Is My Hearing Loss Due to Otosclerosis or a Virus?

by Neil Bauman, Ph.D.

A lady explained,

I am a 41 year-old woman who was diagnosed with otosclerosis in my left ear during my first pregnancy at age 35. (My grandmother was fully deaf in her left ear by age 20, and hard of hearing in her right ear, so it wasn’t a total shock.) The hearing loss gradually spread to my right ear, though that impairment was minimal, and I have hearing aids for both ears now. I know I should be asking my ENT or audiologist for information, but both seem fairly uninformed—the ENT had never heard of any possible connection between pregnancy and otosclerosis, and seemed astonished that my tests showed both conductive and sensorineural hearing loss.

I am currently halfway through my second pregnancy, and have suddenly noticed a serious worsening of the hearing in my right (formerly my better) ear. I have had a cold for several weeks, and first began to notice it starting to worsen during this time, but it is suddenly as if I have about 5 cotton balls in my right ear (normal for me is more like 2-3 in my left and 1 in my right). My family doctor saw no signs of an ear infection when I went in to have a strep test. My question is this, is this more likely to just be a side effect of the cold, or maybe an infection starting to develop, or is it probable that this is a permanent worsening of my condition which would necessitate a visit to the audiologist to have my hearing aids adjusted?

I find that hard to believe that your ENT is so ignorant about otosclerosis. ENT’s are supposed to know about such things! It is well-known that for women with otosclerosis, hearing loss commonly occurs at puberty and that further loss occurs with each pregnancy, with the last flare-up occurring during menopause.

Your doctor should have known that there are two types of otosclerosis—the middle ear version that causes conductive hearing loss and the cochlear (inner ear) version that sometimes occurs when the otosclerosis grows into your inner ear. This results in sensorineural hearing loss in addition to the conductive hearing loss.

Obviously, your otosclerosis has grown into your inner ear. That is why you have the sensorineural hearing loss component on top of your conductive middle ear loss.

There are two possibilities as to why you suddenly have more hearing loss now. One possibility is that your otosclerosis is flaring up (true to form) with your current pregnancy. The other possibility is that your cold virus has attacked your inner ear causing additional sudden sensorineural hearing loss.

Even though your family doctor saw no signs of a middle ear infection, it is possible that the virus was in your inner ear—and did not cause a secondary infection in your middle ear.

Your question is, “How can I tell whether my hearing loss is from my otosclerosis or from a virus?

I think a wise move is to have your hearing tested by an audiologist again. That will answer some of your questions.

I would specifically ask for the pure tone testing, both air and bone (conductive), and then compare the new results to your old audiogram to see where your hearing loss is increasing. If it is all sensorineural, it could well be a result of the cold virus attacking your inner ear, although since your otosclerosis has grown into your inner ear, you can’t rule it out either.

If all the increased hearing loss is conductive, you know your inner ear is ok at this point. Thus it could be the otosclerosis coming into play again and there is nothing much you can do about that.

At the same time, I’d suggest having a tympanogram to be sure your middle ear is not congested. A type “A” tympanogram would indicate all is well in this department. This would further suggest that your otosclerosis is the culprit.

If you show a type “C” tympanogram, it could indicate that your cold is affecting, and clogging up, your middle ear. If that is the case, your hearing loss hopefully will be temporary—and will return to “normal” when your middle ear and Eustachian tubes clear after you get over your cold.