Overview

It can be quite intimidating not to know the best course of action when there are a lot of opinions surrounding a condition. We will try our best to break down Otosclerosis and its relation to pregnancy for you.

What is Otosclerosis?

Otosclerosis is a condition of the ear, mainly targeting the components of the “middle ear” made up of three tiny bones called the malleus (also known as the “hammer”), the incus (commonly known as the “anvil”), and the stapes (in other words “stirrup”).

If we dissect “Otosclerosis” – “Oto” in Latin, translates to “ear” and “sclerosis” means “abnormal bony growth or hardening”.^1,2 The usual components of the bones in the ear are replaced with a different tissue, which hardens and ultimately results in an irregular bony pattern to the typical structure.

Otosclerosis most commonly affects the stapes bone by joining with the surrounding bones and impairing hearing function.

There are two kinds of hearing loss, one is conductive hearing loss- which pertains to hearing loss because of a structural difference, and the other is sensorineural hearing loss, which is due to a difference in the nervous system. Otosclerosis is a condition of conductive hearing loss.

This condition leads to gradual hearing loss in one or both ears and can take up to years to manifest fully. It is a common cause of hearing loss in young people and is usually diagnosed between the ages of 30 to 50, largely affecting more women than men. It is very rare for it to turn into total hearing loss.

Many theories have been put across debating the exact cause of Otosclerosis, yet it still seems unclear. The most popular understanding is that it is caused by a faulty gene, passed by a parent to the child.

Pregnancy and Otosclerosis

There is a concern about the condition progressing during pregnancy. This could be due to the link between the hormone “oestrogens”, produced in increased amounts during pregnancy. This also could be the reason more women are affected than men because this hormone helps regulate the menstrual cycle.³

If you’re pregnant and dealing with Otosclerosis, you’re likely wondering what this means for you and your baby. Do you need to take special precautions? Should anything be done differently? We’re here to support you as we explore these important questions together.

When the body changes to welcome the growth of a baby, it makes certain adjustments to nourish the baby. In doing so there is an increase in hormone production and this may alter some pre-existing conditions of the mother. Oestrogen is a pro-inflammatory hormone, meaning that this hormone increases the rate of bone remodelling and worsens the condition. Oestrogen lingers in the body throughout the pregnancy and during breastfeeding as well, hence, for those who feel like hearing is slightly more impaired, it could continue post-partum as well.

This doesn’t mean that it will affect everyone, the occurrence or progression of the condition is quite unpredictable.

What exactly should you do about it?

To be brutally honest, nothing.

Treat this pregnancy like you would any other, go for regular check-ups with the obstetrician, take your prenatal vitamins, eat food that nourishes your body, do low-intensity workouts, and take it easy.

People who have this condition are usually recommended to use hearing aids, and this usually has a very good outcome unless the condition gets worse. For those who have had reconstructive surgery called a “stapedectomy” (partial or full removal of the stapes bone in the middle ear), studies have wielded excellent results because even though the bone growth may increase, hearing is unaffected because of the prosthesis used in surgery.⁴

What to expect?

The worsening of the condition is only speculation and isn’t something you should expect to happen. However, if you come across symptoms, then we highly recommend visiting your GP. The signs that you may be having Otosclerosis are-

• Progressing hearing loss, it may be in one ear or both
• Dizziness
• Problems with your balance, when shifting positions, walking
• Ringing in your ears

If this is your first time experiencing these challenges then it would be diagnosed and treated the way Otosclerosis usually is. You will be referred to an ENT (Ear, Nose and Throat) Specialist and an audiologist. Together they will carry out a few tests that will determine the condition and its progression (this usually tells us how to go about treating it depending on the severity).

These tests include:

• Otoscopy- your doctor will use a special device with a light to take a look into your ear to help get a better understanding and to exclude any other possible conditions.
• Audiogram – it is a graph that helps doctors determine the cause of hearing loss, whether it is anatomical or neural.
• Tympanogram- it is a graph that directly pays attention to conditions of the middle ear and uses differences in air pressures to tell doctors the cause.
• Acoustic Reflex- this is a test to see the middle ears' response to loud sounds.
• CT of the temporal bone- radiographic imaging to get a better understanding of the middle ear’s structure.

If you are someone with known Otosclerosis and you are using hearing aids, there will be a consideration of performing surgery after weighing out the pros and cons. However, if you are someone who has already had the surgery (stapedectomy), the hearing loss will not be affected because of the technique used in surgery.

During a stapedectomy, the surgeon removes a tiny piece of, or in some cases, the whole “stapes” bone, and replaces it with a prosthetic piece that directly allows for sound waves to pass through and conduct hearing. Therefore, even if there is a theoretical progression due to the pregnancy, it will not affect your hearing.

During pregnancy, if there’s a positive past of Otosclerosis and you feel like it is getting worse, we recommend speaking to your doctor and having regular assessments to monitor the progression.⁵

Due to literature pointing towards the progression relating to hormone fluctuation, it is believed that after birth and breastfeeding, it will return to how it was. We recommend seeking counselling and speaking to your doctor about all the implications. This condition will not affect your baby’s health or complicate the delivery in any way.

Summary

Otosclerosis is a condition of the ear, in which there’s gradual hearing loss. It affects more women than men and  A few women have reported that it has gotten worse while pregnant, however, rest assured, it doesn’t change the outcome of the pregnancy in any way. We advise you to contact your local doctor for support if you feel like it is getting worse, there are excellent treatment options available if that is decided to be the best course of action.

FAQ’s

What is Otosclerosis?

It is a condition of the middle ear, where the bones change their natural structure to obstruct the normal conduction of sound waves leading to gradual loss of hearing.

Does pregnancy make Otosclerosis worse?

There is a theory that some women may feel like the condition is progressing due to the increase in the hormone oestrogen, which enables bony changes.

Should I see a doctor?

We recommend visiting a doctor if you develop any changes to your hearing, feel any dizziness, feel ringing in your ears, or face any problems with your balance.

Are there any risks associated with surgery?

All surgeries carry a potential risk, however, the complications associated with stapedectomies are minimal and before proceeding your doctor will walk you through the entire process and make sure you can make an informed decision.