Main
- Otosclerosis affects the middle ear: bone tissue grows around the stapes and disrupts the transmission of sound to the inner ear.
- Hearing declines gradually, often in one ear: a person hears quiet speech worse, but makes out loud speech better.
- Tinnitus, a feeling of fullness and poor speech intelligibility in noise persist for weeks and require a visit to an ENT doctor or audiologist.
- The diagnosis is confirmed by audiometry, tympanometry and, if necessary, computed tomography of the temporal bones.
- Care includes fitting a hearing aid, surgical treatment when indicated and regular hearing checks with an audiologist.
What is otosclerosis
Otosclerosis is a condition of the middle ear in which bone tissue grows and impedes the mobility of the auditory ossicle. Because of this, sound reaches the inner ear less well, and hearing gradually declines.
What happens in the body
Otosclerosis affects the middle ear, where the three auditory ossicles that transmit sound onwards are located. One of these ossicles, the stapes, normally moves freely and transmits vibrations to the inner ear. In this condition, new bone tissue begins to grow next to it, and the mobility of the ossicle is impaired. Sound ceases to be conducted normally, so a person hears speech and quiet sounds less well. At first this may go unnoticed, because hearing loss develops gradually, sometimes over years. Over time, the overgrown tissue thickens, and the transmission of sound becomes increasingly difficult. If you have noticed that you are asking people to repeat themselves more often or turning up the volume, it is worth seeing an otorhinolaryngologist.
What causes it to develop
- Hereditary predisposition: in some people a family history can be traced, so relatives should be aware of this feature and monitor their hearing.
- Changes in hormonal levels: fluctuations in hormones affect metabolism in bone tissue, which can accelerate the overgrowth.
- Pregnancy and childbirth: during this time hormonal changes are more pronounced, and symptoms sometimes first appear then.
- Past ear infections: inflammation in the middle ear can trigger changes in bone tissue and intensify a process that has already begun.
- Age-related changes in bone tissue: with the years, metabolism in the bones changes, so the condition is more common in adults than in children.
Who experiences this more often
Otosclerosis is more often detected in adults of middle age, and heredity plays a noticeable role here. If close relatives have had hearing loss, the risk of encountering a similar situation is higher, so this family factor is worth remembering. The condition is more common in women than in men, and the first signs often appear during periods of hormonal change. Pregnancy and childbirth can also be the time when a person first notices that they have begun to hear worse. Age-related changes in bone tissue add their own contribution, so with the years complaints are more common. However, in some people hearing loss develops slowly and remains unnoticed by those around them for a long time. If you notice that you are asking people to repeat themselves more often, it is reasonable to discuss this with an otorhinolaryngologist.
What symptoms can occur?
Otosclerosis manifests as a gradual deterioration of hearing, which a person often attributes to fatigue or age. A simple reminder helps to work out which signs point to this condition and when a visit to the doctor should not be postponed.
How it is noticed at the very beginning
Otosclerosis develops gradually, and at first a person may not notice the changes, attributing them to fatigue, a noisy job or age. More often hearing in one ear is affected, and only over time may the process involve the second one too. Many note that they hear quiet speech worse but make out loud speech better, and in a noisy environment it becomes especially difficult. A conversation in a café, in the street or on transport turns into a strain, when one has to strain to listen and ask again. Those around notice it earlier: the person turns up the volume of the television or asks for what was said to be repeated. Gradually the feeling grows that the interlocutor is speaking indistinctly, although they are speaking in an ordinary voice. If such changes persist for weeks, one should not wait until it gets worse, but book an appointment with an ENT doctor or an audiologist to check hearing.
Signs that occur most often
- Gradual hearing loss: sounds become quieter first in one ear, later the second may join in, and this is noticeable in everyday conversations.
- Noise or ringing in the ears: an extraneous sound is present even in silence and prevents concentration, and its constancy is more tiring than it seems.
- A feeling of ear blockage: the sensation arises without a cold or a runny nose, so it is easy to mistake it for temporary congestion or a wax plug.
- Worse speech intelligibility in a noisy environment: loud speech is perceived better than quiet speech, but the general background makes it hard to pick out the interlocutor's words.
- Dizziness with sudden movements: an unpleasant sensation appears with a rapid change in body position and may accompany changes in hearing.
- Persistence of these signs: if they persist for weeks and do not go away on their own, this is a reason for a planned consultation, not for waiting.
When to seek help urgently
Examinations and tests
Examination for suspected otosclerosis begins with a conversation with the doctor and a hearing test, and instrumental investigations are prescribed to clarify the diagnosis. This sequence helps distinguish otosclerosis from other causes of hearing loss and choose the appropriate treatment.
How the examination begins
The first appointment with the doctor begins with questions about complaints and family history, because heredity matters in otosclerosis. The specialist then examines the ear to assess the condition of the eardrum and the external auditory canal. After the examination, hearing is tested using special tests, most often using tuning forks to compare air and bone sound conduction. Such tests give a first idea of the nature of the hearing loss and help to suspect otosclerosis specifically. If the tests indicate impaired sound conduction, the doctor refers for instrumental investigations to confirm. Audiometry and tympanometry clarify the degree, nature and mechanism of hearing loss. It is worth gathering information in advance about how long ago the hearing changes appeared and whether relatives have noticed them.
What is prescribed and what it shows
What is worth preparing for the appointment
- Discharge summaries: take medical documents about previous visits regarding hearing so that the doctor can see the dynamics of the changes.
- Results of previous investigations: bring previous audiograms and reports, if they have been preserved, this will help compare the indicators.
- Family history: check with relatives whether they have had hearing problems, since heredity is important for the assessment.
- Observations: write down how long ago you have noticed hearing changes and in which situations they are most noticeable.
- Questions: formulate in advance what you want to clarify with the doctor so that you do not forget anything during the conversation.
Which doctor should I see?
Otosclerosis is managed by an audiologist, and in their absence, an ENT doctor provides care. Below is what happens at an appointment and what areas of care it consists of.
Which specialist manages this condition
Otosclerosis is managed by an audiologist, and if such a specialist is not available nearby, the initial appointment is conducted by an ENT doctor. The audiologist assesses the degree of hearing loss and determines how it changes over time. The ENT doctor examines the ear and determines whether a more specialised assessment is needed. The doctor then discusses the management approach with the patient, taking into account the degree of hearing loss and their preferences. It is not possible to completely eliminate the cause of otosclerosis, but hearing and quality of life can be improved. Some patients are referred for hearing aid fitting, others are recommended surgery when indicated. For others, monitoring and regular hearing checks are advised. If there is no specialist in your city, start with an ENT doctor: they will advise you on where to go next.
What treatment consists of
- Selection and fitting of a hearing aid: the device is selected for your hearing loss and then adjusted according to your perception.
- Surgical treatment when indications are confirmed: surgery is discussed only when there are grounds for it.
- Follow-up with an audiologist and regular hearing checks: hearing changes over time, so checks are repeated.
- Rehabilitation and communication skills training for hearing loss: sessions help with understanding speech and reduce fatigue during conversations.
- Calm discussion of the approach with the doctor: the decision is made together, taking into account the degree of hearing loss and your preferences.
What depends on the patient themselves
Regular follow-up with an audiologist largely determines how predictably hearing will change. Hearing in otosclerosis changes gradually, and it is not immediately noticeable, but rather at a follow-up check. If checks are missed, the hearing aid settings stop being suitable, and the person starts asking others to repeat themselves again. Follow-up with an audiologist and regular hearing checks give the doctor a clear picture, based on which they adjust the approach. Rehabilitation and communication skills training for hearing loss work better when practised regularly rather than occasionally. The patient decides whether to come to an appointment or postpone it, and this affects when changes are noticed. Talking to the doctor about your perceptions helps to find what suits you specifically. Keep your hearing checks on a regular schedule, even if everything seems fine.
What helps prevent an exacerbation?
An exacerbation of otosclerosis cannot always be predicted, but some everyday habits do affect the course of the condition. Below is what depends on the person themselves and how regular monitoring helps to notice changes in time.
What to change in habits
A careful attitude to the ears and protection from loud sounds is the most accessible measure that reduces additional strain on the auditory system. Headphones with loud music, a noisy workshop, concerts and working with tools create constant pressure on the organ of hearing, which is tolerated worse with otosclerosis. If it is loud around you, it is sensible to step aside, take a break or use protective earplugs. The habit of turning up the television volume or asking the other person to repeat themselves also speaks of changes, and it should not be put down to fatigue. It is important not to clean the ears with improvised objects and not to try to remove earwax on your own, so as not to injure the eardrum and the canal. Smoking and strong alcohol worsen tissue nutrition and general well-being, so giving them up is a sensible step. Adequate sleep and moderate physical activity maintain tone and reduce the effect of stress on the perception of sounds. If the first signs of hearing loss appear, a timely visit to a doctor is more important than any home attempts to cope on your own.
What should be kept under control
- Regular hearing checks with a family history: if close relatives have had hearing loss, it is worth having check-ups routinely in order to notice changes at an early stage.
- A timely visit to a doctor at the first signs of hearing loss: the earlier a person comes with a complaint, the more options there are to preserve their usual quality of life.
- Volume around you: it is worth noticing whether you have to turn up the television sound or ask the other person to repeat themselves, because this is a noticeable everyday marker.
- Protecting the ears in noise: at work with equipment, on trips and at events it is sensible to use earplugs and take breaks from loud sounds.
- Your own observations: it is useful to note whether it has become harder to make out speech in a noisy company, and to share this at an appointment with a doctor.
How often to see a doctor
A regular examination by a specialist is needed even when a person feels well and does not notice obvious changes. Otosclerosis can develop gradually, and the subjective feeling that "everything is fine" does not always match the objective picture. The doctor assesses the condition of the ears, compares the readings with previous data and notices dynamics that the person themselves misses. With a family history, routine hearing checks are especially important, since the risk is higher and early changes are unnoticeable. If there is tinnitus, a feeling of congestion or you have to ask people to repeat themselves, the visit should not be put off until a convenient moment. At the appointment it is sensible to tell the doctor in which situations hearing fails more often: in noise, on the phone or when talking in a group. Such monitoring does not replace the prescribed treatment, but it helps to adjust observation in time and not to miss changes.
What is worth remembering
Otosclerosis is a condition in which hearing changes gradually, and this can be noticed long before pronounced impairments. Understanding the causes, signs and stages of care is important so as not to lose time and not to harm yourself with independent decisions.
Key takeaways
Otosclerosis develops slowly, so the first changes in hearing are easily put down to fatigue, noise around or age-related changes. A person gets used to asking again, turning up the volume and sitting closer to the person they are talking to, and over time stops noticing how much their perception of speech has changed. In otosclerosis, the structures of the middle ear responsible for transmitting sound are affected, and without a doctor's supervision the process may continue. Tinnitus, a feeling of congestion and poor speech intelligibility in noisy environments are a reason not to wait until it becomes really difficult. Examination in otosclerosis helps to understand at what stage the process is and which steps are appropriate right now. Putting off a visit to the doctor is dangerous because over time it becomes harder to select the right care, and the habit of making independent decisions only causes harm. Relying on an in-person specialist and regular monitoring is the most sensible thing one can do when otosclerosis is suspected.
