Otosclerosis Treatment: Hearing Aids or Surgery?

Struggling to follow conversations at meetings? Finding that voices sound muffled while background noise feels sharper? These small but frustrating changes could be signs of otosclerosis and can make daily interactions difficult. Many people dismiss early signs of hearing loss, assuming they just need to focus more. Over time, the problem worsens, affecting confidence and social interactions.

For those noticing these challenges, deciding on the right solution becomes important. Some rely on hearing aids to amplify sound, while others consider surgery for a long-term fix. Each option has advantages, risks, and lifestyle considerations.

Knowing the differences between hearing aids and surgical treatment helps in making an informed choice. This guide gets into both otosclerosis treatment options, weighing effectiveness, cost, and long-term impact.

Otosclerosis Overview

Otosclerosis is a condition that affects the small bones in the middle ear, leading to gradual hearing loss. It primarily involves the stapes, one of the three bones responsible for transmitting sound vibrations to the inner ear. As abnormal bone growth develops around the stapes, its movement becomes restricted, which reduces the ability to conduct sound efficiently.

Hearing loss due to otosclerosis often starts in one ear before affecting both. Initially, individuals may struggle to hear low-frequency sounds, such as whispers or deep voices. Over time, this can progress to more noticeable impairment. Many people also experience tinnitus, a persistent ringing or buzzing sound in the ear, which can become disruptive in quiet environments.

Otosclerosis typically develops between the ages of 15 and 45, with symptoms becoming more pronounced in the 20s or 30s. It progresses gradually, making it difficult to detect in the early stages. Some individuals report better hearing in noisy environments, a phenomenon known as Paracusis of Willis, which is a distinguishing characteristic.

Without intervention, otosclerosis can lead to significant hearing loss. Understanding its effects helps individuals recognise early symptoms and seek appropriate management to maintain hearing function.  

Causes of Otosclerosis

While the exact cause remains uncertain, several factors contribute to its development:

1. Genetic Factors: Otosclerosis often runs in families. If a parent has the condition, there is a higher likelihood of developing it. However, not everyone with a genetic predisposition experiences hearing loss.
2. Viral Infections: Some studies suggest that viral infections, such as measles, may trigger the abnormal bone growth associated with otosclerosis.
3. Hormonal Changes: Pregnancy and hormonal fluctuations have been linked to the progression of otosclerosis. Many women notice worsening symptoms during or after pregnancy.
4. Autoimmune Factors: In some cases, the immune system may contribute to bone changes in the ear, though research is ongoing in this area.

How is Otosclerosis Diagnosed?

Diagnosing otosclerosis involves a combination of hearing tests, clinical evaluation, and sometimes imaging studies. Since its symptoms resemble other ear conditions, a thorough assessment is necessary to confirm the condition.

1. Medical History and Symptom Review

An ENT specialist begins by discussing hearing loss progression, tinnitus (ringing in the ears), and any balance issues. A family history of otosclerosis increases the likelihood of diagnosis, as the condition is often hereditary. Women may also notice worsening symptoms during pregnancy due to hormonal changes.

2. Physical Examination (Otoscopy)

A visual inspection of the eardrum may reveal Schwartze’s sign, a reddish glow behind the eardrum caused by increased blood flow in the affected bone. However, this is not present in all cases.

3. Pure-Tone Audiometry (Hearing Test)

This test measures hearing ability at different frequencies. A specific finding in otosclerosis is Carhart’s notch, a dip in bone conduction hearing at 2000 Hz, which strongly suggests stapes fixation.

4. Tympanometry

This test evaluates eardrum movement. In otosclerosis, the eardrum appears less mobile due to stapes bone fixation.

5. CT Scan (For Advanced Cases)

A high-resolution CT scan of the temporal bone helps confirm severe cases or when surgery is being considered.

An early diagnosis allows for better hearing management and timely intervention based on severity.

Otosclerosis Treatment Options 

While this condition cannot be reversed, different options help manage hearing difficulties. The two primary otosclerosis treatment options include hearing aids and surgery. Each has its advantages, risks, and suitability depending on individual needs.

Hearing Aids: A Non-Invasive Approach

Hearing aids provide an effective way to manage hearing difficulties caused by otosclerosis, especially in cases where surgery may not be the preferred choice. These devices amplify external sounds, making speech and environmental noises clearer.

Unlike surgical procedures, hearing aids do not require any medical intervention, making them a safer and more convenient option for many individuals.

How Hearing Aids Help?

Otosclerosis affects the middle ear, restricting sound transmission. Hearing aids work by picking up external sounds, processing them digitally, and delivering an amplified version to the inner ear. This allows users to hear speech, music, and ambient sounds more clearly, improving daily interactions.

Advantages of Hearing Aids

• No Surgery or Recovery Time: Since hearing aids are external devices, they do not involve medical procedures, surgical risks, or post-operative recovery.
• Immediate Improvement: Unlike surgery, where results take time, hearing aids provide instant sound enhancement once fitted.
• Advanced Technology: High-end models feature noise reduction, directional microphones, and automatic volume adjustments for a clearer listening experience.
• Customised to Individual Needs: Audiologists program hearing aids based on a person’s specific hearing loss for optimal performance.
• Discreet Designs Available: Premium models are nearly invisible, offering an aesthetically appealing solution for those concerned about appearance.

Considerations and Limitations

• Not a Permanent Solution: While hearing aids improve sound perception, they do not stop otosclerosis from progressing.
• Regular Maintenance Required: Batteries need replacement, and periodic adjustments are necessary to maintain performance.
• Device Dependency: Unlike surgery, which may provide a long-term solution, hearing aids must be worn consistently to maintain improved hearing.

For individuals who prefer a non-invasive option, hearing aids offer a practical and effective way to improve auditory clarity. A consultation with an audiologist helps determine the most suitable model based on hearing needs and lifestyle preferences.

Surgical Intervention: Stapedectomy

Stapedectomy surgery is also used to improve hearing in individuals with otosclerosis. The condition causes abnormal bone growth around the stapes, restricting sound transmission to the inner ear. This procedure replaces the immobilised stapes bone with a prosthetic implant, allowing sound vibrations to pass through effectively.

How Stapedectomy Surgery Works?

An ENT surgeon performs the procedure under local or general anaesthesia. A small incision is made in the ear canal to access the middle ear. The affected stapes bone is carefully removed, and a prosthetic implant made of titanium, Teflon, or another biocompatible material is placed in its position.

This restores the natural movement of sound waves to the inner ear. Most surgeries take less than an hour, and patients return home the same day.

Benefits of Surgery

• Addresses the Root Cause: Instead of amplifying sound like hearing aids, surgery restores normal sound transmission by replacing the affected bone.
• Long-Term Solution: Many individuals experience permanent hearing improvement, reducing or eliminating the need for external devices.
• No Device Dependency: Unlike hearing aids, stapedectomy surgery does not require daily maintenance or frequent replacements.

Risks and Considerations

• Surgical Risks: Though rare, complications may include infection, dizziness, changes in taste perception, or in some cases, worsened hearing.
• Recovery Period: Patients require a few weeks for complete healing, with temporary restrictions on travel, strenuous activities, and water exposure.
• Success Rates Vary: While most individuals experience significant improvement, results depend on factors such as overall ear health and surgeon expertise.

For those seeking a long-term option, stapedectomy offers a potential solution. Consulting a skilled ENT specialist helps determine whether this procedure is suitable based on individual hearing conditions.

Making the Right Choice

Deciding between hearing aids and surgery for otosclerosis depends on multiple factors, including the severity of hearing loss, lifestyle preferences, and long-term expectations. Each approach offers distinct advantages, and the right choice varies for each individual. Understanding these options helps in making an informed decision.

When Hearing Aids May Be More Suitable?

Hearing aids provide a practical solution for those who prefer a non-invasive approach. They work well for individuals with mild to moderate hearing loss, offering immediate sound amplification without the need for surgery.

• Low Risk and No Recovery Time – Since hearing aids are external devices, they do not involve surgical risks or post-operative recovery.
• Flexible and Adjustable – Modern digital hearing aids adapt to different environments, reducing background noise and enhancing clarity.
• Suitable for Progressive Hearing Loss – If hearing deteriorates further, adjustments or stronger models can be used without additional medical intervention.
• Ideal for Those Unsure About Surgery – Some individuals prefer trying a non-surgical option before considering a permanent intervention.

Despite these advantages, hearing aids require regular maintenance, periodic recalibration, and consistent use to remain effective. They do not address the root cause of hearing loss, meaning the condition may continue to progress.

When Surgery May Be the Better Option?

For individuals seeking a long-term solution, stapedectomy surgery provides an alternative to hearing aids. This procedure replaces the immobilised stapes bone with a prosthetic implant, allowing natural sound transmission to the inner ear.

• Addresses the Cause of Hearing Loss: Unlike hearing aids, which amplify sound, surgery restores the normal function of the ear.
• Long-Lasting Improvement: Many individuals experience significant, often permanent, hearing enhancement.
• No Need for External Devices: Surgery eliminates the need for daily hearing aid use, making it a preferred option for those who find devices inconvenient.

However, surgery comes with certain risks. Temporary dizziness, infection, or, in rare cases, worsened hearing may occur. Recovery requires a few weeks, during which physical activity and air travel must be limited. Choosing an experienced ENT surgeon increases the likelihood of a successful outcome.

Otosclerosis Treatment Cost Comparison: Hearing Aids vs Surgery

The cost of managing otosclerosis varies based on the chosen treatment, hospital, and specific hearing aid model.

Hearing Aids Cost in India

• Basic models: ₹50,000 – ₹1.5 lakh per ear
• Advanced digital models: ₹2 lakh – ₹6 lakh per ear
• Premium nearly invisible hearing aids: ₹5 lakh – ₹10 lakh per ear

These costs depend on technology, features like noise reduction, and whether the hearing aid is rechargeable or battery-operated. Regular maintenance and occasional replacements also add to the total expenditure over time.

Stapedectomy Surgery Cost in India

• Surgery at a reputed hospital: ₹3.5 lakh – ₹7 lakh
• Additional expenses: Consultation fees, pre-operative tests, and post-operative care

Surgery is a one-time investment, but costs may increase if complications arise or revision surgery is required. Choosing a highly experienced ENT surgeon improves outcomes, though top-tier hospitals charge higher fees.

Both otosclerosis treatment options have long-term financial considerations. Hearing aids need periodic upgrades, while surgery involves an initial investment with fewer future expenses. Your choice depends on hearing loss severity, lifestyle needs, and medical advice.

Note: Prices vary across hospitals, cities, and individual requirements. Consultation with an ENT specialist is essential for accurate cost estimation. 

Conclusion

Otosclerosis can significantly impact hearing and overall quality of life, but modern treatment options provide effective solutions. While hearing aids offer a non-invasive approach by amplifying sound, they require ongoing adjustments and replacements. Surgery, particularly stapedectomy, addresses the underlying issue by restoring sound transmission, though it carries surgical risks and requires recovery time. 

Choosing between these options depends on the severity of hearing loss, lifestyle preferences, and long-term expectations. It is wise to consult an experienced ENT specialist to determine the most suitable course of action.