Can Tympanosclerosis Cause Dizziness?
Tympanosclerosis itself does not typically cause dizziness, but surgical complications during its treatment can result in vertigo and balance problems. 1
Understanding Tympanosclerosis and Its Symptoms
Tympanosclerosis is a condition characterized by calcium deposits and hyaline degeneration in the tympanic membrane and middle ear structures following chronic inflammation. 2, 3 The primary clinical manifestation is conductive hearing loss, not dizziness. 4, 5
Typical Clinical Presentation
- Hearing loss is the hallmark symptom, with the majority of patients experiencing conductive-type hearing loss (81-92% of cases). 2, 5
- The degree of hearing loss correlates directly with the extent and location of sclerotic deposits. 4, 5
- Most patients present with dry ears (77-86% of cases). 4, 5
- Dizziness is not listed among the characteristic symptoms of tympanosclerosis in the clinical literature. 2, 3, 4, 5
When Dizziness Can Occur: Surgical Complications
The most important caveat is that vertigo can occur as a complication of tympanosclerosis surgery, not from the disease itself. 1
High-Risk Surgical Scenarios
- Excision of sclerotic lesions near the vestibular window (oval window area) carries significant risk of vertigo. 1
- Surgical manipulation near the facial nerve canal can result in complications including vertigo, facial paralysis, and sensorineural hearing loss. 1
- Stapedectomy procedures (required when stapes footplate is fixated) have inherent risks of vestibular disturbance. 2, 3
- Mobilization techniques at the stapes level often result in recurrence and poor outcomes. 2, 3
Differential Diagnosis: When to Consider Other Causes
If a patient with known tympanosclerosis presents with dizziness, you must evaluate for alternative etiologies rather than attributing it to the tympanosclerosis itself:
Consider Concurrent Vestibular Pathology
- Sudden sensorineural hearing loss (SSNHL) is associated with dizziness in 30-60% of cases. 6
- The presence of dizziness with sudden hearing loss indicates a poorer prognosis for hearing recovery. 6
- SSNHL can present with vertigo, tinnitus, and ear fullness alongside hearing loss. 6
Red Flags Requiring Urgent Evaluation
- New-onset dizziness with hearing changes warrants audiometric testing and consideration of SSNHL. 6
- Visual symptoms accompanying vertigo (blurring, oscillopsia, difficulty with visual focus) may indicate central causes requiring neuroimaging. 7, 8
- Positional vertigo lasting seconds suggests benign paroxysmal positional vertigo (BPPV), which requires Dix-Hallpike testing. 9
Clinical Approach to the Patient
When evaluating a patient with tympanosclerosis who reports dizziness:
- Establish temporal relationship: Determine if dizziness is new or post-surgical. 1
- Characterize the dizziness: Duration, triggers, associated symptoms (hearing changes, visual symptoms, nausea). 6, 7
- Assess for post-operative complications if surgery was recent, particularly if procedures involved the oval window or stapes. 1
- Evaluate for concurrent vestibular disorders such as SSNHL, BPPV, or vestibular neuritis. 6, 9
- Consider central causes if there are neurological signs or atypical features. 8