From the Guidelines
Tympanosclerosis evaluation begins with otoscopic examination to identify white chalky plaques on the tympanic membrane, followed by audiometry to assess hearing loss, as recommended by recent clinical guidelines 1.
Evaluation and Treatment Options
Treatment depends on symptom severity and functional impact. For asymptomatic tympanosclerosis without hearing loss, observation is appropriate with periodic audiometric monitoring.
- When hearing loss is present, surgical intervention may be necessary, with tympanoplasty being the primary surgical approach, involving removal of sclerotic plaques and reconstruction of the tympanic membrane and/or ossicular chain.
- Stapedectomy or stapedotomy may be required if the stapes is fixed by sclerosis.
- Hearing aids are an alternative for patients who are poor surgical candidates or prefer non-surgical management.
Post-Surgical Care
Post-surgical care includes antibiotic ear drops (such as ciprofloxacin 0.3% or ofloxacin 0.3%, 3-4 drops twice daily for 7-10 days), keeping the ear dry for 2-4 weeks, and follow-up audiometry at 6-8 weeks, as supported by clinical practice guidelines 1.
Outcomes and Prevention
Surgical success rates vary from 60-90% depending on the extent of sclerosis, with better outcomes in cases without ossicular involvement, as reported in recent studies 1. Tympanosclerosis results from calcium deposition in the middle ear following inflammation, often as a sequela of recurrent otitis media or previous ear surgeries, making prevention through prompt treatment of ear infections important, as emphasized by clinical guidelines 1.
From the Research
Evaluation of Tympanosclerosis
- Tympanosclerosis is a condition characterized by the deposition of calcareous plaques in the tympanic membrane and middle ear mucosa, often resulting from prior middle ear infections 2.
- Evaluation of tympanosclerosis involves assessing preoperative features, middle ear findings, and postoperative hearing levels 2.
- Conductive-type hearing loss is commonly present in patients with tympanosclerosis, with an average air-bone gap of 37.8 dB 2.
Treatment Options for Tympanosclerosis
- Surgical treatment is the most common method for treating tympanosclerosis, with the goal of removing sclerotic plaques and reconstructing the auditory ossicular chain 2, 3, 4.
- Stapedectomy is often recommended in surgery, rather than mobilization techniques, especially in cases where the stapes footplate is fixated 2, 5.
- Tympanoplasty is also a common treatment approach, with a success rate of 67% reported in one study 2.
- In some cases, rehabilitation with hearing devices may be preferred as an adjunct to surgery, especially when surgical treatment is not possible or has failed 2, 4.
- Recent studies have also explored the use of topical or systemic agents as a potential treatment for tympanosclerosis, with promising results 2, 6.
Considerations for Treatment
- The location and extent of tympanosclerotic involvement dictate the management approach, with ossicular problems requiring removal of the tympanosclerosis and reconstruction of the chain 5.
- Tympanosclerosis of the oval window combined with other chronic inflammation often requires two-stage surgery 4.
- Tympanosclerotic findings without clinical symptoms should not be removed, and the fitting of conventional or implantable hearing aids may be the only treatment option in some cases 4.