Otosclerosis

Abnormal bone growth fixing one of the hearing bones. A treatable, often surgically curable, cause of hearing loss in younger adults.

What it is

Abnormal bone remodelling in the middle ear, fixing the stapes, the smallest bone in the body, so it can no longer transmit sound.

It typically begins in the twenties to forties, is more common in women, and often runs in families. It frequently worsens during pregnancy.

**It is one of the few readily treatable causes of hearing loss**, which is why it matters to identify. A stapedotomy, replacing the fixed bone with a tiny prosthesis, restores hearing substantially in the large majority of people. Hearing aids are an equally valid alternative and carry no surgical risk.

The pattern is a conductive hearing loss, usually starting in one ear and later affecting both, in a younger adult with a normal-looking eardrum. That combination should prompt audiology assessment and ENT referral rather than being attributed to wax or noise.

A curious and characteristic feature is that people often hear better in noisy environments than in quiet ones, the opposite of most hearing loss.

Over time it can also affect the inner ear, adding a sensorineural component which surgery does not fix, which is an argument for not delaying assessment indefinitely.

Tinnitus is common and often the first symptom people notice.

Signs you might notice

Gradual hearing loss, usually starting in one ear, typically between 20 and 40.

Tinnitus, often early.

Hearing better in noisy places than in quiet ones.

Speaking quietly, because the person hears their own voice loudly through the bone.

Mild dizziness or unsteadiness in some people.

Hearing worsening noticeably during pregnancy.

A family history of hearing loss starting young.

See a GP for any hearing loss in a younger adult, and ask for audiology.

Urgent: sudden hearing loss, which is a different and time-critical problem needing assessment within days.

One-sided hearing loss also warrants consideration of acoustic neuroma and an MRI.

How it can affect day-to-day life

Hearing loss in a younger adult is often hidden for years because of the assumption that it is an older person's problem. Work, relationships and confidence suffer well before anybody has a test.

The choice between hearing aids and surgery is genuinely a choice, and both are reasonable. Surgery has a small risk of making hearing worse or causing complete deafness in that ear, and that risk should be stated plainly.

Modern hearing aids are effective for this type of loss, and trying them first is a legitimate approach that keeps surgery available later.

After stapedotomy, there are restrictions on flying, diving, heavy lifting and nose blowing for a period, and these should be checked rather than guessed.

Pregnancy commonly worsens it, and that is worth anticipating rather than being alarmed by.

Because it is hereditary, relatives with early hearing loss should have it considered rather than assumed to be noise damage.

Supporting someone well

Get a hearing test for any hearing loss in a younger adult; do not assume wax or noise.

Ask for audiology and ENT referral, and ask whether the pattern is conductive.

Ask about both options: hearing aids and surgery, with the risks of each.

Try hearing aids first if unsure; surgery remains available.

Treat sudden hearing loss as urgent.

Ask about an MRI for one-sided loss to exclude an acoustic neuroma.

Follow the post-operative restrictions on flying, diving and lifting.

Mention it to relatives with early hearing loss.

Ask about tinnitus support, which is often the more troublesome symptom.

Where to get help

A GP practice for audiology and ENT referral.

Urgent ENT assessment for sudden hearing loss.

RNID for hearing loss information and support.

Tinnitus UK on the tinnitus that accompanies it.