What is the ear like and how do we hear?
The ear is divided into three parts - the outer (external) ear, the middle ear, and the inner ear. The middle ear behind the eardrum is filled with air. Air comes from the back of the nose up a thin channel called the Eustachian tube. In the middle ear there are three tiny bones (ossicles) - the hammer (malleus), anvil (incus) and stirrup (stapes). The inner ear includes the cochlea and semicircular canals.
- Sound waves come into the outer ear and hit the eardrum.
- The sound waves cause the eardrum to vibrate.
- The sound vibrations pass from the eardrum to the middle ear bones.
- The bones then transmit the vibrations to the cochlea in the inner ear.
- The cochlea converts the vibrations to sound signals which are sent along a nerve from the ear to the brain, allowing us to hear.
The semicircular canals in the inner ear contain a fluid that moves around as we move. The movement of the fluid is sensed by tiny hairs in the semicircular canals. These send messages to the brain along the ear (auditory) nerve to the brain to help maintain balance and posture.
How is otosclerosis diagnosed?
If you are worried about hearing loss, make an appointment to see your doctor. They will ask about the symptoms you have been getting and then they will generally look into your ears using an auriscope. This is the common instrument used to look inside your ears if you have earache. In otosclerosis, your eardrum usually looks normal and healthy when your doctor looks inside your ear.
Your doctor may refer you on to an ear, nose and throat specialist who will be able to make the diagnosis of otosclerosis. They will do hearing tests which will show a specific pattern of hearing loss in otosclerosis. The specialist may also use a small device that is placed in your ear, called a tympanometer. This can help them look at the movement of the bones within your ear. In otosclerosis, the stirrup (stapes) will move less. This test is very quick and does not cause any pain.
Sometimes the specialist may decide that you need to have a CT scan which will give them more information about how severe the otosclerosis is.
Further reading and references
Niedermeyer HP, Arnold W; Otosclerosis and measles virus - association or causation? ORL J Otorhinolaryngol Relat Spec. 200870(1):63-9
Vicente Ade O, Yamashita HK, Albernaz PL, et al; Computed tomography in the diagnosis of otosclerosis. Otolaryngol Head Neck Surg. 2006 Apr134(4):685-92.
Cruise AS, Singh A, Quiney RE; Sodium fluoride in otosclerosis treatment: review. J Laryngol Otol. 2010 Jun124(6):583-6. Epub 2010 Feb 18.
Otosclerosis; British Tinnitus Association
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