Otosclerosis (stapes bone) causes symptoms and treatment

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.