Hearing a persistent ringing, buzzing, or humming sound when there is no obvious source can be unsettling, especially when it occurs alongside gradually worsening hearing. One possible cause is otosclerosis, a condition in which abnormal bone remodeling in the middle ear interferes with the movement of sound.
Otosclerosis most commonly affects the tiny stapes bone, which helps transmit sound vibrations from the eardrum to the inner ear. When this bone becomes less mobile, sound cannot travel through the ear as efficiently, potentially causing conductive hearing loss and tinnitus.
Although otosclerosis can be a source of tinnitus, not everyone with the condition experiences ringing, and tinnitus does not necessarily mean you have otosclerosis. Understanding how the condition affects hearing, how it is diagnosed, and which treatments are available can help you know what to discuss with an ear specialist.
What Is Otosclerosis?
Otosclerosis is a condition involving abnormal bone remodeling in the middle ear, and sometimes the bone surrounding the inner ear. Normally, bone tissue continually breaks down and rebuilds in a controlled process. In otosclerosis, this process becomes abnormal, producing areas of spongy or hardened bone that can interfere with normal sound transmission.
The condition most often affects the stapes, the smallest bone in the human body. The stapes sits at the boundary between the middle ear and inner ear, where it transfers sound vibrations into the fluid-filled cochlea.
When otosclerosis restricts the stapes’ movement, sound vibrations are not transmitted as effectively. This can lead to conductive hearing loss, in which sound has difficulty travelling through the outer or middle ear to the inner ear.
In some cases, the abnormal bone changes extend into the cochlea itself. This may affect the sensory structures involved in hearing and can contribute to a sensorineural component of hearing loss.
Otosclerosis often develops gradually, and symptoms may progress over time. It commonly begins in early or middle adulthood, although the timing and severity vary from person to person.
How Does Otosclerosis Cause Tinnitus?
Tinnitus is the perception of sound without an external sound source. It is often associated with changes in hearing, and otosclerosis can cause the type of hearing loss that may accompany tinnitus.
Stapes Fixation and Conductive Hearing Loss
The middle ear contains three small bones: the malleus, incus, and stapes. Together, they carry vibrations from the eardrum to the inner ear.
In otosclerosis, abnormal bone growth around the stapes can restrict its movement. This is known as stapes fixation. When the stapes cannot vibrate normally, less sound energy reaches the cochlea, resulting in conductive hearing loss.
The brain receives altered auditory input, and some people experience tinnitus alongside this hearing change. The exact mechanisms that generate tinnitus are complex and are not fully understood.
Changes Involving the Inner Ear
In some people, otosclerosis affects the bone surrounding the cochlea. This can contribute to sensorineural hearing loss, which involves the inner ear’s sensory structures or the auditory nerve pathways.
When conductive and sensorineural hearing loss occur together, the condition is described as mixed hearing loss. Tinnitus may accompany either type, but its presence or loudness does not reliably indicate how advanced otosclerosis is.
What Does Otosclerosis-Related Tinnitus Sound Like?
People with otosclerosis may describe tinnitus as:
- Ringing or high-pitched whistling
- Buzzing or humming
- Hissing or static-like noise
- A steady tone that is more noticeable in quiet environments
Tinnitus may be present in one ear or both. It can be continuous or intermittent, and its perceived loudness may fluctuate.
There is no single sound that identifies otosclerosis. Similar tinnitus can occur with noise-related hearing loss, earwax blockage, middle-ear conditions, and other causes. The sound alone cannot confirm the diagnosis.
What Other Symptoms Can Occur With Otosclerosis?
Gradual hearing loss is usually the main symptom. It may begin in one ear and later affect the other. Some people first notice difficulty hearing whispers, low-pitched sounds, or speech when there is background noise.
Other possible symptoms include:
- Tinnitus: Ringing, buzzing, or other internally perceived sounds.
- Difficulty following conversations: Speech may seem less clear, especially in groups.
- Dizziness or balance symptoms: These are less common and can have several possible causes.
- Gradually increasing listening effort: Everyday conversations may require more concentration.
Some people report that they hear speech more clearly in noisy surroundings, a phenomenon traditionally called paracusis of Willis. It is not present in everyone and should not be used to diagnose otosclerosis.
How Is Otosclerosis Diagnosed?
Otosclerosis cannot be confirmed from tinnitus symptoms alone. An audiologist or ENT specialist will assess your hearing, examine your ears, and determine whether additional tests are needed.
1. Medical History and Ear Examination
The specialist may ask when your hearing changes began, whether one or both ears are affected, whether you experience tinnitus or dizziness, and whether close relatives have had similar hearing problems.
An examination with an otoscope or ear microscope helps identify other possible causes, such as earwax, infection, or eardrum abnormalities. The eardrum may look normal in people with otosclerosis, so a normal visual examination does not rule it out.
2. Hearing Tests
An audiogram measures how well you hear different pitches and volumes through headphones and, when needed, through a bone-conduction device. In otosclerosis, the results may show a gap between air-conduction and bone-conduction hearing thresholds, suggesting conductive hearing loss.
Tympanometry assesses how the eardrum and middle-ear system respond to changes in air pressure. Additional tests, such as acoustic reflex testing, may help the clinician assess how the middle ear is functioning.
3. CT Imaging When Needed
A high-resolution CT scan of the temporal bones may be used when the diagnosis is uncertain, when other conditions need to be excluded, or when surgery is being considered. Imaging is not necessary in every case, and a specialist interprets it alongside examination and hearing-test results.
Can Treating Otosclerosis Reduce Tinnitus?
Treatment depends on the type and degree of hearing loss, how much it affects everyday life, and the person’s preferences. Managing the hearing problem may also reduce tinnitus for some people, but improvement is not guaranteed.
Hearing Aids
Hearing aids amplify external sounds to help compensate for hearing loss. By improving access to speech and environmental sounds, they may also make tinnitus less noticeable for some users.
They do not remove the abnormal bone growth or stop otosclerosis from progressing. An audiologist can assess whether a hearing aid is suitable and help adjust it to your hearing needs.
Stapedotomy or Stapedectomy
Surgery may be considered when stapes fixation causes conductive hearing loss and a person is an appropriate candidate.
- Stapedotomy: The surgeon creates a small opening in the fixed stapes and places a tiny prosthesis to transmit sound vibrations to the inner ear.
- Stapedectomy: Some or all of the stapes is removed and replaced with a prosthesis.
Both procedures aim to improve sound transmission. Hearing often improves after appropriately selected surgery, but outcomes vary, and there are risks, including dizziness, changes in taste, persistent hearing loss, and, rarely, more severe hearing deterioration.
Tinnitus may improve after surgery in some people, particularly when hearing improves, but it may remain unchanged or occasionally worsen. Surgery is primarily performed to address hearing loss, not as a guaranteed tinnitus treatment. The potential benefits and risks should be discussed with an experienced otologist or ENT surgeon.
Medical Treatment
There is currently no universally accepted medication that reliably reverses otosclerosis. Some medicines have been investigated for their possible effects on abnormal bone remodeling, but evidence is limited or mixed, and they are not a substitute for specialist assessment.
Avoid taking medication or supplements advertised as a way to dissolve abnormal ear bone or cure otosclerosis without discussing them with a qualified clinician.
What If Tinnitus Remains After Treatment?
Even if hearing improves after a hearing aid fitting or surgery, tinnitus may persist. This is because tinnitus is not simply a sound created by the fixed stapes; it can also involve how the auditory nervous system responds to altered sound input.
If tinnitus remains bothersome, an audiologist or ENT specialist can reassess your hearing and discuss options such as hearing support or sound enrichment. Cognitive behavioural therapy (CBT) may also help reduce the distress, sleep disruption, and concentration difficulties associated with tinnitus. It focuses on the impact of tinnitus rather than promising to eliminate the sound.
Maintaining comfortable sound levels, protecting your ears from hazardous noise, and supporting regular sleep may also help with day-to-day coping. Avoid placing excessive focus on repeatedly testing the tinnitus, as constant monitoring can make it feel more intrusive.
When Should You See an ENT Specialist?
Arrange an appointment with a healthcare professional if you have persistent tinnitus, gradually worsening hearing, or difficulty following conversations. An audiologist can perform hearing tests, and an ENT specialist can assess whether otosclerosis or another ear condition may be responsible.
Seek urgent medical attention if tinnitus occurs with sudden hearing loss, new severe neurological symptoms, or sudden significant balance problems. Tinnitus that beats in time with your pulse also needs medical assessment.
Frequently Asked Questions
Does everyone with otosclerosis develop tinnitus?
No. Hearing loss is the most common symptom, and some people with otosclerosis never experience tinnitus. Others may have tinnitus with or without noticeable hearing difficulties.
Is otosclerosis-related tinnitus permanent?
Not necessarily, but its course varies. Tinnitus may improve when hearing loss is treated, but it can also persist even after successful treatment of stapes fixation. An individual outcome cannot be predicted from the diagnosis alone.
Can otosclerosis cause tinnitus in both ears?
Yes. Otosclerosis can affect one or both ears, and tinnitus may be perceived in either or both. The presence of tinnitus in both ears does not, by itself, confirm otosclerosis.
Does otosclerosis always lead to complete hearing loss?
No. The degree and progression of hearing loss vary. Many people have partial hearing loss that can be managed with hearing aids or, in suitable cases, surgery. Regular assessment helps monitor changes.
Will stapes surgery stop tinnitus?
It may improve tinnitus for some people, but this is not guaranteed. Surgery is intended mainly to improve sound transmission and hearing. Tinnitus can remain or occasionally worsen, so the expected benefits and risks should be reviewed with the surgeon.
Can otosclerosis be prevented?
There is no established method to prevent otosclerosis. Genetic factors may contribute, but the exact cause is not fully understood. Protecting your ears from loud noise is useful for preventing additional noise-related hearing damage, although it does not prevent otosclerosis itself.
Final Thoughts
Otosclerosis is an abnormal bone-remodeling condition that most often restricts the movement of the stapes, interfering with sound transmission and causing gradual hearing loss. Tinnitus can accompany this hearing change, but it is not present in everyone and is not specific to the condition.
If you notice persistent ringing alongside gradually worsening hearing, an audiogram and assessment by an audiologist or ENT specialist can help identify the cause. Hearing aids and stapes surgery may improve hearing in appropriate cases, while tinnitus-focused support can help if the sound remains bothersome.
Medical disclaimer: This article is for general educational purposes only and is not a substitute for professional medical advice, diagnosis, or treatment.