Alerts and Notices
SynopsisTympanosclerosis is characterized by the formation of dense connective tissue (scar) in the tympanic membrane and structures of the middle ear that manifests as whitish / yellow plaques. It does not necessarily cause or lead to loss of hearing; it may be asymptomatic.
The prevalence of tympanosclerosis in patients with chronic otitis media is reported to be between 9% and 38%. The condition occurs across all age groups and may manifest as calcification and scarring resulting from a combination of factors including inflammation, infection, genetic disposition, and trauma. Chronic otitis media with or without effusion, acute otitis media, and placement of polyethylene tubes have all been implicated in the disease process.
As a result of these stressors, collagen fibrils and degraded hyaline are deposited in the tympanic membrane and submucosal layer of the middle ear, leading to eventual calcification. This can be appreciated as chalky white patches or plaques on otoscopy and can be isolated to the tympanic membrane and middle ear or present as larger masses that invade surrounding structures.
If only the tympanic membrane is involved, the process is termed myringosclerosis. Although more commonly asymptomatic, myringosclerosis can also cause a mixed hearing loss if it impacts the movement of the tympanic membrane or ossicular chain. Inflammation can lead to the formation of adhesions (adhesive otitis) and result in damage to the ossicles (cholesteatoma, etc). Involvement of the ossicles can lead to conductive hearing loss due to fixation. Myringosclerosis may be caused by placement of a polyethylene tympanostomy tube, resulting in the formation of retraction pockets in the tympanic membrane.
In children, hearing loss as the result of otitis media or sclerotic processes can affect language development and the auditory processing of information.
H74.09 – Tympanosclerosis, unspecified ear
23606001 – Tympanosclerosis
Differential Diagnosis & PitfallsTympanosclerosis is a physical examination finding in the context of other diagnoses.
- Chronic otitis media – Can result in tympanic membrane perforation.
- Eustachian tube dysfunction
- Cholesteatoma – Epidermal inclusions of the middle ear or mastoid formed by keratinizing squamous epithelial cells. Presents as pearly mass seen on otoscopy. Can have associated conductive hearing loss and otorrhea. A polyp found in the setting of an infected ear is a cholesteatoma until proven otherwise.
- Myringosclerosis – Involves only the tympanic membrane.