What are the key clinical features that suggest a diagnosis of otosclerosis in

Key clinical features suggesting otosclerosis in a patient with hearing loss include:

• Progressive conductive hearing loss, typically bilateral but may be asymmetric, often presenting in early to middle adulthood.
• Normal tympanic membrane and middle ear appearance on otoscopy, as otosclerosis affects the stapes footplate rather than causing middle ear effusion or infection.
• Absent or reduced acoustic reflexes due to stapes fixation.
• Carhart’s notch on audiometry, a specific dip in bone conduction thresholds around 2 kHz, is characteristic.
• Family history may be positive, as otosclerosis has a genetic predisposition.
• Absence of middle ear inflammation or effusion (a “dry middle ear cleft”) helps differentiate otosclerosis from other causes of conductive hearing loss such as otitis media with effusion.
• CT imaging</strong, when performed, may show hypodense foci around the oval window, but is mainly used to exclude other pathologies like enlarged vestibular aqueduct syndrome which can mimic otosclerosis clinically.

These features combined support a clinical diagnosis of otosclerosis in adults presenting with conductive hearing loss, guiding further audiological assessment and management NICE CKS Nguyen et al. 2019 Motta et al. 2024.