İşitmeAtölyesiAt a glance
Remodelling of the bone around the stapes; the bone’s movement becomes restricted and hearing loss develops.
Slowly progressive hearing loss, low-frequency tinnitus, relatively better hearing in noise (paracusis Willisii).
Not an emergency; but because it is progressive it requires regular audiological follow-up.
Surgery (stapedotomy/stapedectomy) or a hearing aid; the decision is individualised.
Medical disclaimer. This content is for informational purposes only and does not replace a physician’s examination, diagnosis or treatment; it should not be used as medical advice. For your complaints or personal situation, always consult an ear, nose and throat physician and an audiologist.
If you notice slowly progressive (worsening) hearing loss in one ear, a family history of hearing loss, low-frequency tinnitus, or relatively better hearing in noisy environments, consult an ear, nose and throat physician and an audiologist. If a sudden change in hearing, dizziness or rapid one-sided worsening is added, prompt assessment is needed.
Definition and epidemiology
Otosclerosis is a localised bone-remodelling disease specific to the otic capsule surrounding the inner ear. Normal bone is replaced by irregular, vascular, spongy bone. The process most often involves the fissula ante fenestram region in front of the oval window.
When this change fixes the stapes footplate, sound vibrations cannot be transmitted adequately to the inner ear and a conductive hearing loss appears. In advanced stages the inner ear may also be affected, producing a mixed loss.
Clinical otosclerosis is more common in people of Caucasian descent; it is more frequent in women and symptoms typically become apparent between 20 and 40 years of age. Hormonal changes such as pregnancy have been reported to accelerate the process (Batson & Rizzolo, 2017).
Symptoms and signs
The most common symptom is slowly progressive hearing loss that often starts in one ear and may spread to both over time. The loss usually affects low frequencies at first.
A substantial proportion of patients have accompanying low-frequency tinnitus. Some patients report understanding speech relatively better in noisy environments; this finding, called “paracusis Willisii,” is specific to conductive losses.
Otosclerosis begins insidiously; there are no signs of infection such as pain, discharge or redness. The eardrum usually looks completely normal on examination; this picture of a “conductive loss in a normal-looking ear” points the clinician toward otosclerosis.
Causes and risk factors
Otosclerosis is a multifactorial disease; genetic predisposition is thought to act together with environmental and hormonal factors. Both familial and sporadic (single-case) forms exist.
Family history is one of the strongest risk factors. Although gene variants related to bone remodelling and a past association with the measles virus have been studied, the cause has not been fully clarified (Chole & McKenna, 2001).
It is clinically known that pregnancy and hormonal changes can activate an existing otosclerotic focus and accelerate hearing loss.
Audiological and clinical assessment
Diagnosis rests on evaluating ENT examination together with audiological findings. Detecting a conductive loss despite a normal-looking eardrum is typical.
- Pure-tone audiometry: conductive (mixed in advanced stages) loss and an air-bone gap.
- Carhart notch: a typical dip in bone-conduction thresholds around 2 kHz; it suggests stapes fixation but is not diagnostic on its own.
- Tympanometry: usually normal (Type A) or a low-peaked (Type As) curve reflecting middle-ear stiffness.
- Acoustic reflexes: typically disappear or weaken markedly in the early stage.
Wideband tympanometry (WBT) and reflectance measures can reveal middle-ear stiffening more sensitively than standard methods. In cases planned for surgery, high-resolution CT (HRCT) is used to assess the extent of the foci (Quesnel et al., 2018).
| Feature | Otosclerosis | Tympanosclerosis | SSCD |
|---|---|---|---|
| Main involvement | Stapes / oval window | Calcification of drum & ossicles | Superior canal (third window) |
| Eardrum | Looks normal | White plaques may be seen | Looks normal |
| Acoustic reflex | Lost early | May be lost | Preserved |
| OAE | May be affected | May be affected | Preserved |
| Distinguishing clue | Carhart notch, family history | Infection/tube history | Autophony, sound-induced vertigo, VEMP |
Treatment and audiological rehabilitation
In surgical treatment, part of the fixated stapes is replaced with a small prosthesis (stapedotomy/stapedectomy). In experienced hands it has high success rates for closing the air-bone gap; the decision is made individually by the physician.
Digital hearing aids are very effective for patients who do not prefer or are not suitable for surgery. Because the inner ear is intact in conductive losses, speech discrimination is usually very good.
In selected cases where the disease has extensively involved the inner ear, an advanced mixed loss has developed, and adequate benefit cannot be obtained from a device, a cochlear implant may be considered.
Impact on quality of life and advice
Hearing loss can cause communication fatigue, social withdrawal and anxiety. Treatment success should be judged not only by the audiogram but also by the patient’s communication comfort in daily life.
Because it is a progressive disease, regular audiological follow-up is important. Family members understanding the condition and communication strategies such as speaking face to face and clearly in noisy settings ease the patient’s burden.
If you used this review, you can cite it as follows (APA 7):
İşitme Atölyesi. (2026). Otosclerosis. Hearing & Balance Health Guide. https://www.isitmeatolyesi.com/en/guncel-haberler/categories/isitme-sagligi-rehberi/otoskleroz/Permanent link: isitmeatolyesi.com/en/guncel-haberler/categories/isitme-sagligi-rehberi/otoskleroz/ · Last reviewed: July 2026 · License: CC BY-NC-ND 4.0
References
- Batson, L., & Rizzolo, D. (2017). Otosclerosis: An update on diagnosis and treatment. JAAPA, 30(2), 17-22.
- Carhart, R. (1950). Clinical application of bone conduction audiometry. Archives of Otolaryngology, 51(6), 798-808.
- Chole, R. A., & McKenna, M. (2001). Pathophysiology of otosclerosis. Otology & Neurotology, 22(2), 249-257.
- Crompton, M., Cadge, B. A., Ziff, J. L., et al. (2019). The epidemiology of otosclerosis in a British cohort. Otology & Neurotology, 40(1), 22-30.
- Quesnel, A. M., Ishai, R., & McKenna, M. J. (2018). Otosclerosis: Temporal bone pathology. Otolaryngologic Clinics of North America, 51(2), 291-303.
Frequently asked questions
Can I fly right after otosclerosis surgery?
Your surgeon usually advises avoiding flying, diving and sudden pressure changes for a certain period so the inner ear can heal. Because this period varies, the safest course is to discuss your travel plans in advance with the physician who performed your surgery.
Will my hearing disappear completely if I don’t have surgery?
Otosclerosis is progressive and hearing loss may increase over time if untreated. However, surgery is not the only option; hearing aids also work very well. What matters is choosing the most suitable method together with your physician through regular follow-up.
Will I need a hearing aid after surgery?
Successful surgery usually corrects the conductive loss to a large extent. However, if there is also inner-ear involvement (a sensorineural component), a mild hearing aid may be needed for extra benefit. This becomes clear from hearing tests done after surgery.
Is otosclerosis hereditary? Will it pass to my child?
Otosclerosis has a strong genetic predisposition and can be seen in more than one family member. However, having it in one parent does not mean it will certainly pass to the child; environmental and hormonal factors also contribute.
Will both my ears be affected?
Otosclerosis often starts in one ear but has a high tendency to involve both over time. Therefore, even if there are symptoms in only one ear, regular follow-up of both ears is recommended.
Scales that can be used to monitor the impact of hearing loss on daily life and hearing-aid benefit in otosclerosis: