Otosclerosis Treatment in Sydney

Otosclerosis is a condition of abnormal bone remodelling in the middle ear that causes progressive hearing loss. It most commonly affects the stapes (stirrup bone), the smallest bone in the body, fixing it in place so it can no longer vibrate and transmit sound to the inner ear. Otosclerosis is one of the most common causes of hearing loss in young and middle-aged adults and is highly treatable with surgery or hearing aids.

Symptoms of Otosclerosis

Otosclerosis typically develops gradually, often beginning in one ear before eventually affecting both. The most common symptoms include:

• Slowly worsening hearing loss, usually noticed first in the 20s or 30s
• Difficulty hearing soft or low-pitched sounds, such as whispered speech
• Tinnitus: ringing, buzzing or humming in one or both ears
• Paradoxically better hearing in noisy environments (paracusis of Willis): background noise causes others to raise their voices above the level blocked by the fixed stapes
• Speaking in a quieter voice than usual, because your own voice sounds louder conducted through bone
• Occasional dizziness or imbalance, particularly if the otosclerosis extends to involve the inner ear (cochlear otosclerosis)

The hearing loss in otosclerosis is usually conductive (caused by a mechanical problem in the middle ear), but in advanced or cochlear otosclerosis, a sensorineural component (inner ear damage) can develop, resulting in mixed hearing loss.

Causes and Risk Factors

The exact cause of otosclerosis is not fully understood, but several factors contribute to its development:

• Genetics: approximately 50% of patients have a family history of otosclerosis. The condition follows an autosomal dominant pattern with variable penetrance
• Hormonal factors: otosclerosis often worsens during pregnancy or with oral contraceptive use, suggesting a hormonal influence on bone remodelling
• Gender: clinical otosclerosis is more commonly diagnosed in women, though histological studies suggest equal prevalence
• Age of onset: symptoms typically begin between ages 15 and 45, with peak onset in the 20s and 30s
• Ethnicity: most common in Caucasian populations, less common in Asian, African and Indigenous Australian populations
• Viral factors: measles virus has been implicated in some research, though this remains an area of investigation

Diagnosis

At Central Sydney ENT, our otology-trained surgeons use a thorough diagnostic approach to confirm otosclerosis and plan treatment:

Clinical history and examination: Your ENT surgeon will review your symptom history, family history, and any aggravating factors such as pregnancy. Examination of the ear canal and eardrum is typically normal in otosclerosis, which helps distinguish it from other causes of conductive hearing loss such as chronic ear infection or cholesteatoma.

Pure-tone audiometry: A hearing test that measures hearing thresholds across different frequencies. Otosclerosis characteristically shows conductive hearing loss with an air-bone gap, often with a specific dip at 2000 Hz on bone conduction (Carhart's notch).

Tympanometry: This test measures the flexibility of the eardrum and middle ear system. In otosclerosis, tympanometry may show reduced compliance (a stiff middle ear), reflected as an As-type (shallow) tympanogram.

CT scan of the temporal bones: High-resolution CT imaging may be requested to visualise the otosclerotic focus around the stapes footplate, assess the extent of disease, and rule out other conditions. CT is particularly useful in planning surgical approach and identifying cochlear involvement.

Treatment Options

Treatment for otosclerosis depends on the degree of hearing loss, the patient's age, lifestyle and personal preference. The main options are surgery and hearing aids.

Stapedectomy and Stapedotomy

Stapes surgery is the definitive treatment for otosclerosis and is one of the most successful operations in ENT surgery. The procedure is performed through the ear canal under general or local anaesthetic using a high-powered operating microscope.

In a stapedectomy, the fixed stapes bone is removed and replaced with a tiny prosthesis (typically titanium or Teflon) that connects the incus bone to the inner ear, restoring sound transmission. In a stapedotomy, a small hole is made in the stapes footplate and a piston prosthesis is inserted: this is the more commonly used technique today as it is less traumatic to the inner ear.

Success rates are excellent, with approximately 90 to 95 percent of patients achieving significant hearing improvement. Surgery is typically performed on one ear at a time, with the worse-hearing ear treated first. Most patients go home the same day and return to work within one to two weeks.

Hearing Aids

Modern hearing aids are an effective non-surgical treatment for otosclerosis. Because the inner ear (cochlea) usually functions normally in early otosclerosis, hearing aids can amplify sound very effectively and provide excellent hearing restoration. Hearing aids are recommended for patients who prefer to avoid surgery, when surgery carries increased risk, or while awaiting surgical treatment.

Sodium Fluoride Therapy

Sodium fluoride supplementation has been used in some cases to slow the progression of active otosclerosis by stabilising bone remodelling. It does not reverse existing hearing loss but may help slow further deterioration, particularly in cases with cochlear involvement. Its use remains somewhat controversial, and your specialist will discuss whether it is appropriate for your situation.

Bone-Anchored Hearing Devices

In rare cases where conventional hearing aids or stapes surgery are not suitable, bone-anchored hearing devices can bypass the middle ear entirely and deliver sound vibrations directly to the inner ear through the skull bone.

Our ear surgery specialists, including Dr Philip Yeung, Dr Arjuna Ananda and Dr Rahuram Sivasubramaniam, have fellowship training in otology and perform microsurgical ear procedures including stapedectomy at hospitals across Sydney.

When to See an ENT Specialist

You should seek a referral to an ENT specialist if:

• You have noticed gradual hearing loss in one or both ears
• You have a family history of otosclerosis or hearing loss in early adulthood
• You experience tinnitus alongside worsening hearing
• Your hearing seems to worsen during or after pregnancy
• You are considering stapes surgery and want to discuss your options with a specialist
• You experience dizziness or balance problems alongside hearing loss

Related Conditions

Otosclerosis is closely related to several other ear conditions treated at Central Sydney ENT:

• Hearing Loss: otosclerosis is a major cause of conductive hearing loss in young adults
• Cholesteatoma: another middle ear condition that can cause conductive hearing loss and requires surgical treatment
• Tinnitus: commonly associated with otosclerosis and may improve after successful stapes surgery