What is Otosclerosis (Ear Calcification)?

The human ear has a complex structure that detects sound waves and transmits them to the brain. The hearing process requires a series of mechanical and biological processes from the outer ear to the inner ear. Sound waves are first collected by the outer ear and travel through the ear canal to reach the eardrum. The vibration of the eardrum is transferred to the ossicles in the middle ear, which are the malleus, incus, and stapes. The movement of these bones transmits the sound waves to the fluids in the inner ear. Nerve endings in the inner ear convert these vibrations into electrical signals and send them to the brain via the auditory nerve. Any disruption in this complex system can lead to hearing loss. Otosclerosis is a disease that causes hearing loss due to abnormal bone growth at the base of the stapes bone in the middle ear. Otosclerosis is an important disease that disrupts this process in the middle ear.

Causes of Otosclerosis

The exact cause of otosclerosis is still not fully understood. However, studies show that this condition can result from a combination of genetic and environmental factors. In some cases, the disease has been observed to affect multiple individuals in a family, supporting the theory of genetic predisposition. Additionally, hormonal changes, especially those occurring during pregnancy, can trigger or accelerate the onset of otosclerosis.

• Genetic Factors: Otosclerosis is thought to be a genetic disease. It is known that individuals with a family history of otosclerosis are at higher risk.
• Hormones and Pregnancy: Otosclerosis is more common in women than in men, suggesting that hormones may play a role in the development of the disease. Hormonal changes during pregnancy can accelerate the progression of otosclerosis.
• Viruses: Some studies suggest that viral infections such as measles may play a role in the development of otosclerosis. However, this has not been definitively proven.
• Environmental Factors: Environmental factors such as stress, nutritional deficiencies, and infections are also thought to affect the development of otosclerosis.

Symptoms of Otosclerosis

The most common symptom of otosclerosis is gradual hearing loss. This loss often affects one ear in the early stages of the disease but can spread to both ears over time. Here are the most common symptoms of otosclerosis:

• Hearing Loss: Initially mild, hearing loss becomes more pronounced over time. Patients with otosclerosis generally have difficulty hearing low-frequency sounds.
• Tinnitus: A constant ringing, buzzing, or hissing sound in the ear may occur. This is often more bothersome in quiet environments.
• Dizziness (Vertigo): In the later stages of the disease, some patients may experience dizziness and balance problems. This is related to the involvement of the inner ear.
• Changes in Sound Perception: People with otosclerosis may notice that they hear other sounds better in noisy environments. This is due to the way hearing loss alters the perception of surrounding sounds.

The disease typically starts between the ages of 15 and 45 and is more common in women than men. The disease can progress rapidly during periods of hormonal changes, such as pregnancy.

How is Otosclerosis Diagnosed?

The diagnosis of otosclerosis is typically made through a series of tests and evaluations. Otolaryngologists (ENT specialists) diagnose the disease through both physical examination and hearing tests. Here are the methods used in the diagnostic process:

• Physical Examination: The eardrum usually appears normal. The physical examination helps rule out other conditions.
• Hearing Test (Audiometry): Hearing tests are used to determine the degree and type of hearing loss. In otosclerosis, conductive hearing loss is typically observed. However, as the disease progresses, sensorineural (nerve-related) hearing loss may also develop.
• Imaging Techniques: Techniques like computerized tomography (CT) are not used to directly show otosclerosis but can help rule out other ear diseases. High-resolution tomography can sometimes reveal calcification at the base of the stapes.

Treatment Options

The treatment of otosclerosis varies depending on the severity of the disease and its impact on the patient’s quality of life. In the early stages, monitoring the condition may be sufficient, while in more advanced cases, surgical intervention or hearing aids may be used.

Monitoring and Observation
In the early stages, if the hearing loss is mild and does not affect daily life, the condition can be monitored with regular hearing tests.

Medication
Some medications may slow the progression of the disease. For example, sodium fluoride, calcium, and vitamin D can affect bone metabolism and reduce calcification. However, this treatment is generally limited in its effectiveness and is not commonly preferred.

Hearing Aids
Hearing aids can be used to compensate for hearing loss. While they do not treat otosclerosis, they help the patient hear better.

Surgical Treatment
One of the most commonly preferred methods for surgical treatment of otosclerosis is known as exploratory tympanotomy. This surgical procedure is crucial for both diagnosing and treating the disease.

What is Exploratory Tympanotomy?

During exploratory tympanotomy, the surgeon carefully lifts the eardrum to gain direct access to the middle ear and ossicles. This procedure allows the movement of the stapes bone to be assessed with the help of surgical instruments. If a restriction in the movement of the stapes is detected, this confirms the diagnosis of otosclerosis. At this point, the surgeon plans the next step for treating the disease.

What are Stapedotomy and Stapedectomy?

When the diagnosis of otosclerosis is confirmed during exploratory tympanotomy, treatment is usually performed using one of the following techniques: stapedotomy or stapedectomy:

Stapedotomy/Stapedectomy
In this procedure, the stapes bone is either completely removed (stapedectomy) or a small hole is made in its base and a prosthesis is inserted (stapedotomy). This prosthesis helps transmit sound waves from the incus to the inner ear. The prosthesis is typically made of Teflon or metal and is designed to transmit sound from the incus to the inner ear. Stapedotomy is considered a less invasive method and generally has a faster recovery time. The surgery is performed under general anesthesia, typically under a microscope or endoscope, through the ear canal.

Success Rate of the Surgery

Stapedotomy and stapedectomy operations generally have high success rates. In the majority of cases, conductive hearing loss improves significantly, and there is a marked improvement in hearing levels. These surgeries are considered one of the most effective ways to treat hearing loss caused by otosclerosis.

Post-Surgery Process

After otosclerosis surgery, patients usually recover within a few weeks. However, there are some important points to consider during the recovery process:

• The hospital stay is usually one day. There will be tampons in the ear canal, which dissolve over a few weeks.
• Dizziness may occur in the first few days. This is generally temporary.
• Activities that increase pressure, such as heavy lifting, straining, exercising, or flying, should be avoided for about three weeks.
• To reduce the risk of infection after surgery, hygiene rules should be followed.

Possible Complications

Otosclerosis surgery is generally safe, but it does come with some risks:

• Continued or worsening hearing loss
• Perforation of the eardrum
• Damage to the facial nerve
• Infection in the middle ear
• Displacement of the prosthesis

Although these complications are rare, patients are informed of these risks before the surgery.

Conclusion

Otosclerosis is a condition that can be managed with early diagnosis and treatment. Hearing loss can negatively impact quality of life, but the effects can be minimized with appropriate treatment methods. If you experience hearing loss, tinnitus, or dizziness, it is important to consult a specialist. Early intervention can make a significant difference in your hearing health.

Timpanosclerosis

Ear Calcification

The condition commonly known as “ear calcification” actually refers to two different diseases that are not directly connected: timpanosclerosis and otosclerosis. Both diseases can lead to hearing loss but develop through different mechanisms and require different treatment methods.

Timpanosclerosis