If you’ve noticed that your hearing has become weaker than before, or you feel like your ear is “blocked” for no clear reason, the cause may be simpler than you think… but it still needs attention.Eardrum sclerosis is a condition many people do not notice at first because it develops gradually and often begins with mild symptoms, such as slight hearing loss or mild tinnitus. Over time, it may affect hearing clarity and daily communication if it is not diagnosed and treated early.In this Dalili Medical article, we will explore together: What is eardrum sclerosis? Why does it happen? What are its main symptoms? And how can it be managed properly before it progresses?

What Is Eardrum Sclerosis?

Eardrum sclerosis is a condition in which thickening and scarring develop in the eardrum and middle ear. This scarring is often caused by chronic inflammation or repeated ear infections, which over time can lead to calcium deposits forming in the affected tissues.

Although eardrum sclerosis is not a contagious disease, it may result from conditions that cause recurrent ear infections, such as chronic middle ear infections. These changes in the eardrum can lead to conductive hearing loss, a type of hearing loss that occurs when sound waves do not pass normally through the middle ear.

❓ Can Ear Sclerosis Cause Permanent Hearing Loss?

In most cases, it causes gradual hearing loss, but it does not necessarily lead to complete hearing loss. With early diagnosis and proper treatment, such as hearing aids or surgery when needed, hearing can improve significantly.

❓ Is Ear Sclerosis Dangerous?

It is not considered life-threatening, but it can significantly affect quality of life, especially if left untreated, due to persistent hearing loss and tinnitus.

❓ Does Ear Sclerosis Get Worse Over Time?

Yes, it is often a progressive condition. Symptoms may start mildly and worsen slowly over time. However, the rate of progression varies from person to person depending on the cause and severity.

❓ Can It Affect One Ear or Both Ears?

It may affect:

• One ear at first
• Or both ears, which is common in some cases

❓ Is There a Permanent Treatment Without Surgery?

There is no medication that completely eliminates the condition. However, it can often be managed and hearing improved through:

• Hearing aids
• Regular medical monitoring in mild cases
• Surgery when necessary, depending on a specialist’s evaluation

❓ Does Surgery Cure Ear Sclerosis Permanently?

Surgery (such as stapes surgery) can greatly improve hearing in many cases, but it does not always guarantee that the condition will stop progressing completely, as progression may continue in some patients.

❓ Can Hearing Loss Return After Surgery?

In some cases, there may be:

• Gradual decline in hearing after a period of time
• Or a need for revision surgery to correct the issue

However, surgical results are often stable for many years in most patients.

❓ Does Tinnitus Disappear After Treatment?

Tinnitus may:

• Improve or decrease significantly
• Or remain to varying degrees depending on the patient’s condition and response to treatment

❓ Is Pregnancy Related to Ear Sclerosis?

In some cases, hormonal changes during pregnancy may:

• Increase the appearance of symptoms
• Or speed up hearing loss progression in some susceptible women

❓ Can Ear Sclerosis Affect Children?

It is very rare in childhood and most commonly appears between the ages of 20 and 40.

❓ How Is Ear Sclerosis Diagnosed?

Common signs include:

• Gradual hearing loss
• Tinnitus
• A normal-looking eardrum on examination

Diagnosis is confirmed through:

• Hearing tests (Audiometry) performed by an ENT specialist

Types of Otosclerosis

Otosclerosis is classified according to where the disease affects the ear, which directly influences symptoms and treatment options.

1. Conductive Otosclerosis

This is the most common type.

It involves:

• Damage to the stapes bone in the middle ear
• Loss of the bone’s normal mobility
• Reduced transmission of sound to the inner ear

Result:

This causes conductive hearing loss, meaning the main problem lies in sound transmission rather than the hearing nerve.

2. Cochlear Otosclerosis (Sensorineural Otosclerosis)

This is a less common type.

It involves:

• Changes affecting the inner ear, especially the cochlea
• Damage or impairment of the cells responsible for hearing

Result:

This leads to sensorineural hearing loss due to involvement of the hearing nerve or sensory hearing cells inside the ear.

3. Mixed Otosclerosis

This is a combination of the previous two types.

It involves:

• Involvement of the stapes bone in the middle ear
• Along with effects on the inner ear (cochlea)

Result:

This causes mixed hearing loss, combining both conductive and sensorineural hearing loss.

Causes, Symptoms, and Stages of Otosclerosis

First: Causes of Otosclerosis

Otosclerosis is not linked to one single cause. It usually develops due to a combination of factors affecting the stapes bone in the middle ear, causing it to lose flexibility and gradually become fixed.

Main Causes and Risk Factors

1. Genetic Factors

The risk increases if there is a family history of the condition, suggesting a clear genetic role.

2. Hormonal Changes

The condition appears more often in women, especially during:

• Pregnancy
• After childbirth

Hormonal changes may contribute to faster disease progression.

3. Viral Infections

Some studies have linked certain viral infections, such as the measles virus, to otosclerosis, although this connection is not yet definitively proven.

4. Abnormal Bone Remodeling

Abnormal growth around the stapes bone may cause stiffening and interfere with normal sound vibration transmission.

5. Immune Factors

Some research suggests the immune system may play a role in affecting the delicate bones inside the ear.

Second: Symptoms of Otosclerosis

Symptoms usually develop gradually and may go unnoticed in early stages due to slow progression.

Common Symptoms

1. Gradual Hearing Loss

This is the most common symptom.

It may:

• Start mildly and worsen over time
• Affect one ear or both ears
• Make soft sounds harder to hear clearly

Some patients may also notice a phenomenon called Paracusis, where hearing seems better in noisy environments.

2. Tinnitus

A person may hear ringing or buzzing in the ear, which can vary in intensity.

3. Difficulty Understanding Speech

This may include:

• Speech sounding unclear
• Difficulty understanding conversations, especially in noisy places

4. Feeling of Ear Fullness

Some people feel as if the ear is blocked or under pressure.

5. Dizziness (Rare)

Some cases may experience:

• Mild imbalance
• Or slight vertigo

Third: Stages of Otosclerosis

Stage 1 (Early Stage)

• Very mild hearing loss
• Often in one ear only
• Mild or barely noticeable tinnitus
• The problem may go unnoticed at first

At this stage, early changes begin in the stapes bone.

Stage 2 (Moderate Stage)

• Noticeable increase in hearing loss
• Difficulty understanding speech, especially with background noise
• Increased tinnitus
• Possible involvement of the other ear

At this stage, stapes movement decreases significantly.

Stage 3 (Advanced Stage)

• Noticeable hearing loss affecting daily life
• Difficulty understanding speech even in quiet settings
• Persistent bothersome tinnitus
• Feeling of ear blockage

At this stage, the stapes may become nearly fixed.

Stage 4 (Severe Stage – In Some Cases)

• Severe hearing loss
• May progress to mixed hearing loss (conductive + sensorineural)
• Sometimes balance problems may appear

At this stage, the inner ear may also be affected.

Diagnosis of Otosclerosis

Diagnosing otosclerosis requires an ENT specialist, as its symptoms may resemble other conditions such as ear infections or other types of hearing loss.

Methods of Diagnosis

1. Medical History and Symptom Evaluation

The doctor may ask:

• When did hearing loss begin?
• Is it gradually worsening?
• Is there tinnitus?
• Is there a family history of the condition?

2. Ear Examination (Otoscopy)

The ear is examined using a medical otoscope, and often:

• The eardrum appears normal

This is a common finding in otosclerosis.

3. Hearing Test (Audiometry)

This is one of the most important tests because it helps determine:

• The degree of hearing loss
• Whether the loss is conductive, sensorineural, or mixed

4. Tympanometry

This test evaluates:

• Middle ear function
• Movement of the hearing bones

5. Tuning Fork Tests (Rinne & Weber)

These simple tests help:

• Differentiate between types of hearing loss
• Provide an initial assessment of the problem

6. CT Scan (When Needed)

A CT scan may be requested to:

• Confirm the diagnosis
• Prepare before surgery
• Rule out other causes of hearing loss

Complications of Otosclerosis

1. Progressive Hearing Loss

This is the most common complication.

• Hearing may worsen gradually over time
• It may eventually interfere significantly with daily life

2. Severe Hearing Loss (In Some Cases)

If the disease progresses or affects the inner ear, hearing loss may become more significant.

3. Chronic Tinnitus

This may cause:

• Persistent ringing or buzzing
• Negative effects on concentration, sleep, and quality of life

4. Social Communication Difficulties

This may include:

• Trouble hearing speech clearly
• Misunderstanding conversations
• Frequently asking others to repeat themselves

5. Psychological and Social Effects

Hearing loss may contribute to:

• Stress and anxiety
• Social isolation
• Frustration due to communication difficulties

6. Balance Problems (Rare)

If the inner ear becomes affected, symptoms may include:

• Mild dizziness
• Balance disturbances

Can Otosclerosis Cause Complete Deafness?

Complete deafness is not common with otosclerosis. However, delayed diagnosis and lack of treatment may lead to significant hearing deterioration over time.

Short-Term and Long-Term Complications of Otosclerosis

Complications vary from person to person, and many cases can be well managed with early diagnosis and follow-up. Having otosclerosis does not necessarily mean severe complications will occur.

Short-Term Complications

1. Gradual Increase in Hearing Loss

• Difficulty hearing soft sounds
• Trouble understanding speech, especially in crowded places
• Needing to increase TV volume or ask for repetition

2. Tinnitus

• Ringing or buzzing in the ear
• It may be intermittent or constant
• It may affect concentration and sleep quality

3. Mental Fatigue Due to Hearing Difficulty

• Increased effort to understand speech
• Fatigue during long conversations
• Difficulty keeping up with daily details

4. Effects on Daily Communication

• Misunderstanding speech
• Missing words during conversations
• Difficulty with phone calls

5. Mild Balance Disturbances (In Some Cases)

• Feeling unsteady
• Mild dizziness 

Second: Long-Term Complications

1. Progressive Hearing Deterioration

• Hearing loss may progress from mild to moderate or severe.
• It may change from conductive hearing loss to mixed hearing loss if the inner ear becomes affected.

2. Sensorineural Hearing Loss (In Some Cases)

• This may occur if the cochlea becomes involved.
• It can make treatment and long-term management more complex.

3. Chronic Tinnitus

• Ringing in the ear may persist for long periods.
• It may significantly affect emotional well-being and quality of life.

4. Psychological and Social Effects

• Social isolation due to communication difficulties
• Stress and emotional strain
• Reduced overall quality of life

5. Effects on Daily Performance

• Difficulty at work or school
• Trouble following instructions or discussions
• Impact on activities that depend directly on hearing

6. Need for More Advanced Treatment in Severe Cases

If treatment is delayed, management may eventually require:

• Long-term use of hearing aids
• Or surgical intervention to improve hearing

Treatment of Otosclerosis: Medications and Surgery

Treatment depends on the severity of the condition and the type of hearing loss. Medications generally do not correct the underlying problem, which is fixation of the stapes bone, and their role is limited in selected cases. Surgery is often considered the most effective treatment in appropriate candidates.

First: Treatment of Otosclerosis with Medications

Medications do not “remove” or “reverse” stapes fixation, but they may be used in certain cases to help slow progression or manage symptoms, as determined by a specialist.

1. Sodium Fluoride

It may be used in selected cases, particularly when there is concern about activity affecting the inner ear.

Goal: Slow disease progression
Scientific evidence: Not fully conclusive
Use: Only under strict medical supervision

⚠️ Important:

• Do not use without a prescription
• Dosage and duration should be determined by a doctor
• Side effects may occur in some patients

2. Bisphosphonates

These medications are primarily used for bone disorders, but they have been studied in some cases of otosclerosis.

Examples include:

• Alendronate
• Risedronate
• Zoledronic acid

They may help stabilize progression in some cases, but:

• They are not routine treatment for all patients
• They should only be used after specialist evaluation

3. Medications for Associated Symptoms

Medications for dizziness:
May be used if dizziness or imbalance is present, mainly for symptom relief.

Managing tinnitus:
There is no definitive medication that cures tinnitus, but supportive therapies or rehabilitation approaches may help reduce how noticeable it feels.

Do Antibiotics or Cortisone Help?

Antibiotics: No, because otosclerosis is not an infection.
Cortisone: It is not a primary treatment for otosclerosis.

When Are Medications Not Enough?

If there is:

• Significant conductive hearing loss
• Stapes fixation

Then medications are usually not sufficient, and other options may be considered, such as:

• Hearing aids
• Or surgery

Second: Surgical Treatment of Otosclerosis

Surgery aims to improve sound transmission when the stapes bone becomes fixed. The type of surgery depends on the condition and test results.

1. Stapedotomy

This is currently the most common procedure.

How it works:

• A very small opening is made in the base of the stapes
• A tiny prosthesis is placed to help transmit sound

Advantages:

• Good hearing improvement outcomes
• Relatively minimally invasive
• High success rates in appropriate cases

2. Stapedectomy

This is an older technique but is still used in some cases.

How it works:

• Part or all of the stapes is removed
• It is replaced with an artificial prosthesis

3. Revision Surgery

This may be performed if another procedure is needed due to:

• Prosthesis displacement
• Hearing decline after surgery
• Or a problem that needs correction

4. Microscopic Surgery

This is not a separate type of surgery, but rather a technique using a surgical microscope for greater precision.

5. Endoscopic Surgery

In some centers:

• Surgery may be performed using an ear endoscope
• It may improve visualization inside the ear
• It depends on the surgeon’s expertise and the patient’s condition

6. Laser Use During Surgery

Laser may be used as a supportive tool during certain surgical steps, but it is not considered a separate operation by itself.

Alternatives to Surgery

Hearing Aids

These may be a suitable option in some cases:

• If a person does not want surgery
• Or if surgery is not appropriate

Surgical Success

In many appropriate cases:

• Hearing improves significantly
• However, results vary depending on the individual case and diagnosis

Potential Risks and Complications of Stapes Surgery

Any surgical procedure may carry risks, and the surgeon will discuss them based on the patient’s condition and test results.

Possible Risks and Complications

Temporary Dizziness

Some patients may experience mild imbalance or dizziness during the first days after surgery, which often improves gradually.

Temporary Changes in Taste

Changes in taste may occur due to effects on a nearby nerve, and this is often temporary.

Persistence of Some Symptoms

In some cases, hearing may not improve as much as expected, or some symptoms may continue to varying degrees.

Other Rare Complications

The surgeon may discuss less common risks that vary from person to person.

Recovery Time After Otosclerosis Surgery

Recovery varies from person to person, but there are approximate stages.

First 24–72 Hours After Surgery

• Mild dizziness or imbalance
• Feeling of ear blockage
• Temporary increase in tinnitus may occur
• Mild general fatigue

Rest at home is usually recommended during this period.

First Week

• Dizziness begins improving gradually
• Balance may improve
• Ear fullness may continue
• Avoid heavy effort and excessive bending

2 to 4 Weeks

• Most side effects improve
• Gradual return to daily activities
• Some patients begin noticing hearing improvement

4 to 8 Weeks

• More noticeable and stable hearing improvement
• Inner ear stability improves
• Follow-up and hearing testing may be performed

Full Recovery

• Often within 6 to 8 weeks
• In some cases, it may take up to 3 months for final results to fully stabilize

Important Recovery Instructions

Doctors commonly advise:

• Avoid heavy lifting or strenuous activity
• Do not allow water into the ear
• Avoid air travel or pressure changes for a period
• Do not clean inside the ear
• Avoid forceful nose blowing

When Does Hearing Improve After Surgery?

• Some people notice improvement within days
• Others improve gradually over several weeks

Prevention of Otosclerosis

There is no guaranteed way to completely prevent otosclerosis, especially when genetic factors are involved. However, certain measures may help reduce risk factors, slow progression, and support hearing health.

Preventing Progression and Protecting Hearing

1. Early Diagnosis and Not Ignoring Symptoms

If you notice:

• Gradual hearing loss
• Tinnitus
• Noticeable changes in hearing clarity

Early medical evaluation is recommended, as early diagnosis may help reduce long-term worsening.

2. Regular Follow-Up If There Is Family History

If there is a family history, it may be helpful to:

• Have regular hearing tests
• Monitor for early changes in hearing

3. Protect the Ear from Loud Noise

Ongoing exposure to loud sounds may negatively affect hearing overall.

Recommendations include:

• Reduce exposure to excessive noise
• Use hearing protection when needed
• Lower headphone volume

4. Treat Ear Problems Promptly

Ear infections or chronic ear problems should be managed, as maintaining ear health may help reduce worsening symptoms.

5. Monitor Hormonal Changes When Relevant

Hormonal changes may play a role in some cases, so medical follow-up may be helpful if hearing changes seem related to periods such as pregnancy.

Preventing Complications

6. Follow the Treatment Plan

If diagnosed, it is important to follow the doctor’s recommendations, such as:

• Using hearing aids
• Regular follow-up
• Or other appropriate treatment

This may help reduce hearing deterioration.

7. Have Regular Hearing Tests

Hearing tests help:

• Monitor progression
• Detect early deterioration even before obvious symptoms appear

8. Do Not Delay Treatment or Follow-Up

Delaying evaluation or treatment may allow the condition to progress further, making management more difficult later.