Otosclerosis: Symptoms, Causes, and Management Strategies

Medically reviewed by Dr. Baraa Alnahhal, MD · Last reviewed: October 2026

Otosclerosis is a common cause of gradual hearing loss in young adults, and it is highly manageable. It happens when abnormal bone growth in the middle ear stops sound from traveling normally. This guide explains the symptoms, causes, diagnosis, and treatment options, including hearing aids, stapedectomy, and cochlear implants.

Quick Answer: What is otosclerosis?

Otosclerosis is a condition in which irregular bone growth in the middle ear, usually fusing the stapes bone, interferes with the ear's ability to carry sound. It causes gradual hearing loss, often in both ears, that rarely leads to total deafness. It cannot be cured but can be managed with hearing aids, stapedectomy or cochlear implants.

What the research says

• Stapes surgery helped many people with tinnitus. A systematic review and meta-analysis of 19 studies (1,318 people with otosclerosis and tinnitus before surgery) found that, in the 14 studies reporting self-rated change (868 people), tinnitus disappeared in 48.52% after stapes surgery, lessened in 28.60%, did not change in 18.12%, and worsened in 3.78%. Pooled hearing results from 6 studies (306 people) showed the air-bone gap closed to 20 dB or less in 91.50% of patients (Yeh et al., Am J Otolaryngol, 2026) [2].

• Endoscopic and microscopic stapes surgery gave comparable hearing. A meta-analysis of 36 studies (2,208 patients) found similar hearing results with the two approaches. The endoscopic approach reduced chorda tympani nerve manipulation (risk ratio 0.42) and taste disturbance (dysgeusia; risk ratio 0.50), and the authors describe it as a viable alternative when performed by experienced surgeons (Alqutub et al., Eur Arch Otorhinolaryngol, 2026) [3].

• Evidence on pregnancy is mixed. A systematic review of audio-vestibular disorders in pregnancy found that most included studies (4 of 6) saw no clinical or epidemiological association between otosclerosis and pregnancy in large samples, while the authors note more research is needed (Frosolini et al., Am J Otolaryngol, 2021) [4].

Study details retrieved from PubMed.

What is otosclerosis, and how does it affect ear anatomy?

Bone remodeling is a lifelong process in which existing bone tissue repeatedly restores itself. In otosclerosis, irregular remodeling in the middle ear interferes with sound's ability to travel. [1]

Deep in your ear, three tiny bones (ossicles) vibrate to amplify sound waves on their way to the cochlea in the inner ear, where they are converted into signals for the brain. Otosclerosis most often develops when the stapes, a small triangular bone in the middle ear, fuses with the surrounding bone tissue. Think of a musical triangle: held by its loop it rings freely, but a hand wrapped around it muffles the sound. Excess bone around the stapes has a similar effect. [1]

It typically affects both ears, though one ear is usually worse. In its early stage, called otospongiosis, soft bone begins to form. Over time those areas scar and harden, and the condition is then called otosclerosis. [1]

Feature	Healthy ear	Ear with otosclerosis
Bone growth	Balanced remodeling	Irregular, excess bone growth
Stapes mobility	Vibrates freely to amplify sound	Fused to surrounding bone and muffled
Sound travel	Clear transmission to the inner ear	Weakened or blocked transmission
Progression	Stable	Usually gradual worsening over many years

What are the symptoms of otosclerosis?

The most common symptom is hearing loss that happens gradually. You may no longer hear whispers or low-pitched sounds. Most people have hearing loss in both ears, while approximately 10% to 15% have it in one ear. [1]

Symptom category	Common experiences
Hearing	Gradual hearing loss, trouble with whispers and low-pitched sounds
Self-perception	You may speak quietly because your own voice sounds loud to you
Balance	Balance issues, vertigo, or dizziness
Ear sounds	Ringing in the ears (tinnitus)

What causes otosclerosis and who is at risk?

Otosclerosis involves abnormal bone remodeling in the ear. Possible risk factors include: [1]

Risk factor	How it relates to otosclerosis
Family history	You are more likely to develop it if a parent, sibling, or grandparent has it.
Sex	Females are more prone to developing otosclerosis.
Race	Overall, white people have a higher chance of getting it.
Pregnancy	People who are already prone to otosclerosis may develop it while pregnant.
Osteogenesis imperfecta (brittle bone disease)	Increases the risk of otosclerosis.

How is otosclerosis diagnosed?

If your primary care physician suspects otosclerosis, they will refer you to an otolaryngologist (ear, nose, and throat specialist). The specialist first rules out other conditions with similar symptoms, then runs hearing tests to find out how much hearing you have lost. [1]

• Audiogram: measures your hearing across a range of frequencies.

• Tympanogram: shows how well your eardrum works.

• CT scan: an imaging test that shows the bones and tissues inside your ear in more detail, if your provider requests it.

What are the treatment options for otosclerosis?

Treatment depends on where the irregular bone is and how severe the condition is. Many people manage otosclerosis-related hearing loss successfully with hearing aids. In select cases, stapedectomy can improve hearing, and people with cochlear otosclerosis (in the inner ear) may be offered a cochlear implant. Your provider may also simply monitor your condition and recommend treatment only if symptoms worsen. [1]

Treatment	What it does	Key points
Monitoring	Periodic checks of your hearing	May be enough at first, with treatment if symptoms worsen
Hearing aids	Amplify the sounds around you	An audiologist can customize them, but they cannot stop otosclerosis from getting worse
Stapedectomy	A prosthesis replaces the function of the fused stapes	Sound bypasses the stapes and reaches the inner ear
Cochlear implant	Bypasses inner ear structures to send sound to the brain	For cochlear otosclerosis

The Stapedectomy Procedure

In a stapedectomy, an otolaryngologist places a prosthesis (replacement hearing bone) in your middle ear. The prosthesis bypasses the stapes bone so sound waves can reach your inner ear and your hearing improves. If both ears are affected, the surgeon operates on one ear at a time, and you will probably need to wait at least six months before the next procedure. [1]

Can otosclerosis be prevented, and what is the outlook?

Unlike some other hearing conditions, otosclerosis has no preventable risk factors such as exposure to loud noise, and some people are simply more prone to it genetically, so it cannot be prevented. It usually gets worse slowly over many years, though in rare cases it can progress quickly. You cannot cure it, but you can manage it. Without treatment it may get worse and, in some cases, spread to the inner ear and cause cochlear otosclerosis. [1]

When should you see a healthcare provider about otosclerosis?

Schedule an appointment any time you notice a change or decrease in your hearing, and especially if the change is sudden. Prompt diagnosis and treatment can ease troublesome symptoms and improve your quality of life. [1]

What is the bottom line on otosclerosis?

Otosclerosis develops slowly, and the first clue is often a quiet loss of low-pitched sounds. It cannot be prevented or cured, but hearing aids, stapedectomy, and cochlear implants manage it well, and it rarely leads to total deafness. See an ear, nose, and throat specialist when you first notice hearing changes, so you can choose between monitoring, hearing aids, and surgery.

Frequently Asked Questions

What is the difference between otospongiosis and otosclerosis?

Otospongiosis refers to the early stages, when soft bone begins to form. Over time, these areas scar and harden, and once this happens the condition is called otosclerosis.

Can otosclerosis cause total deafness?

Otosclerosis rarely does. Otosclerosis can cause mild, moderate, or severe hearing loss, and it can be managed with hearing aids, surgery, or in some cases a cochlear implant.

Why does my voice sound loud to me if I have hearing loss?

People with otosclerosis may speak quietly because their own voice sounds loud to them. Cleveland Clinic lists this as a symptom but does not explain the mechanism.

Is otosclerosis hereditary?

Sometimes. It can run in families, and you are more likely to develop it if a parent, sibling, or grandparent has it.

Does pregnancy make otosclerosis worse?

Cleveland Clinic notes that people who are already prone to otosclerosis may develop it while pregnant. Research is mixed, though: a systematic review found that most included studies with large samples saw no association between otosclerosis and pregnancy. If you are pregnant or planning to be, talk to your ear, nose, and throat specialist.

How long does it take for otosclerosis to progress?

Otosclerosis usually gets worse slowly, over many years, but the timeframe varies from person to person. In rare cases it can progress quickly. See your healthcare provider if you notice sudden changes in your hearing.

Can loud noises cause otosclerosis?

No. Unlike some other hearing conditions, otosclerosis has no preventable risk factors such as exposure to loud noise.

What is a stapedectomy?

A stapedectomy is surgery for otosclerosis in which an otolaryngologist places a prosthesis (replacement hearing bone) in the middle ear. The prosthesis bypasses the stapes bone so sound waves can reach the inner ear.

Can both ears be operated on at the same time?

No. If otosclerosis affects both ears, the surgeon operates on one ear at a time so each can heal, and you will probably need to wait at least six months before the second procedure.

Are hearing aids a permanent fix for otosclerosis?

Hearing aids amplify sound and can improve hearing, but they cannot keep otosclerosis from getting worse.

When should I see a healthcare provider?

Any time you notice a change or decrease in your hearing. Prompt diagnosis and treatment can ease troublesome symptoms and improve your quality of life.

Related Reading

Hearing Test: What It Is, Why It's Done, Types, What to Expect and Results explains the hearing tests used to measure the type and degree of hearing loss.

Weber Test for Hearing Loss: How It's Done and What Results Mean explains the tuning fork test that helps tell conductive from sensorineural hearing loss.

References

1. Cleveland Clinic. Otosclerosis. Cleveland Clinic. Medically reviewed; last updated August 28, 2023. https://my.clevelandclinic.org/health/diseases/22033-otosclerosis

2. Yeh KT, Zhang BY, Yeh TW, et al. Tinnitus and hearing outcomes following stapes surgery in otosclerosis patients: a systematic review and meta-analysis. Am J Otolaryngol. 2026;47(6):104957. PMID: 42822231. DOI: 10.1016/j.amjoto.2026.104957

3. Alqutub A, Kabli A, Alnafie J, et al. Endoscopic versus microscopic stapedotomy: a comprehensive systematic review and meta-analysis incorporating all comparative evidence. Eur Arch Otorhinolaryngol. 2026;283(6):3539-3552. PMID: 41838154. DOI: 10.1007/s00405-026-10062-w

4. Frosolini A, Marioni G, Gallo C, et al. Audio-vestibular disorders and pregnancy: a systematic review. Am J Otolaryngol. 2021;42(5):103136. PMID: 34182351. DOI: 10.1016/j.amjoto.2021.103136

Medical disclaimer

This article is for general informational purposes only and is not a substitute for professional medical advice, diagnosis, or treatment. Always consult a qualified healthcare professional about your health.