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Health condition · Clinically reviewed

Otosclerosis, the stapes bone, and when surgery restores hearing.

Progressive, often one-sided hearing loss from a fixed stapes bone is treatable - with hearing aids or highly effective surgery.

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Why trust this guide

  • 01

    Clinically reviewed

    Written by our editorial team and reviewed by a registered UK clinician before publication.

  • 02

    Sourced from guidance

    Checked against NICE, ENT UK and peer-reviewed sources you can see at the end.

  • 03

    Current for 2026

    Reflects modern UK practice, including audiometry, temporal bone CT and stapedotomy technique.

Key facts

Otosclerosis at a glance.

The essentials, in plain English - what it is, who it affects, and how it's managed in the UK today.

  • What it is

    Abnormal bone remodelling around the stapes footplate fixes the smallest bone in the ear, blocking normal sound transmission.

  • Hearing loss type

    Usually conductive at first, often unilateral - but the cochlea can also be affected, adding a sensorineural component.

  • Who it affects

    More common in women, with a genetic component in a significant proportion of cases - often runs in families.

  • Pregnancy link

    Symptoms can worsen during pregnancy, thought to relate to hormonal changes affecting bone turnover in the otic capsule.

  • Classic clue

    Paracusis Willisii - hearing better in noisy surroundings - is a well-known feature, though not present in everyone.

  • Main options

    Hearing aids or stapedectomy/stapedotomy surgery - the latter highly effective for suitable candidates.

Why this guide matters

A quietly progressive cause of hearing loss.

Otosclerosis is often mistaken for ordinary age-related hearing loss, yet it has its own diagnostic pattern and a genuinely effective surgical option. The three points below shape everything else on this page.

  • It has a recognisable pattern

    Progressive conductive loss, often one-sided at first, with a characteristic dip on bone conduction testing (Carhart’s notch).

  • It runs in families

    A significant proportion of cases have a genetic component - a family history is a useful clue when symptoms first appear.

  • Surgery can be transformative

    Stapedectomy and stapedotomy are highly effective in suitable candidates - worth an early conversation with an ENT specialist.

How the diagnosis is made

From first hearing change to a clear plan.

The steps a UK GP, audiologist or ENT specialist will normally follow, in order - so you know what to expect and why.

  1. 01

    Assessing

    History and family history

    Progressive hearing loss, tinnitus, any family members affected, and whether symptoms changed during a pregnancy.

  2. 02

    Assessing

    Otoscopy

    The eardrum usually looks entirely normal - otosclerosis is a disease of the bone behind it, not the drum itself.

  3. 03

    Assessing

    Pure-tone audiometry

    Shows a conductive hearing loss pattern, often with a characteristic dip on bone conduction - Carhart’s notch.

  4. 04

    Confirming

    Tympanometry

    Reduced compliance (a stiffer middle ear) supports fixation of the stapes rather than a problem with the eardrum.

  5. 05

    Confirming

    CT of the temporal bones

    A fine-cut scan confirms otosclerotic foci around the oval window and shows how far the disease extends, including any cochlear involvement.

  6. 06

    Deciding

    Specialist ENT referral

    An ENT or audiovestibular specialist confirms the diagnosis and discusses hearing aids against surgical candidacy.

  7. 07

    Deciding

    Shared decision on management

    A joint decision between patient and surgeon, weighing hearing aid trial against stapedectomy or stapedotomy.

Typical timeline: a first hearing test to a confirmed diagnosis in a matter of weeks.

Symptoms

What otosclerosis actually feels like.

A slow, often one-sided decline in hearing, sometimes with tinnitus and a curious ability to hear better in noise. And the features that mean it's time to escalate.

  • Progressive hearing loss

    Gradual, often unilateral at first - conductive in nature and slowly worsening over months to years.

  • Bilateral progression

    Many people eventually develop symptoms in the second ear, sometimes years after the first.

  • Tinnitus

    A ringing, buzzing or hissing noise, often alongside the hearing loss rather than as a standalone symptom.

  • Mild balance disturbance

    Occasional unsteadiness can occur, though true vertigo is uncommon and should prompt a wider work-up.

  • Paracusis Willisii

    Hearing conversation more easily in noisy environments - a classic, though not universal, feature of conductive loss.

  • Worsening in pregnancy

    Some women notice a clear step down in hearing during pregnancy, likely linked to hormonal effects on bone turnover.

  • Cochlear (sensorineural) component

    In some cases otosclerotic foci reach the cochlea, adding a sensorineural element to the hearing loss.

  • Red flag - sudden or asymmetric change

    A sudden drop in hearing or a marked asymmetry is not typical otosclerosis and needs urgent assessment.

Treatment

How otosclerosis is managed in the UK.

Hearing aids first for many, with stapedotomy or stapedectomy as a highly effective surgical option for suitable candidates.

  • Hearing aids

    A well-established non-surgical option - amplification can restore useful hearing without an operation, and suits those who prefer to avoid surgery.

  • Stapedotomy

    A small laser or drill fenestra is made in the fixed footplate and a piston prosthesis fitted - the favoured modern technique in most UK centres.

  • Stapedectomy

    The fixed footplate is removed and replaced with a prosthesis - the traditional approach, still used for particular footplate anatomy.

  • Specialist surgical assessment

    ENT evaluation of audiometry, imaging and ear anatomy to judge whether a patient is a suitable candidate for surgery.

  • Pregnancy monitoring

    Given the risk of progression during pregnancy, hearing is monitored and definitive surgery is usually deferred until afterwards.

  • Sodium fluoride

    Historically used to try to stabilise otosclerotic bone activity, but now rarely recommended given limited supporting evidence.

  • Regular audiological follow-up

    Serial audiograms track progression, response to hearing aids, and the case for revisiting surgery over time.

  • Second-ear planning

    When both ears are affected, the worse-hearing ear is usually treated first, with the second side considered later.

What this guide is based on

The sources behind every claim on this page.

UK national guidance and specialist society standards, current at the time of last review.

Key references

Guidelines and standards we relied on.

A quiet reminder

This guide is for information, not medical advice.

Your GP or ENT specialist knows your history and hearing and can tell you which parts apply to you. If in doubt, get seen.

  • NICE. Clinical Knowledge Summaries - hearing loss in adults.

  • ENT UK. Guidance and patient information on otosclerosis and stapes surgery.

  • British Academy of Audiology. Standards for audiometric assessment.

  • Royal College of Radiologists. Imaging guidance for temporal bone CT.

Red flags

When hearing symptoms need urgent attention.

Most otosclerosis is manageable through primary care and routine audiology referral. These are the situations that aren't - and where a specialist opinion is needed sooner.

  • Sudden sensorineural hearing loss

    A sudden drop in hearing, especially with no clear conductive pattern, is a different emergency and needs same-day ENT assessment.

  • Marked asymmetry

    Hearing loss that is much worse on one side, or progressing unevenly, warrants imaging to exclude other causes such as a vestibular schwannoma.

  • True vertigo

    Spinning vertigo is not typical of straightforward otosclerosis and should prompt a broader vestibular work-up.

  • Facial weakness

    Any new facial nerve weakness alongside ear symptoms needs urgent specialist review, not routine follow-up.

  • Post-surgical sudden deterioration

    A sudden dead ear or severe vertigo after stapes surgery is a recognised complication needing same-day contact with the surgical team.

  • Pregnancy with rapid progression

    A fast decline in hearing during pregnancy should be reviewed rather than assumed to be routine otosclerotic worsening.

  • Otorrhoea or discharge

    Ear discharge is not a feature of otosclerosis and points to a separate or coexisting problem, such as infection.

  • Childhood or early-onset cases

    Otosclerosis presenting very young is less typical and deserves wider genetic and audiological assessment.

  • Cochlear otosclerosis with rapid loss

    Fast-progressing sensorineural loss on top of known otosclerosis should be discussed with a specialist promptly, as options and urgency differ.

Living with it

A manageable condition, with a clear path forward.

Four things that make the biggest difference day to day - adapting your environment, tracking changes, deciding calmly between aids and surgery, and being aware of family history.

A quiet reminder

There is no rush - but there is a clear route.

Whether you choose a hearing aid or surgery, both are established, effective options - it is about finding the right fit for you.

  1. 01 Hear

    Get the environment working for you

    Face-to-face conversation, reduced background noise and captioned media all reduce daily strain while decisions are made.

  2. 02 Track

    Keep a symptom diary

    Note when hearing feels different, especially around pregnancy or after any head injury - it helps the specialist judge progression.

  3. 03 Decide

    Weigh aids against surgery calmly

    Both hearing aids and stapes surgery are effective. There is rarely a need to rush - discuss trade-offs with your ENT surgeon.

  4. 04 Family

    Mention family history

    Otosclerosis often runs in families - flagging this to relatives can help them recognise early symptoms themselves.

Frequently asked

Everything we get asked about otosclerosis.

Quick answers on causes, pregnancy, hearing aids and stapes surgery.

  • What is otosclerosis?

    A condition in which abnormal bone growth develops around the stapes, the smallest bone in the middle ear, fixing it in place and preventing normal transmission of sound. It typically causes progressive conductive hearing loss and can, in some people, also affect the cochlea.

  • Is otosclerosis hereditary?

    A significant proportion of cases have a family history, and genetic factors are thought to play a role alongside other influences. If a close relative has otosclerosis, it is worth mentioning this when hearing symptoms appear.

  • Why does otosclerosis get worse during pregnancy?

    Hormonal changes in pregnancy are thought to influence bone turnover in the otic capsule, and some women notice their hearing decline more quickly during this time. Hearing is usually monitored, with definitive surgery often deferred until after delivery.

  • What is paracusis Willisii?

    It is the phenomenon of hearing better in noisy environments rather than quiet ones - a classic feature of conductive hearing loss from otosclerosis, though it is not present in every case.

  • Is surgery or a hearing aid better for otosclerosis?

    Both are legitimate options. Hearing aids avoid surgery and its risks; stapedectomy or stapedotomy can restore hearing very effectively in suitable candidates. The right choice depends on the extent of disease, patient preference and specialist assessment.

  • What does the CT scan show in otosclerosis?

    A fine-cut CT of the temporal bones can identify otosclerotic foci around the oval window and stapes footplate, and shows whether the disease extends towards the cochlea - useful for confirming the diagnosis and planning surgery.

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