Which audiological tests are most useful in confirming a diagnosis of otosclerosis in primary care?

The most useful audiological tests in primary care to help confirm a diagnosis of otosclerosis are pure tone audiometry and tympanometry. Pure tone audiometry assesses hearing thresholds via air and bone conduction, allowing differentiation between conductive and sensorineural hearing loss, which is key in identifying the conductive hearing loss pattern typical of otosclerosis. Tympanometry can provide additional information about middle ear function, which may be abnormal in otosclerosis due to stapes fixation. Otoscopy should also be performed to exclude other causes of conductive hearing loss.

Referral to specialist ENT or audiology services is recommended for further diagnostic confirmation and management, as primary care testing alone cannot definitively diagnose otosclerosis.

This approach aligns with NICE and British Academy of Audiology guidance on hearing loss assessment in adults, which recommends pure tone audiometry and tympanometry as part of the audiological assessment when conductive hearing loss is suspected.