Otosclerosis is a disease that should not be overlooked, especially in young and middle-aged adults presenting with slowly progressing hearing loss. This disease, which affects approximately 0.3–0.4% of the population, can be treated quite successfully when detected early. Otosclerosis should be considered during general ENT evaluations in patients experiencing progressively worsening hearing loss, tinnitus, and communication difficulties.

What is Otosclerosis and How Does it Develop?
Otosclerosis is a bone calcification disorder affecting the stapes (stirrup) bone, which plays a critical role in sound transmission in the middle ear. Normally, the stapes should move freely with vibrations, but in otosclerosis, it becomes immobile due to being surrounded by abnormal bone tissue. This prevents sound from being adequately transmitted to the inner ear, leading to conductive hearing loss. As the disease progresses and affects the inner ear, sensorineural hearing loss may also be added to the picture.

Who is More Likely to See It?
Otosclerosis most often begins to show symptoms between the ages of 20 and 40. It is noteworthy that it is seen 2-3 times more often in women than in men. Symptoms increase during pregnancy due to the effects of hormonal changes.

Genetic Factors are Effective
Genetic factors play a very strong role in the onset of the disease. The risk is significantly increased in individuals with a family history of otosclerosis. Otosclerosis shows autosomal dominant inheritance, but its frequency is variable.

Most Common Symptoms Experienced by Patients
The most prominent complaint is hearing loss, but it is not limited to this. Patients may also experience:
- Tinnitus (ringing in the ear)
- Feeling of fullness in the ear
- Improved hearing in noisy environments (Paracusis Willis). Dizziness is a rare finding in otosclerosis.

Surgery is Not Always the First Step in Treatment
The aim of treatment is to eliminate hearing loss and improve the patient's quality of life. When recommending surgical treatment to patients, the degree of hearing loss, the benefit obtained from hearing aids, and the patient's social/occupational needs are evaluated.

Situations Where Surgery is Recommended
- Conductive hearing loss of at least 20–25 dB
- Hearing loss that significantly affects daily communication
- Insufficient benefit from hearing aids
- Preservation of cochlear reserve is important

There are two main methods in otosclerosis surgery: stapedectomy and stapedotomy. Today, stapedotomy is the most frequently preferred method worldwide because it provides safer and more predictable results. In this method, a small hole is made in the base of the stapes and a prosthesis is inserted. It is preferred due to the lower risk of perilymph fistula, less dizziness, and successful hearing outcomes.

When Does Hearing Improve After Surgery?
In the first few days after surgery, a feeling of blockage and fullness in the ear is normal. Improvement in hearing is usually noticeable within 2–4 weeks. However, it may take 6–12 weeks to become fully stable.

What Does Delaying Surgery Mean?
Delaying surgery does not accelerate the progression of otosclerosis. However, hearing loss may worsen over time, cochlear involvement may develop, and communication difficulties can negatively impact daily life. Therefore, it is important to evaluate treatment options when hearing loss begins to affect quality of life.

Otosclerosis is a disease that can be managed quite successfully with timely diagnosis and treatment. When individuals experiencing hearing loss are diagnosed without ignoring their symptoms, near-complete recovery is possible with the right surgical method.