The short answer
Otosclerosis is diagnosed more often in women and usually appears between the ages of 20 and 45, the years in which many women have children. It has long been taught that pregnancy can bring it on or make it worse. That teaching rests mainly on older studies of what women remembered.
Newer studies that compare women with and without children, using hearing tests or population records, have mostly found no difference. They do not prove that pregnancy never affects otosclerosis: some women clearly notice a change, and group averages can hide an effect in a minority. The fair summary is that the evidence is mixed, and that the more recent and more objective studies do not show a measurable effect across groups of women.
What the older studies reported
In 1983, Gristwood and Venables studied 479 women with otosclerosis. Among those with otosclerosis in both ears, the chance of reporting worse hearing during or soon after a pregnancy was about one in three after one pregnancy, rising to about two in three after six. Women with otosclerosis in one ear reported such a change much less often. The authors found no strong evidence that pregnancy altered the disease in the stapes footplate itself.
A 2022 systematic review brought together eleven studies describing 2,323 women. Hearing was reported to have worsened during childbearing in about one in five, and some change with pregnancy in 44% overall, more often with more pregnancies. The authors concluded that pregnancy seems to have a worsening effect, but that the studies differed too much for firm statements.
What newer studies show
- Women with and without children. Among 94 women who had stapes surgery, half with children and half without, hearing before and after the operation was not worse in those with children, and the number of children made no difference. Breastfeeding was not related to the degree of hearing loss.
- A population study. In Olmsted County, Minnesota, 299 women with otosclerosis were compared with 897 women of the same age without it. Having given birth was not associated with developing otosclerosis, and hearing at diagnosis was no worse in women who had given birth.
- Fathers too. In US insurance records of 6,025 people who had stapes surgery, women with children were operated on about ten years younger than women without. The same was true of men with children. The authors suggest that social factors around parenthood, such as more contact with doctors, may explain earlier reports linking pregnancy and otosclerosis.
- A review of pregnancy and the ear. A 2021 systematic review found that most large studies showed no association between pregnancy and otosclerosis, and that small changes in hearing tests during pregnancy usually recovered after the birth.
Why the question is hard to settle
Otosclerosis progresses slowly through the same years in which pregnancies happen, so a change noticed during a pregnancy may coincide with it rather than be caused by it. Pregnancy also brings ear symptoms of its own, such as a blocked feeling from nasal congestion. Most studies are retrospective. None of this rules out a real effect in some women, and whether a change noticed in pregnancy is temporary or lasting is not well documented.
A change in hearing during or after a pregnancy is worth a hearing test, so that it is measured rather than guessed. Hearing tests are harmless in pregnancy.
The studies in more detail
Gristwood and Venables (1983) relied on subjective deterioration. Fabbris et al. (2022) included 11 of 65 articles: onset during pregnancy in 1%, worsening in pregnancy in 21% and in the puerperium in 4%; hearing change correlated with parity (p = 0.003), but heterogeneity precluded firm conclusions. Macielak et al. (2021): odds ratio 1.16 (95% CI 0.85–1.60) for one or more deliveries and 1.12 (0.58–2.18) for bilateral oophorectomy; pure-tone average at diagnosis did not differ by parity (median 45 vs 43 dB HL) but was higher after bilateral oophorectomy (54 vs 44 dB HL). Qian and Alyono (2020) found no interaction between sex and number of children on age at stapedectomy, arguing against a pregnancy-specific effect, although age at surgery is a crude proxy for progression. A prospective audiometric cohort through pregnancy would be needed to settle the question.
Hormones and the contraceptive pill
Because otosclerosis is more common in women, female hormones have long been suspected of playing a part, but clinical studies have not shown a consistent hormonal effect on its course. For the oral contraceptive pill, the largest study is the Oxford–Family Planning Association cohort: 17,032 women followed for up to 26 years. It found no evidence of an adverse effect of the pill on ear disease, although it was not designed around otosclerosis and cannot exclude a small effect. In the Minnesota study, removal of both ovaries, which sharply lowers oestrogen, was not associated with developing otosclerosis either.
Many pill leaflets list hearing loss from otosclerosis among conditions reported to appear or worsen in pregnancy and with the pill, while stating that the evidence for a link with the pill is inconclusive. This reflects the old uncertainty rather than new evidence of harm. Contraception is best chosen with your GP or gynaecologist; mention the otosclerosis so that it is part of that discussion.
Planning treatment around a pregnancy
Otosclerosis is slow, and none of its treatments is urgent. Observation, a hearing aid and stapedotomy remain the options, compared on hearing aid or surgery?. A pregnancy mainly affects when surgery is done.
During pregnancy. Stapedotomy is elective, and its result does not depend on operating early. Obstetric guidance advises postponing elective surgery until after delivery, and consulting an obstetrician before any other operation in pregnancy. Most ear surgeons therefore do not perform stapes surgery during pregnancy. A CT scan is not needed to diagnose otosclerosis, and one that is not urgent is usually postponed until after the birth.
Before a pregnancy. Some women prefer the operation before trying to conceive, others after a birth or once their family is complete. No study compares these choices. The result is judged at three to six months, and if both ears are affected the second is usually not considered for six months to a year (see otosclerosis in both ears). Many centres send people home the same day or after one night; at the Clinique Causse in Colombiers, where the author practises, patients stay up to a week, usually take one week off work, sometimes more, and avoid flying and sport for two months after an uncomplicated recovery. There is no published rule for how long to wait after stapedotomy before a pregnancy; ask your own surgeon.
After the birth. Surgery can be planned once you are ready. Think about broken nights, the usual advice to avoid straining and heavy lifting while the ear heals, and who can help at home. If you are breastfeeding, tell the anaesthetist when the operation is planned.
Medicines. Sodium fluoride and bisphosphonates, sometimes used to slow otosclerosis, are generally not taken during pregnancy. If you use one, discuss it with the prescribing doctor before trying to conceive. See otosclerosis treatment without surgery.
Hearing aids during pregnancy
A hearing aid can be used at any stage, including pregnancy and breastfeeding; it amplifies sound and has no effect on the baby. Because the inner ear is usually healthy, otosclerosis is one of the hearing losses that aids treat best. If hearing seems to fluctuate during pregnancy, the settings can be adjusted and checked again some months after the birth. A baby monitor with a light or vibration alert can help at night, when aids are usually out.
Other causes of hearing change in pregnancy
Not every change in hearing during pregnancy is otosclerosis.
- Blocked or full ears. Nasal congestion is common in pregnancy and can affect the Eustachian tube, which ventilates the middle ear, giving a blocked feeling or popping. Some women hear their own voice or breathing unusually loudly. These symptoms usually settle after the birth.
- Sudden hearing loss. A drop in hearing in one ear over hours or up to three days, often noticed on waking, is uncommon but needs medical care the same day. Treatment works best when started early, and there are options that can be used in pregnancy. See sensorineural hearing loss.
- After stapes surgery. A sudden drop in hearing or severe, spinning vertigo in an operated ear needs same-day care, pregnant or not. See when to contact your surgeon.
Will my children inherit it?
Otosclerosis runs in families in about half of cases. Inheritance is incomplete: a parent can carry the tendency with little or no hearing loss, not everyone who inherits it develops hearing loss, and severity varies within families. It usually becomes noticeable in adult life rather than childhood. There is no genetic test in routine clinical use. For a grown child who notices hearing difficulty, an ordinary hearing test is the useful first step.
Sources
- Gristwood RE, Venables WN. Pregnancy and otosclerosis. Clin Otolaryngol Allied Sci. 1983;8(3):205-10. PubMed
- Lippy WH, Berenholz LP, Schuring AG, Burkey JM. Does pregnancy affect otosclerosis? Laryngoscope. 2005;115(10):1833-6. PubMed
- Macielak RJ, Marinelli JP, Totten DJ, et al. Pregnancy, estrogen exposure, and the development of otosclerosis: a case-control study of 1196 women. Otolaryngol Head Neck Surg. 2021;164(6):1294-1298. PubMed
- Qian ZJ, Alyono JC. Effects of pregnancy on otosclerosis. Otolaryngol Head Neck Surg. 2020;162(4):544-547. PubMed
- Fabbris C, Molteni G, Tommasi N, Marchioni D. Does pregnancy have an influence on otosclerosis? J Laryngol Otol. 2022;136(3):191-196. PubMed
- Frosolini A, Marioni G, Gallo C, et al. Audio-vestibular disorders and pregnancy: a systematic review. Am J Otolaryngol. 2021;42(5):103136. PubMed
- Vessey M, Painter R. Oral contraception and ear disease: findings in a large cohort study. Contraception. 2001;63(2):61-3. PubMed
- ACOG Committee Opinion No. 775: Nonobstetric surgery during pregnancy. Obstet Gynecol. 2019;133(4):e285-e286. PubMed
Common questions
Does pregnancy make otosclerosis worse?
It may in some women, but the evidence is mixed. Older studies, based on what women remembered, found that a fifth to a third reported worse hearing during or after a pregnancy. Newer studies comparing women with and without children, using hearing tests or population records, have mostly found no difference. A change in hearing during or after pregnancy is worth a hearing test, so that it is measured rather than assumed.
Can I take the contraceptive pill if I have otosclerosis?
The pill leaflet may mention otosclerosis, but the largest study, which followed more than 17,000 women for up to 26 years, found no evidence that the pill harmed the ears. It cannot exclude a small effect. Contraception is best chosen with your GP or gynaecologist, taking your general health into account; mention the otosclerosis so that it is part of that discussion.
Should I have a stapedotomy before getting pregnant?
No study shows that one timing is better. Some women choose surgery before trying to conceive, others wait until after the birth or until their family is complete. Points to weigh are the recovery time, the three to six months needed to judge the result, and whether the other ear may also need treatment. A hearing aid works well in the meantime. Ask your surgeon how long to wait after the operation.
Can stapes surgery be done during pregnancy?
It is usually postponed. Stapedotomy is elective and its result does not depend on operating early, while obstetric guidance advises postponing elective surgery until after delivery. Most ear surgeons therefore wait until after the birth. Hearing tests are harmless in pregnancy, and a hearing aid can bridge the time. Urgent problems are different: a sudden drop in hearing needs medical care the same day, pregnant or not.
Is it safe to wear hearing aids while pregnant?
Yes. A hearing aid amplifies sound and has no effect on the pregnancy or the baby. Because the inner ear is usually healthy in otosclerosis, aids work well. If hearing seems to change during pregnancy, the aid can be adjusted, and a hearing test some months after the birth shows where things have settled. Wearing an aid also leaves surgery open as a later option.
Will my children inherit otosclerosis?
They may, but it is far from certain. Otosclerosis runs in families in about half of cases, and inheritance is incomplete: not everyone who inherits the tendency develops hearing loss, and severity varies. It usually appears in adult life rather than childhood. There is no genetic test in routine clinical use. For a grown child who notices hearing difficulty, an ordinary hearing test is the useful first step.
This page provides general educational information. It cannot replace an individual assessment, which depends on a full history, examination, audiometry and, where relevant, imaging. If you have sudden hearing loss, severe pain, facial weakness, severe dizziness or discharge with fever, seek medical care promptly.