Otosclerosis

Otosclerosis is a middle and inner ear condition. It affects approximately every 250th person which translates to approximately 0.4 percent of the total German population. Learn more about its causes, symptoms and treatment options.

Overview:

• What is otosclerosis?
• What causes this condition?
• What are the symptoms?
• How is this condition treated?

What is otosclerosis?

What does the term mean? Oto is Greek for ear and sclerosis is what medical professionals generally call the process of organ and tissue hardening. Generally speaking, we are talking about hardening processes inside the ear. Let’s take an even closer look:

To understand this condition we have to know how sound is transmitted in the human ear. Sound first hits the ear drum and is then transmitted to the inner ear via the ossicles in the middle ear. It works its way there via the hammer, anvil and stirrup. These three ossicles must be flexible and able to oscillate to transmit sound. Sound is then transmitted from the stirrup to the inner ear via a transition area. This function is impaired in persons suffering from otosclerosis. The stirrup is most often affected by ossification and becomes inflexible. This inflexibility results in hearing loss as no sufficient signal can be passed on to the cochlear in the inner ear.

What causes this condition?

Up to this day, it is not entirely clear what causes otosclerosis. There are, however, several factors that are believed to contribute to its development.

Many suspect a genetic component since scientists have found evidence for family predisposition. Differences can also be found between the sexes: This condition is twice as common among women as opposed to men. Since it is commonly aggravated during pregnancy, hormonal influences are also regarded as a cause of this condition. Finally, the measles virus is believed to be a potential cause.

Currently there are no known measures to prevent otosclerosis.

What are the symptoms?

The condition usually manifests itself as increasing deafness occurring between the ages of 20 and 50. Otosclerosis is identified as the cause of 5 to 9 percent of all hearing impairments. Among patients suffering from conductive deafness ossification is actually the cause in 18 to 22 percent of cases. Usually, impaired hearing initially affects one side, but can spread to both ears over time. Often, the patient’s ears are affected to varying extents. Some patients furthermore report that they can hear better in loud environments. Other possible symptoms include

tinnitus (most often in the range of low sounds) and dizziness. Since this hardening process takes place over the course of a long period, otosclerosis can remain undetected years before the occurrence of impaired hearing. Sufferers usually don't feel any pain.

It’s best to consult an audiologist. In rare cases, examinations of the ear drum, middle ear and auditory tube show no signs of the condition.

The condition is not easy to detect, but it can be identified by means of various audiometric measurements (tone air threshold audiometry and impedance audiometry). In certain cases, further tests such as balance tests, x-rays of the ear region or a tympano-cochlear scintigraphy (TCS) might be required to diagnose an active center of inflammation.

How is the condition treated?

An operation is the only way to successfully treat otosclerosis. The chances of recovery are very high: More than 90 percent of otosclerosis patients report improved hearing after the operation and about half are permanently cured of tinnitus. Therapies using medication, on the other hand, so far show little success.

The main treatment method in the past was called stapedectomy (stapes = stirrup), during which the stirrup and part of the stirrup footplate were completely removed. The stirrup was replaced with a prosthetic which was connected to the anvil. This method is known as stapes surgery.

Today, the main method is the stapedotomy. During a stapedotomy just the upper part of the stirrup is removed – while the footplate remains. Using a laser beam or small needle, the surgeon drills a tiny hole into the footplate and a prosthetic is inserted. Today, this method is the most widely used as it results in fewer complications. Laser stapedotomy is regarded as particularly precise.

The implanted prosthetics help directly conduct the oscillations of the ossicular chain to the inner ear. This bypasses the removed stirrup and the oscillations of the other, healthy ossicles are conducted to the prosthetic.

Such an operation can be performed under local or general anesthesia. For further information on the procedure and the risks of the operation please ask an audiologist .

Patients who only suffer from minor hearing loss should also consider hearing aids as an alternative to improve their hearing. This will not put a halt to the process of increasing ossification, however, requiring regular hearing checks.

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