The short answer
Otosclerosis causes hearing loss by fixing the stapes, the smallest bone of the middle ear, in new bone. Only surgery can make that bone move again. Every other treatment either brings sound to the inner ear by another route, with a hearing aid or a bone-conduction device, or tries to slow the disease with medication.
That is less of a limitation than it sounds. The inner ear is usually healthy, so sound made loud enough is heard clearly, and many people never have an operation. The operation is described on stapedotomy; the two routes are compared on hearing aid or surgery?.
Watchful waiting
If the loss is mild and does not trouble you, doing nothing yet is a legitimate choice. Otosclerosis usually progresses slowly and often stabilises, and waiting does not make a later operation less likely to succeed.
Watching is not ignoring. An audiogram every one to two years, or sooner if hearing changes, shows whether the conductive loss is growing and, more importantly, whether the inner ear (the bone-conduction line) is holding steady. A dip in bone conduction around 2 kHz, the Carhart notch, is common in otosclerosis and is mostly a mechanical effect of the fixed stapes rather than inner-ear damage. See understanding your audiogram.
Hearing aids
Because the inner ear is usually healthy, otosclerosis is one of the hearing losses that hearing aids treat best. It is a “clean” conductive loss: sound simply needs to be louder. With a well-fitted aid, speech understanding is typically excellent, and there is no risk to the inner ear.
An aid is also the most reversible choice. It can be tried, adjusted, set aside, or followed by surgery later. Many otologists suggest a trial of amplification before deciding on an operation, because it makes the comparison concrete.
The costs are practical: daily wear, maintenance, a price that varies widely between countries, and for some people a blocked feeling or the boomy sound of their own voice. An aid amplifies rather than restoring natural transmission, so hearing in noise and locating sounds may be less natural (see binaural hearing).
It is fair to add that people who try both often prefer successful surgery. In a small French study, 22 people with otosclerosis in one ear wore a hearing aid first; 20 went on to have the operation and, on average, rated it above the aid for quality of life, hearing in noise, locating sounds and tinnitus. They were already considering surgery and were not randomised, so this does not apply to everyone.
Bone-conduction devices
A bone-conduction device sends sound through the skull straight to the inner ear, bypassing the fixed stapes. Some are worn on a soft headband or an adhesive pad; others are anchored to the skull behind the ear in a minor operation, though not on the middle or inner ear.
In otosclerosis they are a niche option. They suit people who cannot wear a conventional aid comfortably, for example because of recurrent ear-canal infections or eczema of the canal, and who prefer not to have, or are not suitable for, stapes surgery. In a Birmingham series, implanted devices gave people with otosclerosis benefit over their previous hearing aid, sometimes in comfort or appearance rather than hearing. All of them need an inner ear that still hears well enough. The range of devices is described on hearing rehabilitation.
Sodium fluoride
Sodium fluoride has been used for decades to try to slow otosclerosis. The idea is that it helps the active, spongy bone of the disease mature into denser, quieter bone, and so protects the inner ear. It does not unlock a fixed stapes and does not bring back hearing that has been lost.
The trial evidence is thin. In a double-blind trial from Denmark, 95 patients took 40 mg of sodium fluoride a day or a placebo; hearing deteriorated significantly more with placebo. A systematic review by the author’s Utrecht group in 2014 found only two placebo-controlled studies of sufficient quality, with conflicting results: one reported an 18% absolute reduction in the risk of hearing deterioration, the other no clinically relevant difference. The reviewers judged the evidence weak. There is no Cochrane review of the question.
Practice varies between countries. Where it is used, it is mostly for people whose inner-ear hearing seems to be declining, and like any medicine it has side effects, so it belongs under medical supervision.
Bisphosphonates
Bisphosphonates are the drugs used for osteoporosis. They slow the cells that break bone down, and have been tried in otosclerosis mainly when it reaches the inner ear and causes a slowly worsening sensorineural loss, sometimes called cochlear otosclerosis.
- Randomised trials are few and small. A two-year pilot trial of etidronate showed a trend towards stable hearing but no statistically significant difference from placebo; a six-month trial of alendronate showed no change in hearing.
- Case series are more encouraging but uncontrolled. A Boston group followed seven people (14 ears) with progressive inner-ear loss for five to nine years after treatment with risedronate or zoledronate: hearing stayed stable in 11 ears, improved in two and worsened in one. Without an untreated group, it cannot be said how many would have stayed stable anyway.
- Reviews are cautious. A 2022 systematic review found insufficient evidence to recommend bisphosphonates routinely, with a possible role in worsening sensorineural loss that needs proper trials. A 2026 umbrella review for the World Health Organization judged the evidence for drug treatment equivocal.
They also have rare but serious side effects. If your inner-ear hearing is falling steadily, they are reasonable to discuss with your ENT specialist, knowing the evidence is uncertain.
The trials in more detail
Hentschel et al. (2014) screened 168 titles, applied the Cochrane risk-of-bias tool and retained two placebo-controlled sodium fluoride studies with high directness and moderate risk of bias: one showed an absolute risk reduction for deterioration of 18% (95% CI 17–19), the other no clinically relevant difference in air conduction, bone conduction or air-bone gap. In the six-month alendronate RCT summarised by Patel et al. (2022), hearing did not change but MRI signal anterior to the oval window did. A French placebo-controlled phase 3 trial of tiludronic acid for inner-ear involvement in advanced otosclerosis (OTOPHOS, ClinicalTrials.gov NCT01617057) enrolled 31 patients and was terminated without posted results. The 2026 umbrella review covered 11 systematic reviews (163 studies, 6235 patients). In short: a plausible mechanism, small or uncontrolled studies, and no adequately powered trial in the patients most likely to benefit.
Vitamin D, supplements and “natural” treatments
There is no convincing evidence that vitamin D, calcium, herbal remedies or any particular diet on its own slows or reverses otosclerosis. A few small studies have looked for links between otosclerosis, vitamin D and bone density, with inconsistent results. If a blood test shows that you are low in vitamin D, correcting it is sensible for your general bone health, but it should not be expected to change your hearing.
What does not work
- Nothing taken by mouth or put in the ear can free a fixed stapes. The problem is bone, not wax, fluid or a blocked Eustachian tube, so ear drops, ear candles, syringing and decongestants have no part to play.
- Supplements marketed “for hearing” have not been shown to affect otosclerosis.
- A hearing aid neither slows nor speeds up the disease; it makes sound audible.
- Be cautious with anyone who promises to cure otosclerosis without surgery.
When non-surgical management is the better choice
Often it is the better choice on its merits, not only for people wary of an operation:
- A mild loss or a small air-bone gap. Surgery has least to offer when the gap it would close is small.
- A mixed loss. When the inner ear is also affected, a hearing aid is likely to be needed even after a successful operation. For some people surgery plus an aid still works better than the aid alone, so this is a discussion, not a rule.
- An only-hearing ear. The risk of severe inner-ear loss with stapes surgery, about 0.5–1%, becomes unacceptable when there is no other ear to fall back on.
- Poor bone conduction or word recognition, or a medical reason to avoid an operation.
- While the first operated ear settles in bilateral otosclerosis, before the second is considered.
- Your own preference. Contentment with a hearing aid, or unwillingness to accept any risk to the inner ear, is a sound reason. Surgery remains available later.
When even a powerful hearing aid no longer gives clear speech, the options change; see far-advanced otosclerosis.
When to seek prompt advice
Otosclerosis changes slowly. A sudden drop in hearing, or new spinning vertigo, is not its usual pattern and should be assessed promptly, the same day if possible, because sudden inner-ear hearing loss is treated more effectively early (see sensorineural hearing loss). After stapes surgery, follow the guidance on when to contact your surgeon.
Sources
- Hentschel MA, Huizinga P, van der Velden DL, et al. Limited evidence for the effect of sodium fluoride on deterioration of hearing loss in patients with otosclerosis: a systematic review of the literature. Otol Neurotol. 2014;35(6):1052-7. PubMed
- Bretlau P, Salomon G, Johnsen NJ. Otospongiosis and sodium fluoride. A clinical double-blind, placebo-controlled study on sodium fluoride treatment in otospongiosis. Am J Otol. 1989;10(1):20-2. PubMed
- Kennedy DW, Hoffer ME, Holliday M. The effects of etidronate disodium on progressive hearing loss from otosclerosis. Otolaryngol Head Neck Surg. 1993;109(3 Pt 1):461-7. PubMed
- Jan TA, Remenschneider AK, Halpin C, et al. Third-generation bisphosphonates for cochlear otosclerosis stabilizes sensorineural hearing loss in long-term follow-up. Laryngoscope Investig Otolaryngol. 2017;2(5):262-268. PubMed
- Patel S, Walters B, Eastwood M, et al. A systematic review of the effectiveness of bisphosphonates for otosclerosis. Otol Neurotol. 2022;43(5):530-537. PubMed
- Chau IJ, McCray LR, Nguyen SA, et al. Interventions for the diagnosis and management of otosclerosis: an umbrella review. Otolaryngol Head Neck Surg. 2026;174(4):904-915. PubMed
- Molinier CE, Gallois Y, Deguine O, et al. Stapedotomy versus hearing aids in the management of conductive hearing loss caused by otosclerosis: a prospective comparative study. Otol Neurotol. 2022;43(7):773-780. PubMed
- Burrell SP, Cooper HC, Proops DW. The bone anchored hearing aid: the third option for otosclerosis. J Laryngol Otol Suppl. 1996;21:31-7. PubMed
Common questions
Can otosclerosis be cured without surgery?
Not in the sense of reversing it. The hearing loss comes from new bone that locks the stapes, and no tablet, diet or supplement has been shown to unlock it. What can be done without surgery is to treat the hearing: a hearing aid or a bone-conduction device brings sound to an inner ear that is usually healthy, often very effectively. Medicines aim only to slow the disease, and the evidence for that is weak.
Does sodium fluoride work for otosclerosis?
It may slow the disease in some people, but the evidence is weak. A Danish placebo-controlled trial found that hearing deteriorated less in people taking sodium fluoride; a systematic review in 2014 found only two placebo-controlled studies of adequate quality, with conflicting results. Sodium fluoride does not restore hearing that has been lost and does not free a fixed stapes. How often it is prescribed varies between countries.
Are bisphosphonates a treatment for otosclerosis?
Some specialists use them when otosclerosis appears to be damaging the inner ear, with the aim of keeping hearing stable. Small case series suggest hearing can stay stable for years on treatment, but they had no untreated comparison group, and the randomised trials are few, small and inconclusive. Reviews conclude there is not enough evidence to recommend them routinely. They do not help the conductive part of the loss.
Is a hearing aid a good option for otosclerosis?
Yes. Because the inner ear is usually healthy, otosclerosis is one of the hearing losses that hearing aids treat best: speech is typically clear once it is loud enough. There is no risk to the inner ear, and trying an aid does not stand in the way of surgery later. The drawbacks are those of any device: wearing it every day, maintenance, cost, and the fact that it amplifies sound rather than restoring natural transmission.
Is there a natural treatment for otosclerosis?
No natural remedy has been shown to slow or reverse otosclerosis. There is no convincing evidence that vitamin D, calcium, herbal products or special diets on their own treat it, and none can free a fixed stapes. If a blood test shows that you are low in vitamin D, correcting it is sensible for your general bone health, but it should not be expected to change your hearing. Be wary of anyone offering a cure.
Will waiting make surgery less successful later?
No. Otosclerosis usually progresses slowly, and the result of stapedotomy does not depend on operating early. Waiting, with a hearing aid or without one if the loss is mild, keeps every option open. What waiting cannot prevent is a slow change in the inner ear in some people, which is why an audiogram every one to two years is worthwhile whatever you decide.
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.