Medicines for Otosclerosis

What it is

Otosclerosis is a condition in which there is abnormal growth of bone in the middle ear, around one of the tiny bones (ossicles) that transmit sound — most importantly the stapes (the smallest bone in the body). Normally, these tiny bones move freely to carry sound vibrations from the eardrum to the inner ear. In otosclerosis, the abnormal bone growth causes the stapes to become fixed and unable to move properly, so sound is not transmitted efficiently, leading to a gradual hearing loss (a "conductive" hearing loss). It usually develops slowly over years, often starting in early to middle adulthood, and commonly affects both ears (though often one more than the other). As well as gradually worsening hearing, some people have tinnitus (ringing in the ears), and occasionally mild balance disturbance. Interestingly, some people notice they can hear better in noisy environments. Otosclerosis often runs in families (it has a genetic component) and is more common in women, and can worsen during pregnancy. It is a recognised cause of hearing loss in younger and middle-aged adults, and — importantly — it is treatable, so it should not be dismissed as simply "getting older", and its gradual hearing loss warrants assessment. It is diagnosed with hearing tests and examination.

How it is treated

Otosclerosis is assessed by an ENT specialist and audiologist, with hearing tests confirming the type and degree of hearing loss, and management is tailored to the individual's hearing and preferences, with effective options available. There are two main approaches. Hearing aids are a very effective, non-surgical option: because otosclerosis causes a conductive hearing loss (a mechanical problem transmitting sound), hearing aids work well to amplify sound and improve hearing, and many people choose this option, which avoids surgery. The alternative is surgery — an operation called a stapedectomy (or stapedotomy), in which the fixed stapes bone is bypassed or replaced with a tiny prosthesis, restoring the transmission of sound vibrations to the inner ear; this can significantly improve hearing and is often very successful, though, as with any surgery, it carries some risks, which are discussed. The choice between a hearing aid and surgery depends on the person's hearing, general health, and preferences, and both are reasonable options. Regular hearing monitoring tracks the condition, which can be progressive. In some people, the inner ear can also be affected over time. The reassuring message is that otosclerosis is a treatable cause of hearing loss — effectively managed with hearing aids or, for those who choose it, surgery to improve the movement of the ear bones — so gradual hearing loss in a younger or middle-aged adult is well worth assessing.