The main options for otosclerosis include observation with repeated hearing tests, a hearing aid(s), or surgery. Observation is recommended only for mild hearing loss. Some medicines such as sodium fluoride or bisphosphonate supplements have been reported to limit the worsening of otosclerosis, but there is no definitive evidence of preventing its progression.
Hearing aids can help overcome a fixed stapes by increasing the sound volume. Cost, style, fit, and possible benefits of a hearing aid should be discussed with your ENT specialist. In some states, a hearing aid trial may also allow you to sample a device prior to purchase. If a patient is prone to dizziness or has a diagnosis of Ménière’s disease, then trying a hearing aid before surgery may be advised.
Surgery for otosclerosis is called a stapedectomy or stapedotomy. In general, the stapes surgery is an outpatient procedure that can be done under local or general anesthesia. The surgery is done through the ear canal with an operating microscope, or endoscope. It involves removing part (stapedotomy) or all (stapedectomy) of the fixed stapes bone and replacing it with a prosthetic device or implant. The prosthetic device allows the bones of the middle ear to move again, correcting the conductive hearing loss. This surgery will not address any inner ear (sensorineural) hearing loss. The stapes prostheses are very small and will not set off metal detectors. Modern prostheses are also MRI compatible.
Pain is usually minimal but can vary. Some patients may experience dizziness the first few days after surgery. Taste sensation may also be altered for several weeks or months following surgery, but usually returns to normal. Risks of injuring the ear drum or causing additional hearing loss are rare but should be discussed. The ear canal is generally packed at the time of surgery to allow the ear drum to heal properly. Hearing improvement may not be noticed until it is removed. Discuss specific instructions on ear drops and other post-operative directions with your ENT specialist.
If otosclerosis affects both ears, typically the surgeon will choose to operate on the worst-hearing ear first and will not operate on both ears at the same time. The surgeon usually waits a minimum of six months before performing surgery on the second ear.
Following surgery, patients may be asked to refrain from nose blowing, swimming, or other activities that may get water in the operated ear or cause pressure within the middle ear space. Normal activities (including air travel) are usually resumed two to four weeks after surgery. Notify your ENT specialist immediately if any of the following occurs:
- Sudden hearing loss
- Intense pain
- Facial weakness
- Prolonged or intense dizziness, especially room-spinning sensation (vertigo)
- Any new symptom related to the operated ear
In advanced cases of otosclerosis, in which the disease has caused additional inner ear (sensorineural) hearing loss, a stapedectomy procedure may not be enough to restore useful hearing. In these situations, a cochlear implant may be considered.