risks and complications that can arise, as with any surgery. These risks include:

Hearing Loss
- Incidence: In very rare cases (less than 1%), partial or total hearing loss may occur.
- Causes: This is usually related to issues in the inner ear or improper placement of the implant.
Tinnitus (Ringing in the Ear)
- Impact: The ringing sound may continue or worsen after surgery.
- Recovery: Tinnitus generally improves gradually over weeks or months, but medical follow-up may be needed to address the causes and treatment.
Dizziness or Balance Loss
- Impact: Some patients may experience dizziness or imbalance during the first few days following surgery.
- Recovery: This is usually temporary and resolves with rest and medical monitoring.
Bleeding or Fluid Accumulation
- Normal Cases: Mild bleeding or fluid buildup is common during the first few days.
- Medical Follow-up: If bleeding becomes severe or continues, it’s important to see a doctor immediately.
Infection
- Impact: Localized infections in the ear canal or area near the surgical site may occur.
- Treatment: Infections are generally treated with antibiotics prescribed by the doctor.
Taste or Facial Issues (Very Rare)
- Causes: The proximity of the facial nerve to the middle ear may cause temporary numbness or changes in taste or facial movements.
- Recovery: These issues are rare and typically resolve within weeks.
Implant Movement or Failure
- Causes: If the implant does not stay properly in place, hearing loss may persist.
- Recovery: A second surgery may be necessary to adjust or replace the implant if it fails to function properly.

Post-Surgery Considerations for Ear Calcification Surgery

After undergoing ear calcification surgery, it's important to follow certain guidelines and tips to ensure proper recovery and avoid complications:

Rest and Avoid Strain
- Rest: Take complete rest during the first few days after surgery to reduce pressure on the ear and help with healing.
- Restricted Activities: Avoid heavy lifting or intense physical activities for 2-3 weeks after surgery.
Protect the Ear from Water and Contaminants
- Water: Avoid getting water in the ear while showering or swimming during the first few weeks to prevent ear infections or contamination.
- Pollutants: Stay away from dust, smoke, or other irritants that may cause infections or complications.
Prevent Pressure on the Ear
- Avoid Sneezing or Coughing Forcefully: When sneezing or coughing, use your mouth to minimize pressure on the ear.
- No Insertion of Objects: Do not use ear plugs or cleaning tools inside the ear without doctor approval, as these may cause damage.
Monitor Emergency Symptoms
- Danger Signs: Immediately consult the doctor if any of the following symptoms appear:
  - Severe bleeding from the ear.
  - Sudden hearing loss or worsening tinnitus.
  - High fever or signs of infection.
  - Abnormal discharge from the ear.
Hearing Follow-up
- Routine Hearing Tests: Schedule hearing tests after a few weeks to check for improvement in hearing and ensure results are stable.
Adherence to Medications
- Follow Medication Instructions: Take prescribed antibiotics, pain relievers, or ear drops as directed.
- Do Not Stop Medications: Do not stop any medication without consulting your doctor first.
Healthy Nutrition and Rest
- Balanced Diet: Ensure you consume light, nutritious meals to help speed up recovery.
- Adequate Sleep: Get enough rest and keep your head slightly elevated during sleep to reduce swelling and dizziness.