Ears Otosclerosis

Overview

Otosclerosis is a condition where abnormal bone growth happens in the middle ear. The middle ear has three tiny bones that carry sound to the inner ear. In otosclerosis, one of these bones, called the stapes, becomes stuck or stiff. Sound cannot pass through as well, so hearing slowly gets worse. It is not caused by earwax or an ear infection.

Otosclerosis is fairly common in some populations. It is one of the more common causes of hearing loss in young and middle-aged adults. It is not rare, but it does not affect everyone.

It often starts between the ages of 20 and 40. It can affect children, but this is less common. It is more common in women than in men. Pregnancy may make symptoms worse in some women. Having a parent or sibling with otosclerosis makes it more likely.

Symptoms

Common symptoms

• Hearing loss that gets worse slowly, often starting in one ear.
• Sounds seem muffled or far away.
• You may hear better in a noisy place than in a quiet one. This is called paracusis.
• Ringing, buzzing, or hissing in the ears, called tinnitus.
• Trouble hearing low sounds or whispers.
• Dizziness or poor balance is less common but can happen.

Symptoms in children

• Children may not say they cannot hear. They may ask 'what?' often or turn up the TV loud.
• Speech may be delayed or unclear.
• Teachers may notice the child does not follow instructions or seems distracted.
• Schoolwork may become harder, or the child may seem tired from listening.

Symptoms in older adults

• If you already have age-related hearing loss, otosclerosis can make it worse.
• You may need the TV or phone louder than before.
• You may find it hard to follow conversations in groups or in background noise.
• You may feel tired or left out because listening takes more effort.
• Balance problems are less common, but they can happen.

Causes

Main causes

• The exact cause of otosclerosis is not fully known.
• It happens when bone in the middle ear grows in an abnormal way. This makes the stapes bone less able to move.
• Genes and family history play a part. Otosclerosis often runs in families.

Risk factors

• Having a parent, sibling, or other close family member with otosclerosis.
• Being between about 20 and 40 years old when symptoms start.
• Being female. Pregnancy may make hearing loss worse in some women.
• Some ethnic groups are affected more often than others.

When to see a doctor

See a doctor urgently if:

• You lose hearing suddenly, especially in one ear.
• You have severe dizziness or vertigo that will not stop.
• You have ear pain with fever, discharge, or swelling.
• You have a head injury and then notice hearing loss or dizziness.

Book a routine appointment if:

• Your hearing seems to be getting worse slowly.
• You often ask people to repeat themselves.
• You notice ringing or buzzing in your ears.
• You have a family history of otosclerosis and want your hearing checked.
• Hearing loss is affecting your work, school, or social life.

Diagnosis

A doctor or hearing specialist will ask about your symptoms and family history. They will look in your ears and do simple hearing checks. You may be referred for a full hearing test. The diagnosis is usually made from these tests, not from a scan alone.

Tests that may be done

• Otoscopy: looking inside the ear to check for wax or infection.
• Tuning fork tests: simple checks that help show where the hearing problem is.
• Audiometry: a full hearing test that measures what sounds you can hear at different volumes and pitches.
• Tympanometry: a test that checks how well the eardrum moves.
• Sometimes a CT scan of the ear may be used if surgery is being considered or the diagnosis is unclear.

What to expect at your appointment

These tests are usually painless and do not take long. You may need more than one visit. The specialist will explain your results and talk with you about hearing aids, surgery, or watching your hearing over time.

Treatment

There is no proven medicine that cures otosclerosis or reverses the bone change. Treatment focuses on helping you hear better and stay connected. The main options are hearing aids, assistive listening devices, and sometimes surgery. Your doctor or hearing specialist will help you choose based on your hearing, lifestyle, and preferences.

Self-care at home

• Use hearing aids if they are recommended. They can make speech clearer and help you take part in conversations.
• Try assistive listening devices, such as TV listeners or amplified phones.
• Ask people to face you when they speak and to speak clearly, not louder.
• Reduce background noise when you can, such as turning off the TV during conversation.
• Protect your ears from very loud noise to avoid extra hearing damage.
• Tell friends, family, and colleagues about your hearing needs so they can help.
• Have regular hearing checks so changes are noticed early.

Medical treatments

No medicine is known to stop or reverse otosclerosis. Hearing aids are the main nonsurgical treatment and can help many people hear much better. A hearing specialist may also talk with you about other support, such as communication training or assistive devices. Always ask your doctor or pharmacist before starting any medicine, and do not use unproven remedies.

When is surgery considered?

Surgery may be an option if hearing aids do not help enough or if you prefer an operation. The most common operation is called a stapedotomy or stapedectomy. It replaces or bypasses the stiffened stapes bone with a tiny man-made part. Many people hear better after surgery, but it has risks. These include dizziness, taste changes, and, rarely, worse hearing. Discuss the benefits and risks carefully with an ear specialist.

Living with this condition

Otosclerosis usually changes slowly. You may need regular hearing tests and may need to adjust how you communicate. Planning ahead for noisy places, using captions, and asking people to face you can make daily life easier. Hearing aids and other devices can help you stay connected at home, work, and school.

Lifestyle tips

• Avoid very loud noise and use ear protection at concerts, mowing, or noisy workplaces.
• Keep your general health in check. Conditions like diabetes and high blood pressure can affect hearing over time.
• Let people know you have hearing loss so they can speak clearly and face you.
• Use good lighting and reduce background noise when talking with others.
• Ask about workplace or school adjustments if hearing loss affects your daily tasks.

Diet and exercise

There is no special diet that treats otosclerosis. Eating a balanced diet and staying active are good for your general health and may help you cope with stress. Exercise does not cure otosclerosis, but it supports overall well-being. Protect your ears during activities with loud noise.

Mental health and emotional wellbeing

Hearing loss can be frustrating and tiring. It can lead to feelings of isolation, anxiety, or low mood, especially if you struggle to follow conversations. These feelings are common and help is available. If hearing loss is making you feel very low, anxious, or isolated, tell your doctor. If you have thoughts of harming yourself, contact your local crisis service or emergency number right away.

Prevention

Otosclerosis cannot usually be prevented because it is linked to genes and changes in the ear bones. You can protect your hearing by avoiding very loud noise and using ear protection. Regular hearing checks can help you notice changes early, especially if otosclerosis runs in your family.

Vaccines

No vaccine prevents otosclerosis. Keep up with routine vaccines as advised by your doctor for your general health.

Screening programmes

There is no routine screening programme for otosclerosis. If you have a family history or notice hearing loss, ask your doctor about a hearing test.

Complications

If left untreated

• Hearing loss may get worse over time.
• You may find it harder to follow conversations, especially in groups or noisy places.
• Ringing in the ears, called tinnitus, may become more noticeable.
• Some people feel isolated, tired, or low in mood because of hearing difficulties.
• Balance problems can happen, but they are less common.

Long-term outlook

Most people with otosclerosis can be helped. Hearing aids improve hearing for many, and surgery helps some people hear better. Otosclerosis is not life-threatening. With regular hearing checks and the right support, you can manage well and stay connected to the people and activities you enjoy.

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