Otosclerosis: your questions answered

Written by: Mr Harry Powell
Edited by: Aoife Maguire

Otosclerosis is a condition which can significantly affect the ability to hear. Distinguished ENT surgeon Mr Harry Powell answers the questions you have about the condition.


What exactly is otosclerosis?


Otosclerosis is a condition that affects the bone of the inner ear. All of the bone in our body is constantly being turned over so it's being remodelled and it's changing all the time.



With otosclerosis, the bone turnover becomes abnormal. There is hard new bone formation around the inner ear, which has a consequent effect on a person’s hearing.


The key bone out of all the hearing bones responsible for taking sound in the inner ear is called the stay piece. This bone becomes stuck and won’t move in and out, and because you can't then move it in and out, the sound cannot get through into the inner ear to give patients better hearing.


How is otosclerosis most effectively managed?


There are several ways to manage otosclerosis. The method chosen fundamentally depends on the amount of hearing loss related to the condition at the time of diagnosis. If the hearing loss is very mild, it would be entirely reasonable to treat the patient conservatively. The decisions for treatment should be made collaboratively between the doctor and patient.  


If the condition is worse and the hearing is more significantly affected, hearing aids or surgery may be an option for patients. Hearing aids at certain levels of hearing loss become less effective, and when the hearing loss reaches that point, it's likely that surgery will be a better option. However, any operation can carry some risks, therefore it is essential to have a candid conversation about the operation.


The key thing is that during stapes surgery, the inner ear has to be open, which conveys some risk to the hearing. Despite this risk, the operation is usually successful and will lead to an improvement in the hearing in over 95% of cases, which can be life-changing for patients.


When is surgery required?

Surgery may be appropriate for otosclerosis if the patient is not able to wear conventional hearing aids or if they would prefer to have an operation rather than wear a hearing aid.


Surgery is usually carried out all down the ear canal and involves lifting up the eardrum under general anaesthetic, or occasionally under local anaesthetic and then assessing the hearing mechanism to check that the diagnosis is correct. If the diagnosis is correct, the next step may be to remove the stapes bone and replace it with a prosthesis, which is then able to take the sound energy into the inner ear to improve the hearing.


Is surgery the most advisable treatment option?


There is no correct answer as to whether to choose surgery or decide on a hearing aid instead. Every patient is unique and has different needs and expectations. A hearing aid can be a popular option for otosclerosis and depending on how the patient feels or manages with their hearing aid, they may or may not want to choose surgery. While some may try with a hearing aid, some will choose to have surgery immediately.  


The key thing is that the surgery is performed with the utmost care and that any possible difficulties or complexities are addressed. If difficulties occur, they can usually be overcome and surgery will be successful.


What are the main non-surgical treatment options?


Otosclerosis can be managed conservatively depending on the level of severity of the condition at the time of diagnosis. If it is mild, it may be entirely reasonable to opt for conservative management.


A hearing aid may not be required and surgery may not be necessary or indicated. Some patients may wish to watch and wait in such a situation; to observe the progression of the condition, and therefore the progression of the hearing loss, before intervening and changing the course of management.




If you would like to book a consultation with Mr Powell, simply visit his Top Doctors profile today.

By Mr Harry Powell
Otolaryngology / ENT

Mr Harry Powell is a leading consultant ENT surgeon based in London. He currently sees patients at London Bridge Hospital, Guy's and St Thomas' Hospitals and The Portland Hospital. Mr Powell looks after both children and adults with ENT problems. These include hearing loss, tinnitus, vertigo, ear infections and microtia/atresia.

He carried out the majority of his ENT specialist training at London’s most prestigious hospitals, including The Royal Marsden, The Royal National Throat Nose and Ear Hospital, Great Ormond Street and Guy's and St Thomas'.

Mr Powell was awarded the Graham Fraser Memorial Fellowship and two Royal College of Surgeons grants for advanced surgical training in ear surgery and auditory implantation in Sydney, Australia. He worked there in 2014 and developed his interest in endoscopic ear surgery before returning to London.

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