Tympanosclerosis is a condition of the ear that is common in people with a history of ear infections.¹ However, it can also occur as a complication following ear surgeries, which can impair sound conduction and negatively impact surgical outcomes. In this article, we provide an overview of tympanosclerosis: its causes, the reasons why you are more likely to develop the disease after having ear surgery, prevention and management strategies.

Overview of tympanosclerosis

What is tympanosclerosis?

The name Tympanosclerosis (tim-puh-nohss-kluh-ROH-siss) refers to the formation of scar tissue (fusion of collagen fibres) in the middle ear.¹ The middle ear hosts the eardrum (tympanic membrane) and three small bones known as ossicles (the incus, the malleus and the stapes). In around 50% of tympanosclerosis cases, only the eardrum is affected (and is then called Myringosclerosis).^1,2,3 However, it is also possible to find it in the other elements of the middle ear.^1,2,3  

The middle ear plays a crucial role in the hearing process as part of the auditory (hearing) system. It is where sound vibrations are transported through the eardrum and the ossicle chain to the cochlea, where they are then turned into electric impulses for the auditory nervous system to process.⁴ If the elasticity of these elements is reduced because of stiff masses (tympanosclerosis), sound vibrations cannot travel to the cochlea, resulting in hearing loss.^3,5 Although tympanosclerosis is irreversible, it can be managed and prevented.¹  

Incidence of tympanosclerosis

The overall incidence of tympanosclerosis is difficult to determine. However, it is clear that having a history of chronic ear infections (otitis media) increases risks.^5,6 Various studies conducted on different clinical populations reported that between 7% and 33% of people with long-term or repeated ear infections developed tympanosclerosis.⁷ Children more frequently only experience tympanosclerosis on the eardrum, the middle ear cavity is most often affected in adults, particularly those over 30 years old.^1,8

Causes of tympanosclerosis

Tympanosclerosis forms during healing from an inflammation of the middle ear due to infection or injury.² During the last stage of recovery from inflammation, the ear tissue is supposed to return to its original state. However, sometimes, the inflammation is forced to heal abnormally and creates scar tissue as a result.¹ Tympanosclerosis can affect the tympanic membrane or any part of the middle ear (ossicles, middle ear cavity). It does not always happen, but the more the middle ear experiences inflammation, the more likely it is for the condition to form.^9,10 Therefore, aside from genetic susceptibility, the primary factors contributing to tympanosclerosis are conditions that trigger inflammation.

• Long-term and/or repeated (chronic) ear infections—he ear is inflamed repeatedly during infection episodes
• Ear surgeries—the trauma inflicted on the ear causes an immune response in the form of inflammation
• Genetic predisposition—the type of inflammatory mediators produced in response to middle-ear inflammation is determined by someone’s genes

Tympanosclerosis after ear surgery

How can ear surgery cause tympanosclerosis?

Getting surgery, regardless of the area of the body, causes injury to the tissue operated on and potentially exposes it to microbes. One of the immune system’s responses to this process is inflammation.¹¹ Depending on the success of the immune and inflammatory systems, postoperative issues may occur.¹¹ Considering the small size of the middle ear, this means that any ear surgery, even the most common, causes post-surgery inflammation that may lead to abnormal healing, in other terms, tympanosclerosis.¹²

The following ear surgeries are common treatments for chronic ear conditions and can lead to the development of tympanosclerosis:¹²

• Tympanoplasty—It is done to repair any damaged part of the sound transmission mechanism (e.g., eardrum, ossicles). It involves using a skin graft to replace the damaged eardrum and a prosthesis for damaged ossicles¹³
• Mastoidectomy—IIn cases of mastoiditis, a surgical procedure may be performed to eliminate infected air cells from the mastoid bone located behind the ear¹⁴
• Stapedectomy—It is done as treatment for otosclerosis. It involves the removal of the stapes (ossicle closest to the inner ear) and associated footplate¹⁵ 

Symptoms of tympanosclerosis

Hearing loss

Many people have tympanosclerosis but are completely unaffected and often unaware that they have the condition. However, depending on the extent of the condition and/or the areas affected, others experience hearing loss.¹ If only the eardrum is affected (as in 50% of cases), it is rare for hearing loss to occur.^7,16 On the other hand, when the condition is on other elements of the middle ear and makes them stiffer as a result, it often reduces how well sound vibrations can travel to the inner ear.¹⁷ This is known as conductive hearing loss and can be partial or complete depending on the case. 

Physical manifestation

Tympanosclerosis is identified using medical imaging techniques such as otoscopy and CT scanning.^1,16 It is diagnosed by the presence of white plaque on the eardrum.¹ When the eardrum is perforated, it might also be possible to see it inside the middle ear.¹ However, the extent of the condition cannot be precisely determined without surgery.¹²

Treatment

When tympanosclerosis does not cause hearing loss, there is no need for treatment.¹ In the event of hearing loss, hearing aids are recommended.¹ It can also be fully removed surgically, leading to hearing recovery.¹⁸ However, the side effects of surgical interventions can significantly affect quality of life.^1,18,12 As a result, experts still debate the use of surgery as treatment for this condition, as some argue that the risks outweigh the benefits. They include:¹⁸

• Return of tympanosclerosis
• Deafness
• Facial palsy
• Retraction of the eardrum
• Sensorineural hearing loss occurs due to damage to the inner ear or the auditory nerve¹⁹

Prevention

Tympanosclerosis cannot be fully prevented. However, avoiding inflammation of the middle ear limits the chances of abnormal healing, which would allow scar tissue to form. Therefore, seeking treatment for ear infections early and limiting ear obstruction (e.g., cotton swabs) or contact with chemicals (e.g., hair products) can reduce the number or length of inflammations.²⁰

Summary

Tympanosclerosis is a disease of the middle ear. It forms as a result of an abnormal recovery from inflammation after infection and/or surgery. Although it does not require treatment in most cases, when it causes hearing loss, it should be investigated by a professional. A more conservative approach to treatment would involve the use of a hearing aid, whereas some patients benefit from further surgery. In both instances, some level of hearing can be recovered.

FAQs

Does tympanosclerosis always affect both ears?

No, the condition can be unilateral (one ear) or bilateral (both ears).¹

Is tympanosclerosis life-threatening?

No, but it can cause significant hearing loss. 

Can I catch tympanosclerosis from someone else?

No, the condition forms because of abnormal healing from inflammation of the middle ear. It only occurs because of someone’s individual immune profile.^1,9,10  

When to see a doctor?

If you experience any hearing loss, you should seek advice from a medical professional. 

Should I get surgery to cure my tympanosclerosis?

This needs to be decided with an ENT (Ear, Nose and Throat) surgeon on a case-by-case basis. Although many tympanosclerosis removal surgeries are successful and lead to some hearing recovery, postoperative risks are to be considered, such as hearing loss, return of the condition, and facial palsy.^12,18