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Tympanosclerosis

This PatientPlus article is written for healthcare professionals so the language may be more technical than the condition leaflets. You may find the abbreviations list helpful.

Synonym: myringosclerosis

Tympanosclerosis is a condition in which there is calcification of tissue in the eardrum and middle ear.1 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.

Aetiology

The precise cause is not understood. It may be an abnormal healing response.1 Tympanosclerosis is probably associated with:

Epidemiology

In one small study, in patients aged <30 years attending an ear, nose and throat (ENT) outpatient clinic, 35% of patients who had a history of grommet insertion showed signs of myringosclerosis on otoscopy. 12% of those with no history of grommets had signs of myringosclerosis.6

Presentation

  • Characteristic chalky white patches are seen on inspection of the eardrum.7
  • There is conductive hearing loss, in some cases.

Investigations

  • 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 - if hearing loss is suspected.

Diagnosis1

The opaque or patchy white appearance of the eardrum is fairly unique and usually easy to identify.7

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 nonprogressive conductive deafness and no family history of otosclerosis.

Differential diagnosis

  • Cholesteatoma may look similar but the whiteness appears behind, rather than in/on the tympanum.8
  • Other causes of conductive hearing loss, e.g. otosclerosis.

Management

Treatment is only required if there is hearing loss.1

  • Hearing aids can be used, as with any form of conductive hearing loss.
  • Surgery:
    • Surgery for tympanosclerosis involves excision of the sclerotic areas and reconstruction of the ossicular chain.
    • There are various surgical procedures, and some involve 2-stage surgery. Reported success rates are variable.9,10,11,12,13,14
    • Damage to the inner ear is a possible and serious complication, which can cause sensorineural deafness.14,15

Complications1

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.

Prognosis

The prognosis for hearing depends on the extent of middle ear disease (see Complications section, above).1

According to studies following children with chronic otitis media treated with grommets:

  • In most cases, tympanosclerosis probably does not cause significant hearing loss; however, the longest follow-up was for 10 years, so there is no information as to possible late effects.5,16
  • The sclerotic changes seem to stabilise by 3 years.17
  • The sclerotic changes do not seem to resolve with time.17,18

Prevention

There are no standard prevention measures. However, one small study using vitamin E applied topically to patients with grommet insertion found a reduced incidence of tympanosclerosis in the treated ears.19

Document references

  1. Gibb AG; President's address. Tympanosclerosis. Proc R Soc Med. 1976 Mar;69(3):155-62.
  2. Wielinga EW, Peters TA, Tonnaer EL, et al; Middle ear effusions and structure of the tympanic membrane. Laryngoscope. 2001 Jan;111(1):90-5. [abstract]
  3. Williamson I; Otitis media with effusion in children. Clin Evid (Online). 2011 Jan 12;2011. pii: 0502. [abstract]
  4. Lous J, Burton MJ, Felding JU, et al; Grommets (ventilation tubes) for hearing loss associated with otitis media with effusion in children. Cochrane Database Syst Rev. 2005 Jan 25;(1):CD001801. [abstract]
  5. Johnston LC, Feldman HM, Paradise JL, et al; Tympanic membrane abnormalities and hearing levels at the ages of 5 and 6 years in relation to persistent otitis media and tympanostomy tube insertion in the first 3 years of life: a prospective study incorporating a randomized clinical trial. Pediatrics. 2004 Jul;114(1):e58-67. [abstract]
  6. Friedman EM, Sprecher RC, Simon S, et al; Quantitation and prevalence of tympanosclerosis in a pediatric otolaryngology clinic.; Int J Pediatr Otorhinolaryngol. 2001 Sep 28;60(3):205-11. [abstract]
  7. American Academy of Pediatrics; Images of tympanosclerosis as revealed by pneumatic otoscopy
  8. Ear, Nose and Throat - USA, Accessed August 2010; Photographs of ear conditions seen by otoscopy
  9. Bayazit YA, Ozer E, Kara C, et al; An analysis of the single-stage tympanoplasty with over-underlay grafting in tympanosclerosis. Otol Neurotol. 2004 May;25(3):211-4. [abstract]
  10. Teufert KB, De La Cruz A; Tympanosclerosis: long-term hearing results after ossicular reconstruction. Otolaryngol Head Neck Surg. 2002 Mar;126(3):264-72. [abstract]
  11. Magliulo G, Celebrini A, Cuiuli G, et al; Malleostapedotomy in tympanosclerosis patients. J Laryngol Otol. 2007 Dec;121(12):1148-50. Epub 2007 May 25. [abstract]
  12. Yetiser S, Hidir Y, Karatas E, et al; Management of tympanosclerosis with ossicular fixation: review and presentation J Otolaryngol. 2007 Oct;36(5):303-8. [abstract]
  13. Stankovic MD; Hearing results of surgery for tympanosclerosis. Eur Arch Otorhinolaryngol. 2009 May;266(5):635-40. Epub 2008 Aug 14. [abstract]
  14. Pau HW, Just T; Third window vibroplasty: an alternative in surgical treatment of Otol Neurotol. 2010 Feb;31(2):225-7. [abstract]
  15. Bellucci RJ; Cochlear hearing loss in tympanoplasty. Otolaryngol Head Neck Surg. 1985 Aug;93(4):482-5. [abstract]
  16. Riley DN, Herberger S, McBride G, et al; Myringotomy and ventilation tube insertion: a ten-year follow-up. J Laryngol Otol. 1997 Mar;111(3):257-61. [abstract]
  17. Maw AR; Development of tympanosclerosis in children with otitis media with effusion and ventilation tubes. J Laryngol Otol. 1991 Aug;105(8):614-7. [abstract]
  18. De Beer BA, Schilder AG, Zielhuis GA, et al; Natural course of tympanic membrane pathology related to otitis media and ventilation tubes between ages 8 and 18 years. Otol Neurotol. 2005 Sep;26(5):1016-21. [abstract]
  19. Uneri C, Baglam T, Yazici M; The effect of Vitamin E treatment on the development of myringosclerosis after Int J Pediatr Otorhinolaryngol. 2006 Jun;70(6):1045-8. Epub 2005 Dec 20. [abstract]

Internet and further reading

  • Asiri S, Hasham A, al Anazy F, et al; Tympanosclerosis: review of literature and incidence among patients with middle-ear infection. J Laryngol Otol. 1999 Dec;113(12):1076-80. [abstract]

Acknowledgements

EMIS is grateful to Dr N Hartree for writing this article and to Dr Sean Kavanagh for earlier versions. The final copy has passed scrutiny by the independent Mentor GP reviewing team. ©EMIS 2011.
Document ID: 661
Document Version: 23
Document Reference: bgp25285
Last Updated: 15 May 2011
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