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Otosclerosis - Diagnosis
Last reviewed: 04.07.2025
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In the overwhelming majority of cases, the first manifestations of the disease cannot be linked to a specific cause. In a third of women, a connection is found in the anamnesis between the first signs of hearing loss and pregnancy or childbirth, the period of breastfeeding. Hearing loss is progressive, at first the hearing loss is unilateral, then the other ear is involved in the process. The patient's indications of unilateral damage to the organ of hearing require clarification, since against the background of the previously diseased and worse hearing ear, hearing on the other side seems normal to them.
Physical examination
Otoscopic signs of otosclerosis are extremely scarce. Characteristic symptoms are found in only 10-21% of patients. These include Lempert's symptom (thinning of the eardrum with a change in its color due to atrophy of the fibrous layer) and Schwartze's symptom (translucence of the pink-colored hyperemic mucous membrane in the promontory area through the thinned eardrum: a sign of the active stage of otosclerosis). Characteristic are the absence or decrease in the amount of sulfur (Tounbee's symptom), atrophy and dryness of the skin of the external auditory canal. With otosclerosis, a decrease in the sensitivity of the skin of the external auditory canal and eardrum, a decrease in the secretion of the sweat glands, a wide external auditory canal (Virchowsky-Tillot's symptom) are also observed. None of the otoscopic signs of otosclerosis can be called pathognomonic; they can be taken into account and assessed only in combination with other manifestations of the disease.
Laboratory research
Not applicable.
Instrumental research
Audiological examination of patients with otosclerosis serves as a foundation for diagnostics and clarification of the form of the disease. Perception of low-frequency tuning forks during air conduction is worse in them. Various tuning fork tests based on comparison of hearing during bone and air conduction are widely used. Rinne's test is a method of differential diagnostics of lesions of the sound-perceiving and sound-conducting apparatus, based on comparison of the duration of sound perception during examination of bone and air conduction using a tuning fork C128 (less often C512), transferred from the mastoid process to the external auditory canal. Predominance of the first over the second is usually designated as a positive Rinne test. For patients with mixed or conductive otosclerosis with a bone-air interval of more than 20 dB, a negative Rinne test is characteristic. Bing's tests, Jelly's test and Politzer-Federici symptom are also negative.
Tonal threshold audiometry is the most widely used method for diagnosing otosclerosis. It evaluates not only the level of hearing in air and bone, but also the size of the air-bone interval (cochlear reserve). Otosclerosis is characterized by an increase in thresholds for air conduction, often in the form of an ascending curve with a slight rise. As the disease progresses, the conduction of high-frequency sounds worsens, which leads to a "flattening" of the audiometric curve. The results of impedance audiometry and X-ray examination are also important for diagnosis.
Differential diagnostics
Differential diagnostics are necessary to determine the indication for surgery depending on the form of the disease (the effect of surgical intervention can be expected in the tympanic and mixed forms, with a sufficient bone-air interval and a threshold of sound perception through the bone of no more than 30 dB according to audiological examination data).
Among the diseases accompanied by impaired sound conduction, adhesive otitis media is distinguished, developing as a consequence of previous inflammation of the middle ear. Otoscopy allows detecting cicatricial changes in the eardrum, which are also possible in patients with otosclerosis. The progression of hearing loss in patients with adhesive otitis media due to the development of cicatricial changes in the tympanic cavity also complicates differential diagnostics.
The patient associates traumatic damage to the ossicular chain with a previous head injury, but hearing thresholds in this situation are stable. The latter symptom is also characteristic of various congenital anomalies of the middle ear and can be detected in early childhood. In addition, the symptoms of otosclerosis are similar to those of neoplasms of the middle ear (facial nerve neuroma, congenital cholesteatoma). CT provides significant assistance in differential diagnostics.
Indications for consultation with other specialists
Consultation with an otoneurologist (neurologist) is indicated in the event of attacks of dizziness and unilateral progressive perceptual hearing loss.
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