Otosclerosis is a condition where abnormal bone growth occurs in the middle ear, specifically affecting the stapes bone (stirrup bone), one of the three tiny bones responsible for transmitting sound vibrations. This irregular bone remodelling causes the stapes to become fixed in place, preventing it from vibrating properly and resulting in progressive hearing loss. The condition typically begins in early adulthood and can affect the population, with variations in prevalence among different ethnic groups. In Singapore, otosclerosis can be a cause of adult-onset hearing loss, particularly affecting individuals between 20 and 40 years of age.
Otosclerosis in Singapore
If you’ve been experiencing gradual hearing loss, particularly difficulty hearing low-pitched sounds or conversations in quiet environments, you may be dealing with otosclerosis. This progressive ear condition affects the tiny bones in your middle ear, leading to conductive hearing loss that can impact your daily life. At our clinic, our ENT Specialist provides comprehensive evaluation and treatment for otosclerosis, utilising both conservative management approaches and modern surgical techniques. Understanding your condition is the first step towards addressing your hearing concerns. Individual results and timelines may vary.
Dr Gan Eng Cern
MBBS
MRCS (Edin)
mmed (orl)
FAMS
What is Otosclerosis?
Types of Otosclerosis
Fenestral Otosclerosis
Fenestral otosclerosis is a form of the condition. This type affects the oval window area where the stapes footplate connects to the inner ear. Abnormal bone growth may gradually immobilise the stapes, creating a mechanical blockage that can prevent sound waves from being efficiently transmitted to the inner ear fluid. Patients with fenestral otosclerosis may experience primarily conductive hearing loss.
Cochlear Otosclerosis
Cochlear otosclerosis involves the bony capsule surrounding the cochlea (inner ear). This type can occur alone or combined with fenestral otosclerosis. Abnormal bone growth may affect the delicate structures within the cochlea, potentially leading to sensorineural hearing loss in addition to any conductive component. This form can present treatment challenges as it may affect the nerve function of hearing.
Histologic Otosclerosis
Histologic otosclerosis refers to microscopic bone changes that can only be detected through specialised imaging or post-mortem examination. Individuals with histologic otosclerosis may never develop clinical symptoms or hearing loss. This subclinical form can be found in temporal bones examined at autopsy, but may only progress to cause symptoms in some cases.
Causes & Risk Factors
Causes
The exact cause of otosclerosis remains unclear, though research points to multiple contributing factors. Genetic mutations affecting bone metabolism may play a role, with several genes identified that could influence the development of otosclerosis. Viral infections, particularly measles virus, have been detected in otosclerotic tissue samples, suggesting a possible infectious trigger. Autoimmune processes may also contribute, as the body’s immune system could inappropriately target normal bone tissue in the ear.
Risk Factors
- Family histor: Having a parent with otosclerosis may increase your risk
- Gender: Women are more likely to develop clinical otosclerosis than men
- Pregnancy: Hormonal changes during pregnancy can accelerate otosclerosis progression
- Age: Symptoms typically begin between ages 20-40, though onset can vary
- Ethnicity: More common in some populations than others
- Hormonal factors: Oestrogen may influence disease progression
- Previous measles infection: Some studies suggest a correlation with childhood measles
- Fluoride deficiency: Low fluoride levels in drinking water may increase risk
Signs & Symptoms
Mild Symptoms
- Difficulty hearing whispers or soft speech
- Need to increase television or radio volume slightly
- Mild tinnitus (ringing or buzzing in affected ear)
- Occasional feeling of ear fullness
- Better hearing in noisy environments (paracusis)
Moderate Symptoms
- Noticeable difficulty following conversations
- Frequent requests for repetition
- Persistent tinnitus that affects concentration
- Dizziness or mild balance problems
- Hearing loss affecting both ears
- Difficulty using the telephone
Severe Symptoms
- Hearing loss that may require hearing aids
- Tinnitus that can affect sleep
- Vertigo episodes
- Difficulty hearing conversational speech
- Communication difficulties that may affect social interaction
- Emotional impact related to hearing changes
Otosclerosis typically progresses slowly over years or decades, with periods of progression that may be influenced by hormonal changes. Some patients first notice symptoms in one ear, though bilateral involvement may develop over time.
Experiencing these symptoms?
Consult with an ENT specialist for an accurate diagnosis and treatment plan.
When to See an ENT Specialist
Consult an ENT specialist if you notice gradual hearing loss, particularly if it affects your daily communication. Red flag symptoms requiring prompt evaluation include sudden hearing loss, severe vertigo, ear pain, or ear discharge, as these may indicate complications or other conditions. Early consultation is especially important if you have a family history of otosclerosis or are planning a pregnancy, as hormonal changes can accelerate progression.
During your first consultation, the ENT specialist will take a thorough medical history, focusing on your hearing symptoms, family history, and any triggering factors. The examination includes otoscopy to examine your ear canal and eardrum, followed by comprehensive hearing tests. Early intervention may help preserve remaining hearing and provide more treatment options before significant hearing loss occurs.
Diagnosis & Testing Methods
Accurate diagnosis of otosclerosis requires a comprehensive audiological and medical evaluation. Our ENT Specialist employs multiple diagnostic approaches to confirm otosclerosis and rule out other causes of hearing loss.
- Audiometry Testing: Pure tone audiometry measures hearing thresholds across different frequencies. In otosclerosis, this may reveal a characteristic pattern called Carhart’s notch, showing hearing loss at certain frequencies. Bone conduction testing helps differentiate between conductive and sensorineural components of hearing loss.
- Tympanometry: This test evaluates middle ear function by measuring eardrum movement in response to pressure changes. Otosclerosis may show reduced compliance due to stapes fixation, though early cases may have normal results.
- Stapedial Reflex Testing: The acoustic reflex test checks the stapedius muscle response to loud sounds. Absent or elevated reflexes may suggest stapes fixation characteristic of otosclerosis. This non-invasive test provides diagnostic information.
- CT Imaging: High-resolution temporal bone CT scans can visualise otosclerotic bone changes, particularly useful for surgical planning. The imaging may show characteristic lucent areas around the cochlea or oval window.
Treatment Options Overview
Hearing Aids
Modern digital hearing aids provide effective management for many otosclerosis patients. These devices amplify sound to help overcome the conductive hearing loss caused by stapes fixation. Contemporary hearing aids offer features including directional microphones, noise reduction, and Bluetooth connectivity. Your audiologist will programme the device for your hearing loss pattern, with regular adjustments as needed.
Sodium Fluoride Therapy
Oral sodium fluoride supplementation may help slow otosclerosis progression, particularly in cases with sensorineural involvement. The treatment aims to promote mature bone formation and reduce active otosclerotic lesions. Your healthcare professional will determine appropriate dosing and monitoring requirements whilst managing potential side effects.
Vitamin D Supplementation
Vitamin D deficiency may be associated with otosclerosis progression. Supplementation aims to help regulate bone metabolism and may help slow abnormal bone remodelling in the ear. Our healthcare professional will assess your vitamin D levels and recommend appropriate supplementation if indicated. This treatment may work alongside other medical management approaches.
Stapedectomy Surgery
Stapedectomy involves removing part or all of the fixed stapes bone and replacing it with a prosthesis. This microsurgical procedure aims to restore the mechanical transmission of sound vibrations to the inner ear. The surgery is performed under local or general anaesthesia. The procedure can help improve conductive hearing loss, though outcomes vary by individual anatomy and healing response.
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Stapedotomy Surgery
Stapedotomy is a modified technique where only the stapes superstructure is removed, and a small hole is created in the footplate for prosthesis placement. This approach aims to preserve more of the original anatomy whilst achieving hearing outcomes. Many surgeons use stapedotomy for its potentially reduced risk of inner ear complications. Recovery time and hearing results vary by individual.
Laser-Assisted Surgery
Laser technology may enhance surgical precision during stapedectomy or stapedotomy procedures. The laser creates openings in the stapes footplate with reduced mechanical trauma to surrounding structures. This technique may help reduce the risk of inner ear damage and post-operative vertigo. Different laser types (CO2, KTP, diode) offer different advantages depending on the surgical approach.
Bone Conduction Implants
For patients who cannot undergo stapedectomy or have had unsuccessful surgery, bone conduction implants offer an alternative. These devices bypass the middle ear, transmitting sound vibrations through the skull bone to the inner ear. Modern implants can be surgically placed or attached via magnetic coupling. Whilst not addressing the underlying otosclerosis, they may help restore functional hearing.
Every patient’s condition is unique.
Our ENT Specialist can assess your specific situation and recommend the most suitable treatment.
Complications if Left Untreated
Without treatment, otosclerosis may progressively worsen, potentially leading to bilateral hearing loss. Complete deafness could eventually occur, particularly if cochlear otosclerosis develops. The psychological impact may include social isolation, depression, and reduced quality of life as communication becomes increasingly difficult. Professional limitations may arise, especially in jobs requiring good hearing.
Untreated otosclerosis can also lead to chronic tinnitus that may become increasingly distressing over time. Some patients may develop persistent vertigo or balance problems as the disease affects inner ear structures. The combination of hearing loss and balance issues may increase fall risk in some patients. Early treatment aims to prevent or reduce these complications while preserving remaining hearing function.
Prevention
Whilst otosclerosis cannot be entirely prevented due to its genetic component, certain measures may help reduce risk or slow progression. Maintaining adequate vitamin D levels through diet, supplementation, or sun exposure supports healthy bone metabolism. Some research suggests fluoridated water may have protective effects, though this remains under investigation.
For those with a family history of otosclerosis, genetic counselling can provide risk assessment and family planning guidance. Women with otosclerosis should discuss pregnancy plans with their ENT specialist, as hormonal management strategies may help minimise progression during pregnancy and breastfeeding.
Protecting ears from loud noise exposure prevents additional sensorineural damage that could compound otosclerosis-related hearing loss. Regular hearing monitoring allows early detection and intervention if otosclerosis develops.
Frequently Asked Questions (FAQ)
Is otosclerosis surgery painful, and what is the recovery time?
Stapedectomy or stapedotomy surgery involves minimal discomfort, with patients typically describing mild ear pressure rather than pain. The procedure is performed through the ear canal without external incisions. Recovery may take several weeks for initial healing, during which you’ll need to keep your ear dry and avoid strenuous activities. Hearing improvement often begins within days but continues improving as swelling resolves. Patients may return to normal activities within a few weeks, though flying and diving restrictions may apply for several months.
Can otosclerosis affect both ears, and do I need surgery on both?
Otosclerosis patients may eventually develop bilateral involvement, though progression rates vary between ears. Surgery is typically performed on one ear at a time, starting with the worse-hearing ear. After first-ear surgery, the decision for second-ear surgery depends on hearing loss severity and patient preference. Some patients achieve satisfactory hearing with one operated ear and a hearing aid in the other. Our ENT Specialist will assess each ear independently and recommend individualised treatment timing.
What are the outcomes and risks of otosclerosis surgery?
Stapedectomy and stapedotomy can improve conductive hearing loss in many patients. Patients may achieve near-normal hearing or significant improvement. Complications can include taste disturbance, temporary dizziness, persistent vertigo, and hearing loss. Our ENT Specialist will discuss your individual risk factors and expected outcomes based on your specific condition and hearing tests.
Will I still need hearing aids after surgery?
Many patients achieve sufficient hearing improvement to function without hearing aids after stapedectomy. However, outcomes depend on pre-operative hearing levels and whether sensorineural hearing loss is present. Patients with mixed hearing loss may still benefit from hearing aids post-surgery, though less powerful devices are usually adequate. Long-term follow-up is important as age-related hearing loss or otosclerosis progression may eventually require hearing aid use.
Can otosclerosis recur after surgery?
Recurrence, where new otosclerotic bone growth affects the prosthesis, can occur in some cases over time. Revision surgery can address recurrence with good outcomes in many cases. Patients may experience a gradual hearing decline due to age-related changes or progression of cochlear otosclerosis affecting nerve function. Regular hearing monitoring helps detect changes early, allowing timely intervention if needed.
Is otosclerosis hereditary, and should my family members be tested?
Otosclerosis has a genetic component, with many cases showing family history. Children of affected parents may have an increased chance of developing clinical otosclerosis. Routine screening of asymptomatic family members isn’t necessary, but awareness of family history is important. Family members should seek evaluation if they notice hearing changes, particularly when otosclerosis typically manifests.
For Singaporeans & Singapore Permanent Residents
Medisave & Insurance Shield Plan approved
Your ENT procedure may be eligible for Medisave claims, with the claimable amount varying based on the procedure’s complexity. For additional options, including the use of your insurance or Integrated Shield Plan, reach out to our friendly clinic staff today for assistance.
Conclusion
Otosclerosis, while progressive, is treatable with various management options available. Whether through surgery, hearing aids, or medical management, options exist that may help restore functional hearing and support quality of life. Treatment selection depends on accurate diagnosis and choosing the appropriate intervention based on your specific condition, hearing needs, and lifestyle factors. With appropriate treatment, patients with otosclerosis may maintain good hearing function.
Take the First Step Towards Better Hearing
Living with otosclerosis can be challenging, but you don’t have to face it alone. Our ENT Specialist has experience diagnosing and treating otosclerosis using current evidence-based approaches.
Dr Gan Eng Cern
MBBS
MRCS (Edin)
mmed (orl)
FAMS
With over 15 years of experience, Dr Gan specialises in the comprehensive management of a broad range of conditions related to the ear, nose and throat (ENT), and head and neck.
Dr. Gan has contributed to the academic field as a Senior Clinical Lecturer at the Yong Loo Lin School of Medicine, National University of Singapore. He underwent his subspecialty training in Rhinology (Nose & Sinus conditions) and Endoscopic Skull Base Surgery at the renowned St Paul’s Sinus Center, part of the University of British Columbia in Vancouver, Canada. He is recognised for his extensive research work, with numerous contributions to reputable international ENT journals. Dr Gan is also highly sought after as a speaker and has shared his surgical knowledge as a surgical dissection teacher at various prominent ENT conferences and courses.
- 2020 – Reader’s Choice Gold Award for Best ENT Specialist (Expat Living Singapore)
- 2016 – Best Educator Award (Eastern Health Alliance)
- 2016 – “Wow” Award (Patient Compliment)
- 2014 – Eastern Health Alliance Caring Award – Silver
- 2014 – 19th Yahya Cohen Memorial Lectureship (awarded by the College of Surgeons, Academy of Medicine Singapore for best scientific surgical paper)
- 2012 – Human Manpower Development Award (Ministry of Health, Singapore)
- 2007 – Singhealth Best Doctor Award
Qualifications
- MBBS – Bachelor of Science, Bachelor of Medicine, Bachelor of Surgery (University of New South Wales, Sydney, Australia)
- MRCS (Edin) – Member of the Royal College of Surgeons Edinburgh, United Kingdom
- MMed (ORL) – Master of Medicine in ENT (National University of Singapore)
- FAMS – Fellow of the Academy of Medicine Singapore
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A Specialist Clinic for Sinus, Snoring & ENT
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Mount Elizabeth Novena Hospital
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