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Tympanosclerosis is a condition in which there is calcification of tissue in the eardrum and middle ear, including the tympanic membrane. If extensive, it may affect hearing.
Tympanosclerosis may be classified as:
- Myringosclerosis - involving only the tympanic membrane.
- Intratympanic tympanosclerosis - involving other middle ear sites: the ossicular chain or, rarely, the mastoid cavity.
- The precise cause is not understood. It may be an abnormal healing response.
- Tympanosclerosis commonly develops secondary to acute and chronic otitis media.
- Studies have shown that there are identical risk factors for atherosclerosis and tympanosclerosis. Patients with tympanosclerosis have high levels of homocysteine, low-density lipoprotein, total cholesterol and triglyceride.
- Children who have had a ventilation tube (grommet) inserted for otitis media with effusion have a higher risk of developing tympanosclerosis.This risk has been reported as 11-37%.
- There are no symptoms associated with tympanosclerosis.
- Characteristic chalky white patches are seen on inspection of the eardrum.
- There is conductive hearing loss in some cases.
- The opaque or patchy white appearance of the eardrum is fairly unique and usually easy to identify. The amount of eardrum involvement can vary considerably between cases.
- Intratympanic tympanosclerosis is more difficult to identify but may be suspected if there are typical chalky lesions on the eardrum, scarring of the eardrum, or a history of otitis media, with non-progressive conductive deafness and no family history of otosclerosis.
- Cholesteatoma may look similar but the whiteness appears behind, rather than in/on the tympanum.
- Other causes of conductive hearing loss - eg, otosclerosis.
- Investigations are not usually required if the lesions are typical, not extensive and there is no suspicion of hearing loss or other middle ear disease.
- Audiometry should be undertaken if hearing loss is suspected.
- Transtympanic endoscopy may be undertaken in some cases.
Treatment is only required if there is hearing loss.
- Hearing aids can be beneficial, as with any form of conductive hearing loss.
- Surgery for tympanosclerosis involves excision of the sclerotic areas and reconstruction of the ossicular chain.
- Stapes mobilisation is usually required.
- There are various surgical procedures and some involve two-stage surgery. Reported success rates are variable.
- Manubrio-stapedioplasty has been shown to be an effective method for ossicular reconstruction in cases of malleus and incus fixation due to tympanosclerosis.
- In those patients with isolated malleus fixation with tympanosclerosis, performing a canaloplasty to clean the sclerotic plaques without damaging the normal anatomy of the ossicle system using a diamond burr is a safe surgical option that provides significant recovery in hearing levels.
- Surgery for tympanosclerosis usually results in significant improvement of hearing.
- Damage to the inner ear is a possible and serious complication, which can cause sensorineural deafness.
Conductive hearing loss:
- With myringosclerosis alone, hearing loss is uncommon but may occur if the plaques are large or adhere to other structures (as the drum will be less compliant).
- Conductive hearing loss can occur with intratympanic disease; the severity depends on the severity of the middle ear involvement and on how the ossicular chain is affected.
Further reading and references
Dinc AE, Comert F, Damar M, et al; Role of Chlamydia pneumoniae and Helicobacteria pylori in the development of tympanosclerosis. Eur Arch Otorhinolaryngol. 2015 May 9.
Doluoglu S, Gocer C, Toprak U, et al; Increased carotid artery intima-media thickness in patients with tympanosclerosis: Common risk factors with atherosclerosis? Kaohsiung J Med Sci. 2015 Apr31(4):199-202. doi: 10.1016/j.kjms.2015.01.003. Epub 2015 Feb 9.
Wallace IF, Berkman ND, Lohr KN, et al; Surgical treatments for otitis media with effusion: a systematic review. Pediatrics. 2014 Feb133(2):296-311. doi: 10.1542/peds.2013-3228. Epub 2014 Jan 6.
Kuo CL, Tsao YH, Cheng HM, et al; Grommets for otitis media with effusion in children with cleft palate: a systematic review. Pediatrics. 2014 Nov134(5):983-94. doi: 10.1542/peds.2014-0323. Epub 2014 Oct 6.
Eardrum and Middle Ear Pictures; ENT USA
Kakehata S; Transtympanic endoscopy for diagnosis of middle ear pathology. Otolaryngol Clin North Am. 2013 Apr46(2):227-32. doi: 10.1016/j.otc.2012.10.006.
Vijayendra H, Parikh B; Bone conduction improvement after surgery for conductive hearing loss. Indian J Otolaryngol Head Neck Surg. 2011 Jul63(3):201-4. doi: 10.1007/s12070-011-0130-0. Epub 2011 Feb 23.
Sennaroglu L, Gungor V, Atay G, et al; Manubrio-stapedioplasty: new surgical technique for malleus and incus fixation due to tympanosclerosis. J Laryngol Otol. 2015 Jun129(6):587-90. doi: 10.1017/S0022215115000973. Epub 2015 Apr 17.
Sakalli E, Celikyurt C, Guler B, et al; Surgery of isolated malleus fixation due to tympanosclerosis. Eur Arch Otorhinolaryngol. 2014 Dec 14.