<prompt> Which of the following is not true about otosclerosis?Hearing better in louder conditionsThe eustachian tube is always abnormalThe tympanic membrane is normalBilateral progressive conductive deafness  <response>: Ans: B Eustachian tube is always abnormal Ref: Diseases of the Ear, Nose, and Throat by PL Dhingra 5th edn.2010. P. 98 Explanation: Eustachian tube function is normal in otosclerosis. Otosclerosis Irregular spongy bone replaces the dense endochondral layer of the bony labyrinth. Hereditary. Associated with Van der hooves syndrome- osteogenesis imperfecta, otosclerosis and blue sclera. More common in females. Hearing loss worsens during pregnancy. Cochlear type presents with SNHL. The stapedial type has CHL and may have anterior most common posterior, circumferential, biscuit or obliterative focus. CF Hearing loss. Paracusis willisi and tinnitus indicates an active focus. OE Schwartze sign-- reddish hue over the promontory because of the increased vasculature in active lesions. PTA will show the type of hearing loss and Carharts notch which is a dip in the bone conduction at 2kHz. Impedance audiometry will show an As type curve. Medical treatment with sodium fluoride can be tried. Surgery is the treatment of choice and includes stapedotomy or stapedectomy followed by replacement with a piston made of Teflon or stainless steel or titanium. 