A retrospective analysis of nonsurgical approaches to tinnitus and otosclerosis through complex patient case studies – a literature review

Introduction. Otosclerosis is a progressive, incurable con­di­tion characterized by abnormal bone remodeling in the middle ear and otic capsule, leading to conductive or mixed hearing loss. A significant proportion of individuals with otosclerosis also experience tinnitus, which further im­pacts the quality of life. While surgical interventions, such as stapedectomy, remain the primary treatment, not all pa­tients are suitable candidates. Consequently, nonsurgical ma­nage­ment strategies, including hearing aids, cognitive be­ha­vio­ral therapy (CBT), pharmacological treatments and sound therapy, have gained increasing attention. Materials and method. We conducted a comprehensive literature re­view, analyzing peer-reviewed studies published between 1973 and 2025. Databases such as PubMed, Scopus, Web of Science and Google Scholar were searched using keywords re­la­ted to otosclerosis, tinnitus, nonsurgical management, phar­ma­co­lo­gi­cal interventions and rehabilitation stra­te­gies. Stu­dies were selected based on relevance to non­sur­gi­cal treat­ment modalities and their impact on auditory out­comes and tinnitus management. Data extraction and processing fo­cused on treatment efficacy, patient adhe­rence and the evo­lu­tion of otosclerosis. Results and discussion. Findings high­light that nonsurgical in­ter­ven­tions offer varied ef­fi­cacy de­pen­ding on individual pa­tient factors. Hearing aids im­prove sound input and can si­mul­ta­ne­ously reduce tin­ni­tus per­cep­tion through ambient sound am­pli­fi­cation. CBT and sound therapy show promise in addressing the psy­cho­lo­gi­­cal distress associated with tinnitus, although pa­tient ad­he­rence remains a challenge. Pharmacological in­ter­ven­tions, including bisphosphonates and fluoride the­rapy, have been explored, but their effectiveness in mo­di­fy­ing disease pro­gres­sion remains inconclusive. Ad­di­tio­nally, neu­ro­mo­du­la­tion techniques such as transcranial mag­ne­tic stimulation (TMS) have emerged as potential future the­ra­pe­u­tic answers. How­ever, large-scale, multicenter stu­dies are needed to va­li­date these findings and establish stan­dar­dized treatment pro­to­cols. Conclusions. The non­sur­gical management of otosclerosis-associated tinnitus is a multifaceted and evol­ving field, currently requiring in­di­vi­dua­lized treatment stra­te­gies. While hearing aids, CBT and sound therapy provide symp­to­ma­tic relief, pharmacological and neuromodulatory treat­ments require further research to determine their long-term efficacy. Future studies should fo­cus on personalized treat­ment approaches, incorporating both audiological and psy­cho­lo­gi­cal dimensions to optimize pa­tients’ outcomes and im­prove their quality of life.