Tympanosclerosis Myringosclerosis

Last updated by Peer reviewed by Dr Hayley Willacy, FRCGP
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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 of tympanosclerosis is not understood. It may be an abnormal healing response.
  • Tympanosclerosis commonly develops secondary to acute and chronic otitis media[1].
  • 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[2].
  • Children who have had a ventilation tube (grommet) inserted for otitis media with effusion have a higher risk of developing tympanosclerosis[3]. This risk has been reported as 11-37%[4].
  • 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[5].
  • 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[6].

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 required[7].
    • 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[8].
    • 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[9].
    • 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.

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Further reading and references

  1. 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.

  2. 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.

  3. 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.

  4. 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.

  5. Eardrum and Middle Ear Pictures; ENT USA

  6. 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.

  7. 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.

  8. 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.

  9. Sakalli E, Celikyurt C, Guler B, et al; Surgery of isolated malleus fixation due to tympanosclerosis. Eur Arch Otorhinolaryngol. 2014 Dec 14.

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