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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 is not understood. It may be an abnormal healing response.
- Tympanosclerosis commonly develops secondary to acute and chronic otitis media.
- 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.
- Children who have had a ventilation tube (grommet) inserted for otitis media with effusion have a higher risk of developing tympanosclerosis.This risk has been reported as 11-37%.
- 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.
- 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.
Treatment is only required if there is hearing loss.
- Hearing aids can be beneficial, as with any form of conductive hearing loss.
- Surgery for tympanosclerosis involves excision of the sclerotic areas and reconstruction of the ossicular chain.
- Stapes mobilisation is usually required.
- 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.
- 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.
- 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.
Further reading and references
; Role of Chlamydia pneumoniae and Helicobacteria pylori in the development of tympanosclerosis. Eur Arch Otorhinolaryngol. 2015 May 9.
; 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.
; 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.
; 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.
; ENT USA
; 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.
; 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.
; 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.
; Surgery of isolated malleus fixation due to tympanosclerosis. Eur Arch Otorhinolaryngol. 2014 Dec 14.
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