Index
It is a condition of the middle ear and mainly affects the small stapes bone.
Otosclerosis is a common cause of hearing loss . It is caused by a problem with the small bones (ossicles) that transmit vibrations through the middle ear so that we can hear sound.
Usually both ears are affected in otosclerosis, but sometimes only one ear is affected.
It usually develops first between the ages of 15-35 years, but sometimes it develops in younger children.
Pregnancy is not a cause, but it can make the condition worse, which is why symptoms are first noticed during pregnancy.
Symptoms
Hearing loss
Hearing loss is the main symptom of otosclerosis. Hearing loss may remain mild, but it commonly gets gradually worse.
It usually affects both ears, but not always. In some people, hearing loss remains mild for several years before getting worse.
In others, the hearing loss gets worse quickly. Without treatment, in time, the affected ears often become totally deaf.
Hearing loss is generally lower-pitched, while age-related hearing loss has more of an effect on higher-pitched sounds.
Speak quietly
If you have otosclerosis, you may speak unusually in silence. The effect of otosclerosis in your ears is to make your own voice sound loud to you.
Hear better in a noisy environment
Paracusis is also common. If you have this, you can hear better when there is a lot of background noise. For example, you seem to be a better listener when talking to someone in a pub or cafe that is full of other people. This may be due to other people raising their voices in noisy places.
Hear sounds inside your body
Tinnitus is an abnormal noise that you hear but that does not seem to be coming from outside your ear. It occurs in about 4 out of 5 people with otosclerosis.
The noises heard include buzzing, hissing, roaring, machine-like noises, etc. Tinnitus tends to get worse as hearing loss worsens.
Dizziness and balance problems
Vertigo is a condition in which dizziness and balance problems are experienced.
This condition develops in some people with otosclerosis, although it is less common. It occurs when the balance mechanism in the inner ear (the semicircular canals) is affected.
What are the possible causes of otosclerosis?
No one really knows why otosclerosis occurs. However, what is known is that otosclerosis is not caused or worsened by listening to loud music or working in a noisy environment.
It is not clear why this happens, but it is likely caused by a combination of several factors:
- Hereditary (genetic) factors.
- Complications from having had a virus.
- Possible effect of low fluoride levels.
- Otosclerosis symptoms.
- Hearing loss.
- Talking in a low voice.
- Hear better in a noisy environment.
- Hear sounds inside your body.
- Dizziness and balance problems.
Faulty bone formation
Bone is living tissue and contains cells that make, shape, and restore bone (resorption). Normally, bone continually breaks down and reshapes itself.
In otosclerosis, the remodeling process of the stapes (stapes), one of the small bony bones in the middle ear, appears to become defective.
The new bone is not made correctly and abnormal bone is formed. However, why this occurs primarily in the stapes (and sometimes the cochlea) is not entirely clear.
Is it hereditary?
Hereditary (genetic) factors appear to be important because a tendency to otosclerosis can be inherited. About 2 out of 3 people with otosclerosis have other family members who also have this condition.
However, some people with otosclerosis do not have a family history.
Could it be a virus?
It is also believed that a virus may play a role and the measles virus has been suggested.
In fact, the number of people diagnosed with otosclerosis appears to have decreased since the measles virus vaccine was administered.
Some people may inherit the genetic tendency to develop otosclerosis. Then a trigger, such as a viral infection, actually causes the condition to develop.
Low levels of fluoride
It is also possible that low levels of fluoride have something to do with the development of otosclerosis.
The number of otosclerosis cases in the UK decreased after fluoride was routinely added to drinking water. However, this possible link to low fluoride levels is controversial.
Risk factor’s
Otosclerosis mainly affects the small bone (ossicles) called the stapes (stapes).
Women are affected twice as often as men.
For normal hearing, the ossicles need to be able to move freely in response to sound waves. In otosclerosis, abnormal bone material grows around the stapes.
The foot of the stapes, where it joins the cochlea, is usually where the condition begins.
The abnormal bone reduces the movement of the stapes, reducing the amount of sound that is transferred to the cochlea. The growth of the abnormal bone is very gradual.
However, eventually the stapes may become fixed or fused with the bone of the cochlea.
This can cause severe hearing loss. Hearing loss is known as conductive hearing loss because sound vibrations cannot be conducted (transmitted) from the stapes to the cochlea.
In most cases, it is only the stirrup that is affected. However, sometimes over time, otosclerosis can also affect the bony shell of the cochlea and the nerve cells it contains.
If this is the case, nerve cell damage means that the transmission of nerve impulses to the brain may be impaired. Then a different type of hearing loss can occur, called sensorineural hearing loss.
What is the ear like and how do we hear it?
The ear is divided into three parts: the outer (outer) ear, the middle ear, and the inner ear. The middle ear behind the eardrum is filled with air.
Air comes from the back of the nose into a thin canal called the Eustachian tube.
In the middle ear there are three small bones (ossicles):
- Hammer.
- Anvil.
- Stapes.
The inner ear includes the cochlea and semicircular canals.
Sound waves enter the outer ear and hit the eardrum. Sound waves vibrate the eardrum. Sound vibrations pass from the eardrum to the bones of the middle ear. The bones then transmit the vibrations to the cochlea in the inner ear.
The cochlea converts vibrations into sound signals that are sent along a nerve from the ear to the brain, allowing us to hear.
The semicircular canals in the inner ear contain a fluid that moves as we move.
The movement of the fluid is detected by small hairs in the semicircular canals. These send messages to the brain along the ear (auditory) nerve to the brain to help maintain balance and posture.
How is otosclerosis diagnosed?
If you are concerned about hearing loss, make an appointment to see your doctor.
They will ask you about the symptoms you have been getting and then they will usually examine your ears with an auriscope. This is the common instrument used to look into your ears if you have an earache.
In otosclerosis, your eardrum usually looks normal and healthy when your doctor looks into your ear.
Your doctor can refer you to an ear, nose, and throat specialist who can diagnose otosclerosis.
They are going to do hearing tests that will show a specific pattern of hearing loss in otosclerosis.
The specialist may also use a small device that is placed in your ear, called a tympanometer.
This can help them observe the movement of the bones inside your ear.
In otosclerosis, the stapes (stapes) will move less. This test is very quick and does not cause any pain.
Sometimes the specialist may decide that you need a CT scan that will give you more information about the severity of otosclerosis.
What are the treatment options for otosclerosis?
Earphones
At first, when hearing loss is mild, you may not need any treatment. As the disease progresses and hearing loss worsens, hearing aids can make a big difference.
However, when hearing loss becomes severe, hearing aids may not be of much help.
Surgery
The most common operation performed is to replace the stirrup with an artificial bone made of plastic or metal. The operation is called a stapedectomy (or sometimes a stapedotomy).
In most cases, this operation is successful and restores hearing. It can also reduce the chance of otosclerosis progressing and affecting your inner ear.
However, it is a very delicate operation. There is a small risk that the operation will fail and cause total deafness in the operated ear.
In addition, there is a small risk of damaging other nerves during the operation and causing disturbances to balance or taste.
The operation may not cure tinnitus and may not improve hearing in the small number of cases involving the cochlea. You should ask your surgeon about his success rates for this type of surgery.
Fluoride tablets
There is some limited evidence that fluoride tablets can slow the progression of otosclerosis in some cases.
They can help preserve hearing and also help reduce symptoms of dizziness and balance problems. However, such a treatment is not widely used in the UK.
Hormonal tablets and the contraceptive pill
Some doctors believe that taking the birth control pill or hormone replacement therapy can make otosclerosis worse.
If you have otosclerosis and are considering taking a hormone treatment like this, you should discuss the pros and cons fully with your doctor.
Forecast
In general, hearing loss progresses over time, although this can be very slow. If it becomes severe enough that you need an operation, it is generally very successful in solving hearing problems and other symptoms.
