In order for a person to listen normally, the middle ear must function normally. First of all, the tympanic membrane should be intact and the air must have the same pressure on both sides. Secondly, the ossicles (malleus, incus and stirrup) that connect the tympanic membrane to the inner ear through the oval window should be properly connected and have mobility. One of the most common problems that affect the acoustic alyssum is otosclerosis. It is a strange situation, with no known etiology, that affects women more often than men and tends to appear more often in families and so many female individuals in many generations can have it. Of course, new cases of otosclerosis are often observed in individuals with no family history. This situation almost always affects both ears in simultaneously, although some patients develop otosclerosis in one ear and still have normal hearing in the other.

What happens in otosclerosis is that the bone that surrounds the oval window, in which the base of the stirrup rests, begins to grow and thicken. The base of the stirrup is based on the oval window with a thin, strong elastic membrane called the ring connector. When normal, this device allows sound waves collected by the tympanic membrane to be transported efficiently and effectively in the inner ear fluids. As the excessive growth of the new bone increases involving the ring connector, the mobility of the stirrup and hearing is reduced. The condition progresses slowly until the stirrup is finally stranded completely and the hearing cannot get any worse – at least on the part of the conductivity. Usually, one of the ears is affected and after several years the second ear starts to show the same signs, which is when most patients begin to understand the problem. Pregnancy is considered to accelerate the process of fixation of the stirrup and so the hearing will deteriorate more rapidly during these 9 months than when not pregnant. This is considered to be the result of very high levels of hormones, but there is no satisfactory evidence in audiology tests that it is actually happening. Moreover, there is insufficient evidence to support the hypothesis that modern contraceptive drugs that contain estrogen or hormone replacement therapy may have negative influence on the development of otosclerosis.

Patients feel that they hear better when there are noises in relation to the hearing in quiet places and this is probably because the noise makes the stirrup to move and because people speak louder when in noise.

There are several ways of dealing with otosclerosis:

No treatment: If the situation is not so serious as to cause problems in daily life or if only one ear is infected many patients do not seek help.

Inserting a hearing aid: Otosclerosis is a condition that can be helped very easily from a conventional device, because the only requirement is to make incoming sounds stronger enough to overcome the obstacle caused by the production of the new bone.

Surgery: It is impossible to remove the new bone that is created, but it can be bypassed by removing the arc of the stirrup and opening a small hole at the base of the stirrup, so that an artificial bone can be inserted (preposition) to the hole in the stirrup and then be connected to the anvil. In fact, the acoustic alyssum is reconstituted in miniature and is fully mobile, so the sound can still be directed by the tympanic membrane to the inner ear through the oval window. That is, nature is copied. The surgery is called anavolektomi. More correctly it is called anavolotomi since the stirrup is not removed, but a hole is created in it.