Otosclerosis is an inherited condition in which abnormal bone growth fixes the stapes, a tiny middle-ear bone, in place; it causes progressive hearing loss and, in roughly two-thirds of people, tinnitus, which surgery often improves.
The stapes is the smallest bone in the body, and the last of three tiny bones that transmit sound vibrations to the inner ear. Once the bone growth around it stops it vibrating freely, less sound gets through: the result is progressive conductive hearing loss, and in most people who have it, tinnitus as well.
How common tinnitus is with otosclerosis
Tinnitus is reported in roughly two-thirds of people with otosclerosis prior to any treatment: in the records of 1,014 people whose otosclerosis was confirmed at surgery in South Australia, 65% had tinnitus beforehand. That makes it one of the more reliably tinnitus-associated structural ear conditions. It's an autosomal dominant hereditary condition with variable penetrance, meaning it runs in families but doesn't affect every person who carries the relevant genetic tendency, and severity varies considerably even among affected relatives.
Recognizing it
Otosclerosis typically presents as gradually progressive hearing loss, often starting in one ear and moving to both, sometimes accompanied by a sensation that your own voice sounds different to you. Unlike sensorineural hearing loss (the kind linked to noise or aging), otosclerosis causes conductive hearing loss — the problem is mechanical transmission through the middle ear, not the inner ear's sensory cells — which is a meaningful diagnostic distinction an audiogram can identify. How to read your audiogram shows what that difference looks like on the chart.
Treatment, and what it does for tinnitus
Otosclerosis has two broad treatment paths, and unlike many tinnitus causes, one of them has real, moderately strong evidence for improving tinnitus specifically, not just hearing:
Hearing aids are a non-surgical option that can meaningfully help the hearing loss, though they don't stop the underlying bone changes from progressing and have less direct evidence for tinnitus improvement specifically compared to surgery. Hearing aids for tinnitus covers what they do for tinnitus more generally.
Stapedectomy or stapedotomy — surgery to remove or bypass the fixed stapes bone and replace it with a small prosthesis — is the more definitive treatment. A 2025 systematic review of 22 studies and 2,233 patients found stapes surgery improves both hearing and tinnitus severity, with a moderate-to-strong relationship between how much the hearing gap (the air-bone gap) closes and how much the tinnitus improves — most patients saw significant improvement within six months. The studies were too varied in design and measures to pool into a single figure: most reported improvement in tinnitus severity after surgery of 15.7% to 64% (median 46.3%). Single studies range widely. In a small prospective study of 29 patients, 82.8% had complete or partial absence of tinnitus one month after surgery. In a larger prospective study of 168 patients having stapedotomy, 55% had a significant reduction in tinnitus severity and 37% said it had disappeared completely, while 38% reported no change and 7% an increase.
The tradeoff worth knowing about
Surgery isn't without risk: some patients' tinnitus is unchanged afterwards, and in the fewer studies in the review that reported worsening, 2.9% to 11% of patients were worse.
Research on who does best is less settled than it is sometimes presented. In one prospective study of 133 people having stapedotomy, younger patients were significantly more likely to find their tinnitus reduced, and hearing at very high frequencies after the operation predicted whether it improved. Tinnitus pitch is contested: in a study of 56 patients, low-pitched tinnitus had a more favourable outcome than high-pitched, but a study of 50 patients found the pitch and loudness of the tinnitus did not provide significant information about how it would respond. On technique, that same 50-patient study found tinnitus reduced more after a small-fenestra stapedotomy than after a partial stapedectomy that removed the back half of the stapes footplate. All of this is worth discussing directly with an experienced otologic surgeon rather than assuming outcome odds are the same for everyone, and tinnitus after ear surgery covers the wider picture.
Who should ask about it
If you have progressive hearing loss, especially one that started in one ear, along with tinnitus and a family history of hearing loss, otosclerosis is worth raising specifically with an ENT — it's identifiable on a standard audiogram, and it has a treatment with evidence for improving the tinnitus itself, not just the distress around it. It is on the short list of tinnitus that can be cured, against a background where, in a German clinic study of 388 patients with chronic tinnitus first seen between 2012 and 2017 and surveyed again in 2018, only 3 (0.8%) reported that it had gone.