Otosclerosis is abnormal bone remodeling around the stapes in the middle ear that locks the bone in place, so sound cannot pass well to the inner ear. It usually starts in young adults, often runs in families and can worsen during pregnancy.
Key symptoms
- Slowly worsening hearing loss, often in both ears
- Hearing speech better in noisy places
- Tinnitus
- Mild imbalance in some patients
- Family history of early hearing loss
What you find on exam
- Normal ear canal and eardrum on otoscopy
- Sometimes a faint pink blush behind the eardrum (Schwartze sign)
- Weber test louder in the worse ear
- Rinne test negative in the affected ear: bone conduction louder than air
Tests
- Audiogram: conductive hearing loss with an air-bone gap
- Dip in bone conduction near 2000 Hz (Carhart notch)
- Tympanometry and absent stapedial reflexes
- CT of the temporal bone in unclear cases or before surgery
Treatment basics
- Hearing aids as a first, noninvasive option
- Stapedotomy or stapedectomy: the fixed stapes is replaced by a prosthesis
- Sodium fluoride in selected patients with inner ear involvement
- ENT referral and repeat audiograms over time
Red flags
- Sudden hearing loss in one ear
- Vertigo, facial weakness or new neurologic signs
- Ear discharge, pain or a mass behind the eardrum
Practice it in Making Synapses
Making Synapses cases
Related guides
Sources: NCCPA PANCE Content Blueprint; NBOME COMLEX-USA clinical presentations; AAMC Core Entrustable Professional Activities (Core EPAs). Written by Making Synapses. Making Synapses is not affiliated with these organizations.