Tympanosclerosis

What is tympanosclerosis?

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.

Tympanosclerosis causes (aetiology)

• The precise cause of tympanosclerosis is not understood. It may be an abnormal healing response.

• Tympanosclerosis commonly develops secondary to acute and chronic otitis media¹ .

• 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 triglyceride² .

• Children who have had a ventilation tube (grommet) inserted for otitis media with effusion have a higher risk of developing tympanosclerosis³ . This risk has been reported as 11-37%⁴ .

Tympanosclerosis symptoms

• 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.

Tympanosclerosis diagnosis

• 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.

Differential diagnosis

• Cholesteatoma may look similar but the whiteness appears behind, rather than in/on the tympanum⁵ .

• Other causes of conductive hearing loss - eg, otosclerosis.

Investigating tympanosclerosis

• 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 cases⁶ .

Tympanosclerosis treatment and management

Treatment is only required if there is hearing loss.

• Hearing aids can be beneficial, as with any form of conductive hearing loss.

• Surgery:
  

  • Surgery for tympanosclerosis involves excision of the sclerotic areas and reconstruction of the ossicular chain.

  • Stapes mobilisation is usually required⁷ .

  • 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 tympanosclerosis⁸ .

  • 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 levels⁹ .

  • 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.

Complications with tympanosclerosis

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.