Imaging Studies

CT scanning of the temporal bone can often demonstrate foci of demineralization in the otic capsule in cases of cochlear otosclerosis.^[1]

Other Tests

A full audiometric evaluation, including impedance testing, is necessary.

Histologic Findings

See Pathophysiology.

Treatment & Management

Virk JS, Singh A, Lingam RK. The role of imaging in the diagnosis and management of otosclerosis. Otol Neurotol. 2013 Sep. 34(7):e55-60. [QxMD MEDLINE Link].
Toynbee J. Pathological and surgical observations of the diseases of the ear. Trans Med Chir Soc Lond. 1841. 24:190-196.
Jack FL. Remarkable improvement of hearing by removal of the stapes. Trans Am Otol Soc. 1893. 284:474-89.
Holmgren J. The surgery of otosclerosis. Ann Otol Rhinol Laryngol. 1937. 46:3-12.
Sourdille M. New technique in the surgical treatment of severe and progressive deafness from otosclerosis. Bull NY Acad Med. 1937. 13:673.
Lempert J. Improvement in hearing in cases of otosclerosis: A new, one-stage surgical technic. Arch Otolaryngol. 1938. 28:42-97.
Rosen S. Restoration of hearing in otosclerosis by mobilization of the fixed stapedial footplate; an analysis of results. Laryngoscope. 1955 Apr. 65(4):224-69. [QxMD MEDLINE Link].
Shea JJ Jr. A personal history of stapedectomy. Am J Otol. 1998 Sep. 19(5 Suppl):S2-12. [QxMD MEDLINE Link].
Wiatr A, Składzien J, Swiezy K, Wiatr M. A Biochemical Analysis of the Stapes. Med Sci Monit. 2019 Apr 12. 25:2679-86. [QxMD MEDLINE Link]. [Full Text].
Kashio A, Ito K, Kakigi A, Karino S, Iwasaki S, Sakamoto T, et al. Carhart Notch 2-kHz Bone Conduction Threshold Dip: A Nondefinitive Predictor of Stapes Fixation in Conductive Hearing Loss With Normal Tympanic Membrane. Arch Otolaryngol Head Neck Surg. 2011 Mar. 137(3):236-40. [QxMD MEDLINE Link].
McCabe BF. Otosclerosis and vertigo. Proc Trans Pacific Oto-Ophth Soc. 1966. 47:37.
Thomeer HG, Kunst HP, Cremers CW. Congenital stapes ankylosis associated with another ossicular chain anomaly: surgical results in 30 ears. Arch Otolaryngol Head Neck Surg. 2011 Sep. 137(9):935-41. [QxMD MEDLINE Link].
Wegner I, Bittermann AJ, Zinsmeester MM, van der Heijden GJ, Grolman W. Local versus General Anesthesia in Stapes Surgery for Otosclerosis: A Systematic Review of the Evidence. Otolaryngol Head Neck Surg. 2013 Sep. 149(3):360-5. [QxMD MEDLINE Link].
Vincent R, Wegner I, Vonck BM, Bittermann AJ, Kamalski DM, Grolman W. Primary stapedotomy in children with otosclerosis: A prospective study of 41 consecutive cases. Laryngoscope. 2015 May 28. [QxMD MEDLINE Link].
de Vilhena D, Gamboa I, Duarte D, Lopes G. Vestibular Disorders after Stapedial Surgery in Patients with Otosclerosis. Int J Otolaryngol. 2016. 2016:6830648. [QxMD MEDLINE Link]. [Full Text].
Luryi AL, Schettino A, Michaelides EM, Babu S, Bojrab DI, Schutt CA. Outcomes After Tympanic Membrane Perforation During Primary Stapes Surgery for Otosclerosis. Laryngoscope. 2021 Feb 12. [QxMD MEDLINE Link].
Shim YJ, Bae YJ, An GS, et al. Involvement of the Internal Auditory Canal in Subjects With Cochlear Otosclerosis: A Less Acknowledged Third Window That Affects Surgical Outcome. Otol Neurotol. 2019 Mar. 40 (3):e186-90. [QxMD MEDLINE Link].
Kishimoto M, Ueda H, Uchida Y, Sone M. Factors affecting postoperative outcome in otosclerosis patients: Predictive role of audiological and clinical features. Auris Nasus Larynx. 2015 Oct. 42 (5):369-73. [QxMD MEDLINE Link].
Dziendziel B, Skarzynski H, Gos E, Skarzynski PH. Tinnitus Severity Change Following Stapedotomy in Patients With Otosclerosis. Otol Neurotol. 2019 Jun. 40 (5):578-83. [QxMD MEDLINE Link].
Kojima H, Komori M, Chikazawa S, Yaguchi Y, Yamamoto K, Chujo K, et al. Comparison between endoscopic and microscopic stapes surgery. Laryngoscope. 2013 May 13. [QxMD MEDLINE Link].

Media Gallery

A tympanomeatal flap is incised along the posterior external auditory canal.
The fibrous tympanic annulus is elevated with the tympanomeatal flap to expose the middle ear.
Scutal bone is curetted to allow visualization of the pyramidal process, tympanic segment of the facial nerve, and the stapedial footplate.
The incudostapedial joint is disarticulated after measurements have been made.
The stapedial tendon is sectioned either with a laser or scissors and then the posterior crus of the stapes is sectioned either with a drill as shown or a laser.
The stapes superstructure has been down-fractured and removed. The footplate remains and may now be removed completely as in a total stapedectomy or a stapedotomy hole may be made with a laser or microdrill.
A stapedotomy has been performed. A prosthesis may now be placed.
A piece of tissue (fascia, perichondrium, or vein) is placed over the stapedectomy/stapedotomy.
A Robinson bucket handle prosthesis is placed over the stapedotomy and looped over the incus.
A stapedotomy procedure with a bucket handle prosthesis positioned over the footplate.
Video of laser stapedotomy with SMart piston prosthesis.
Video of bucket handle prosthesis positioning.

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Author

Jack A Shohet, MD President, Shohet Ear Associates Medical Group, Inc; Clinical Professor, Department of Otolaryngology-Head and Neck Surgery, University of California, Irvine, School of Medicine

Jack A Shohet, MD is a member of the following medical societies: American Academy of Otolaryngology-Head and Neck Surgery, American Neurotology Society, California Medical Association

Disclosure: Medical Advisory Board Member, consultant for: Envoy Medical.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Gerard J Gianoli, MD Clinical Associate Professor, Departments of Otolaryngology-Head and Neck Surgery and Pediatrics, Tulane University School of Medicine; President, The Ear and Balance Institute; Board of Directors, Ponchartrain Surgery Center

Gerard J Gianoli, MD is a member of the following medical societies: American Academy of Otolaryngology-Head and Neck Surgery, American College of Surgeons, American Neurotology Society, American Otological Society, Society of University Otolaryngologists-Head and Neck Surgeons, Triological Society

Disclosure: Nothing to disclose.

Chief Editor

Arlen D Meyers, MD, MBA Professor of Otolaryngology, Dentistry, and Engineering, University of Colorado School of Medicine

Arlen D Meyers, MD, MBA is a member of the following medical societies: American Academy of Facial Plastic and Reconstructive Surgery, American Academy of Otolaryngology-Head and Neck Surgery, American Head and Neck Society

Disclosure: Serve(d) as a director, officer, partner, employee, advisor, consultant or trustee for: Cerescan; Ryte; Neosoma; MI10<br/>Received income in an amount equal to or greater than $250 from: Neosoma; Cyberionix (CYBX)<br/>Received ownership interest from Cerescan for consulting for: Neosoma, MI10.

Additional Contributors

Cliff A Megerian, MD, FACS Medical Director of Adult and Pediatric Cochlear Implant Program, Director of Otology and Neurotology, University Hospitals of Cleveland; Chairman of Otolaryngology-Head and Neck Surgery, Professor of Otolaryngology-Head and Neck Surgery and Neurological Surgery, Case Western Reserve University School of Medicine

Cliff A Megerian, MD, FACS is a member of the following medical societies: American Academy of Otolaryngology-Head and Neck Surgery, American College of Surgeons, American Neurotology Society, American Otological Society, Association for Research in Otolaryngology, Massachusetts Medical Society, Society for Neuroscience, Society of University Otolaryngologists-Head and Neck Surgeons, Triological Society

Disclosure: Nothing to disclose.