Tympanosclerosis - Understanding the Causes, Symptoms, and Treatment

Introduction:

The accumulation of hyaline in the tissues of the eardrum and the middle ear is referred to as Tympanosclerosis. It also involves the tympanic cavity and the ossicular chain (the ossicular chain comprises three bones: malleus, incus, and stapes). Tympanosclerosis usually occurs due to repetitive middle ear infections and swelling. In addition, tympanosclerosis can cause conductive hearing loss (disruption in the mechanism of transfer of sound from the outer ear to the middle ear).

What Is the Incidence of Tympanosclerosis?

• The incidence of tympanosclerosis was observed more in patients with chronic and recurrent middle ear infections.

• The incidence of tympanosclerosis was reported more in the younger age group between 15 to 30 years of age.

• Tympanosclerosis affects both males and females, but a higher incidence was reported in males, which was approximately sixty percent of all the cases.

What Are the Types of Tympanosclerosis?

Tympanosclerosis is divided into two types:

• Myringosclerosis: Myringosclerosis is limited to the tympanic membrane only. It presents with alteration in the connective tissue layer of the tympanic membrane due to hyalinization and calcium deposition (white patch or plaque-like deposition), resulting in immobility or restriction in the movements of the ear ossicles (malleus, incus, and stapes), leading to conductive hearing loss.

• Intratympanic Tympanosclerosis: Intratympanic tympanosclerosis affects the middle ear sites along with the tympanic membrane, like the ossicular chain and mastoid bone as well in rare cases.

What Are the Causes of Tympanosclerosis?

The exact cause of tympanosclerosis is not known. However, it is supposed to be caused from:

• Recurrent or repetitive middle ear infections.

• Long-standing middle ear infections (chronic otitis media).

• Patients who have a history of ventilation tube (grommet) insertion for the treatment of middle ear infections are at higher risk (around 12 to 30 percent) of getting tympanosclerosis.

• Acute middle ear infections.

• Several studies have reported biochemical analysis suggesting high LDL (low-density lipoprotein), homocysteine levels, cholesterols, and triglycerides are associated with the risk of tympanosclerosis.

• Patients with a previous history of myringotomy surgery.

• Side effects due to ototoxic drugs.

• Continuous usage of hearing aids by patients.

What Are the Signs and Symptoms of Tympanosclerosis?

The signs and symptoms associated with tympanosclerosis are:

• It presents with a white patch or plaque-like appearance.

• Conductive or mixed hearing loss.

• Otorrhea (drainage from the middle ear).

• Swelling within the ears.

• Pain in the ears.

• Ear blockage.

• Ringing sensation in the ears (tinnitus).

• Ear fullness.

How Can We Diagnose Tympanosclerosis?

The following methods can diagnose tympanosclerosis:

• History and Clinical Examination: A detailed history of the patient to rule out symptoms like ear drainage, use of ototoxic drugs, and previous ear surgery is recorded. The clinical examination of the ear is done by an ENT (ear, nose, and throat) specialist to evaluate any acute or chronic middle ear infection, ear swelling, perforated eardrum, and white plaque or chalk-like deposits present on the tissues of the eardrum, middle ear, and tympanic membrane should be ruled out.

• Computed Tomography (CT) Scans: The computed tomographic scans for the temporal bone reveals a small, radio-opaque mass of tissue in the involved areas. It helps to diagnose the size and extent of the spread of calcification and hyalinization within the tympanic membrane and middle ear.

• Pure Tone Audiometry Test (Hearing Test): It is done to rule out the type and severity of hearing loss in patients in whom hearing loss is suspected. This test helps to identify if the hearing loss is conductive (due to a defect in the mechanism of sound transfer), sensory (due to involvement of the hearing nerve-the eighth cranial nerve), or mixed type.

• Transtympanic Endoscopy: The transtympanic endoscopic procedure is used to diagnose the immobility of ossicles and stapes fixation, especially in cases of myringosclerosis where restriction of the movement of ear ossicles is present.

• Histopathological Diagnosis: The confirmatory diagnosis of tympanosclerosis can be made based on histopathological features of tympanosclerosis. Histopathological assessment of tympanosclerosis presents with hyalinization and calcification of fibrous connective tissues and mineralization of the lamellar bone.

What Are the Treatment Methods for Tympanosclerosis?

Different treatment modalities for tympanosclerosis are:

• Surgical Management: Surgical treatment can be performed to remove the sclerotic mass of tissue within the tympanic membrane. Depending on the severity of the spread, the reconstruction and repair of the tympanic membrane and ossicular chain should be performed. Surgery is not indicated in patients with isolated myringosclerosis with an absence of hearing loss. Surgical management in patients with tympanosclerosis also results in improved hearing efficiency.

• Manubrio-stapedioplasty: This procedure is done for the reconstruction and repair of the immobile ear ossicles, which are the malleus, incus, and stapes that have occurred due to tympanosclerosis.

• Canaloplasty: It is a surgical procedure performed with the help of a diamond bur attached to an electric motor to remove the areas of white patches or plaques without damaging the surrounding normal structures. This procedure is considered safe.

• Hearing Aids: Artificial hearing aids are recommended for patients who end up developing hearing loss due to tympanosclerosis. Bone-anchored hearing devices or cochlear implants are suggested to patients for the management of hearing loss.

• Stapesplasty: It is a procedure done to treat stapes footplate fixation.

• Tympanoplasty: This procedure removes the excessive plaque deposits from the tympanic membrane except for the sensitive areas around the facial nerve and near the stapes.

What Are the Complications Associated With Tympanosclerosis?

The complications associated with tympanosclerosis are:

• Conductive hearing loss.

• Sensorineural hearing loss.

• Facial nerve paralysis during surgical procedures.

Conclusion:

Tympanosclerosis is a rare condition affecting the eardrum, ear ossicles, and middle ear, resulting in the deposition of white patches or plaque within the tympanic tissue. Tympanosclerosis is mostly reported in patients with recurrent middle ear infections or previous history of ear surgery like ventilation tube insertion for the management of chronic middle ear infection and myringotomy. Tympanosclerosis presents with symptoms like tinnitus, ear fullness, and blockage of the ears. Surgical management of tympanosclerosis helps to improve and preserve hearing abilities. Therefore, early diagnosis and management of tympanosclerosis are crucial to prevent associated complications like permanent hearing loss.