Gradual Hearing Loss: Could Otosclerosis Be the Cause?

Picture this: you start turning up the volume of your phone or TV more than you’re used to. You often ask people to repeat themselves because you weren’t able to hear them the first time. Or you’re starting to notice a pattern of getting lost in conversations, especially if you are in a crowded room.
Hearing loss doesn’t always happen suddenly. For some people, hearing changes can happen slowly, and so gradually that many miss the early signs of it. Eventually, you notice the changes in your hearing when it’s already affecting your work, communication skills, relationships, and day-to-day routine.
There are many possible explanations for gradual hearing loss, and otosclerosis may be one of them, but definitely not the only contributing factor.
Here at Austin Ear, Sinus & Allergy, we help patients in Austin, TX, understand what might be contributing to the gradual changes in their sense of hearing, how otosclerosis may be one of many possible causes, and when further evaluation may be warranted.
What Is Otosclerosis?
Otosclerosis is a condition that causes hearing loss and occurs when there is irregular bone remodeling or growth within the ear. It commonly affects the area around the stapes, one of the three tiny bones located in the middle ear.
These three tiny bones include the malleus, incus, and stapes, all of which work together to transmit sound vibration from the eardrum toward the inner ear.
When otosclerosis occurs, irregular bone growth or changes in the stapes gradually restrict its movement. When these tiny bones cannot move as normally as they should, sound vibrations may not be transferred as efficiently into the inner ear.
This can result in gradual hearing loss, which may vary in severity and affect one or both ears.
What Are the Symptoms of Otosclerosis?
The most common symptom of otosclerosis is gradual hearing loss. Individuals with this condition may notice that they have trouble or can no longer hear low-pitched sounds. Other possible symptoms may also include:
- Tinnitus, or perceived sound in the ear without an external source
- Vertigo or dizziness
- Balance issues
- Tendency to speak quietly because your own voice sounds loud to you
The symptoms above do not necessarily mean that you have otosclerosis. Many ear and hearing conditions may cause similar symptoms. A consultation with your healthcare provider can help assess your symptoms and determine the type and possible cause of hearing loss.
Who Is at Risk of Developing Otosclerosis?
Otosclerosis is a recognized cause of middle ear mechanical hearing loss, particularly in younger and middle-aged adults.
Otosclerosis can affect anyone, but symptoms commonly begin during early to middle adulthood. Otosclerosis is more commonly diagnosed in adults and has historically been reported more frequently in women and people of European ancestry. However, it can affect individuals of different ages and backgrounds.
Family history may also play a role, as it can occur in families.
How Is Otosclerosis Evaluated?
If you are experiencing gradual or progressive hearing loss, an evaluation with an ENT specialist can help determine whether the issue involves the outer, middle, or inner ear.
Evaluation for otosclerosis may include:
- A thorough discussion and assessment of your symptoms and medical history
- Questions about when hearing has started to change, and whether one or both ears are affected
- Evaluating whether other symptoms such as dizziness, tinnitus, and ear pain are also present
- Physical examination of the ears to look for other potential causes, such as earwax buildup, fluid buildup, or any other visible problem
- Hearing tests, or audiogram, to help determine the degree and type of hearing loss
- Tympanometry, which can assess the eardrum and middle-ear system functions
- Imaging, when additional anatomical information is needed
Diagnostic tests and methods may vary per patient, depending on individual patient needs. Your care provider can help guide diagnosis and treatment planning based on symptom severity, clinical findings, medical history, and other individual health factors.
How Is Otosclerosis Treated?
Treatment for otosclerosis varies, depending on the severity of hearing loss, whether one or both ears are affected, how the degree of hearing loss affects everyday life, and the patient’s individual health needs and preferences.
Potential treatment and management approaches may include:
- Periodic hearing evaluations and monitoring for changes, for mild hearing loss that does not significantly interfere with daily communication and activities.
- Hearing aids, which can amplify sound and may help some individuals hear and communicate more effectively. It does not, however, remove the bone changes associated with otosclerosis.
- Surgery, such as stapedotomy or stapedectomy, for clinically appropriate patients, may improve sound transmission by addressing the impaired movement of the stapes.
Your ENT care provider will discuss your treatment options, including potential benefits, risks, limitations, and alternatives to help you make informed decisions.
Gradual Hearing Loss: When It’s Not Otosclerosis
Otosclerosis is not the only possible explanation for gradual hearing loss. There are several other potential causes, including:
- Earwax buildup
- Noise-induced hearing loss
- Hearing changes related to age
- Middle-ear problems, such as fluid behind the eardrum, middle-ear disease, and abnormalities in the middle-ear bones
- Certain medications that affect hearing
- Other auditory conditions
When Should You Seek Medical Attention for Gradual Hearing Loss?
Consider consulting with an ENT specialist if you are noticing the following:
- You find yourself increasing the volume of your phone and TV
- You are frequently asking others to repeat themselves
- You are having trouble following and understanding conversations
- You are hearing differently between your ears
- You are experiencing persistent tinnitus, or the perception of sound without an external source
- Your hearing problems are significantly interfering with your everyday activities, work, communication, and relationships
If you experience sudden hearing loss or a noticeable decrease in hearing over several hours or days, seek immediate medical attention, ideally within 24 hours. Sudden hearing changes may require urgent evaluation and time-sensitive treatment.
Conclusion: Could Otosclerosis Be the Cause of Gradual Hearing Loss?
Gradual hearing loss can be frustrating, confusing, and at times, scary. While otosclerosis may be one of many possible causes, it’s not the only explanation.
If you are experiencing progressive or gradual hearing loss, schedule a consultation with us here at Austin Ear, Sinus & Allergy to determine if otosclerosis or some other underlying condition may be contributing.
We offer ear, nose, and throat care services for patients in Austin and the nearby Texas communities.


